Surgery
What OMRSE tests
Surgery questions cover acute abdomen, trauma, perioperative assessment, wound care, and common procedures. They test safe prioritization: airway and bleeding before imaging, and source control before antibiotics alone.
Core rules
- In trauma, use the primary survey (catastrophic bleeding, airway, breathing, circulation, disability, exposure) and reassess after every intervention.
- In acute abdominal pain, pregnancy status is a mandatory early test in women of childbearing age.
- Do not withhold analgesia for acute abdomen; it does not mask the diagnosis in modern practice.
- For suspected appendicitis, clinical scoring supports but does not replace imaging or serial examination.
Worked example
A 22-year-old woman has 24 hours of periumbilical pain migrating to the right iliac fossa, anorexia, and fever 38.1°C. Examination shows guarding at McBurney point; pregnancy test is negative; ultrasound is equivocal. The presentation is classic appendicitis. Give analgesia, antibiotics, and intravenous fluids, then proceed to laparoscopic appendectomy. If diagnostic uncertainty is high and surgery is not immediately available, CT can clarify, but do not delay source control for repeated scoring.
Traps that cost marks
- Reassuring a normal white cell count in early appendicitis.
- Missing an ectopic pregnancy because the patient has no vaginal bleeding.
- Treating a peri-anal abscess with antibiotics alone when drainage is needed.
- Forgetting tetanus prophylaxis and wound exploration in penetrating trauma.