Surgery: Acute Abdomen, Trauma, and Operative Judgement
Surgery in the Myanmar MMLE tests safe assessment of the acute abdomen, trauma, wounds, burns, and common elective conditions. The exam expects ATLS priorities, compartmentalized differentials by age and sex, and clear indications for operative versus conservative care. Answers should show resuscitation before definitive surgery and recognition of the deteriorating abdomen.
Core rules
- Trauma: catastrophic haemorrhage and tension pneumothorax are clinical diagnoses; act before imaging.
- Acute abdomen: serial examination and resuscitation outperform a single test; appendicitis and perforation need timely surgery.
- Wounds: irrigate, debride, and give tetanus prophylaxis; antibiotics are adjuncts, not substitutes for drainage.
- Burns: estimate total body surface area with the Wallace rule of nines; start fluids for major burns and monitor urine output.
Worked example
A 22-year-old man has periumbilical pain migrating to the right lower quadrant, anorexia, low-grade fever, and McBurney point tenderness. Reasoning: appendicitis; Alvarado score supports the diagnosis. Give IV fluids, analgesia, and antibiotics, keep him nil by mouth, and arrange appendicectomy. Use ultrasound if the diagnosis is equivocal, especially in a woman of childbearing age, but do not delay surgery for perforation signs.
Traps
Attributing right lower quadrant pain to urinary infection without urinalysis; missing perforation because pain temporarily improves; failing to exclude ectopic pregnancy; giving opioids only after imaging when analgesia is clinically indicated; and inadequate tetanus cover.