Surgery
Surgery questions test safe decision-making more than operative detail: who needs the theatre now, what to do first, and what complication is brewing.
Core rules
- Acute abdomen: assess peritonism (rigidity, rebound). Its presence means urgent surgical review and imaging; analgesia does not mask signs and should be given.
- Appendicitis: the Alvarado score (migration, anorexia, nausea, right iliac fossa tenderness, rebound, fever, leukocytosis) stratifies risk; ultrasound or CT depends on age and sex.
- Trauma: primary survey ABCDE with catastrophic hemorrhage control first; permit hypotension in penetrating trauma until surgical control.
- Post-operative fever: wind (atelectasis, day 1–2), water (urinary), wound, walk (DVT), wonder drugs, and anastomotic leak (day 5–7).
Worked example
Day 6 after sigmoid colectomy: fever 39 °C, pulse 118, abdominal pain, rising CRP, cloudy drain fluid. This is not atelectasis. Anastomotic leak is the leading diagnosis: obtain urgent contrast CT and blood cultures, start broad-spectrum antibiotics with anaerobic cover, and call the surgeon for source control (drainage or reoperation). Delay is the main driver of mortality.
Traps
- Attributing post-operative fever to atelectasis when the patient is tachycardic and CRP is climbing.
- Withholding analgesia before surgical review.
- Forgetting tetanus status and wound exploration in bites or dirty wounds.
- Overlooking a groin hernia as the cause of obstruction in an elderly patient.