Surgery
Surgery
The surgical station tests acute abdominal assessment, trauma priorities, consent, and post-operative complications. You must show safe ABCDE, a structured abdominal examination, and a plausible differential rather than a single diagnosis. NZREX examiners also expect awareness of Māori and Pacific health inequities, informed consent under the Code, and antibiotic stewardship.
Core rules
- In trauma, follow ABCDE and cervical spine protection; assess pelvis and long bones after primary survey.
- Acute abdomen: ask about pain migration, vomiting, bowels, urine, menstruation, and previous surgery.
- For suspected appendicitis, calculate an Alvarado score, obtain pregnancy test, urinalysis, FBC/CRP, and imaging as indicated.
- Consent: discuss diagnosis, procedure, material risks, alternatives including doing nothing, and capacity.
- Post-op fever: consider atelectasis, urine, wound, lines, and anastomotic leak by timeline.
Worked example
A 22-year-old woman has 18 hours of periumbilical pain migrating to the right iliac fossa, anorexia and fever 37.9°C. Reasoning: ABCDE stable; abdomen shows guarding at McBurney's point; pregnancy test negative; WBC 14; Alvarado 7. You request ultrasound or CT, keep nil by mouth, give IV fluids and analgesia, and consent for appendicectomy after explaining risks of bleeding, infection, conversion, and anaesthetic.
Traps
Failing to exclude ectopic pregnancy, missing a pulsatile mass before examining an abdominal aortic aneurysm, not asking about anticoagulants, and consenting a patient before checking capacity.