Surgery
General Surgery tests acute abdominal pain, trauma, wound care, perioperative risk, and recognition of surgical emergencies. The candidate must decide whether to resuscitate, image, operate, or refer.
Core rules
- Assess shock and peritonism first; a rigid abdomen or guarding needs urgent surgical review.
- Trauma follows ABCDE with cervical spine protection, haemorrhage control, and FAST where available.
- Appendicitis is clinical plus inflammatory markers and ultrasound/CT; migration of pain and localised right lower quadrant tenderness are typical.
- Bowel obstruction presents with colicky pain, vomiting, distension, and absent flatus; look for hernia and prior surgery.
- Perioperative care includes VTE risk, antibiotic prophylaxis, glycaemic control, and anticoagulation planning.
Worked example
A 24-year-old woman has 18 hours of periumbilical pain migrating to the right lower quadrant, fever 38.1°C, and rebound tenderness. Pregnancy test is negative; ultrasound shows a 9-mm appendix. The reasoning: migration, localised peritonism, and imaging support appendicitis; analgesia and IV fluids do not delay surgery. Appendectomy or referral according to the local surgical pathway is correct.
Traps
Do not give oral antibiotics and discharge suspected perforation; do not miss ectopic pregnancy in a woman of childbearing age; do not rely on a normal white cell count to exclude early appendicitis.