Surgery and Surgical Subspecialties
Surgery and Surgical Subspecialties tests acute abdominal pain, hernia, wounds and burns, breast and thyroid lumps, and basic trauma. The focus is triage and recognition of surgical emergencies.
Core rules
- Appendicitis classically migrates from periumbilical pain to the right lower quadrant, with anorexia, fever, and rebound tenderness. Analgesia does not mask the diagnosis and should not be withheld.
- Testicular torsion is a surgical emergency: sudden severe pain, high-riding testis, absent cremasteric reflex. Do not wait for ultrasound if suspicion is high.
- Hernia: reducible inguinal hernia can be elective; irreducible, tender, or with vomiting suggests strangulation and needs emergency referral.
- Burns: estimate with the rule of nines; Parkland formula for fluids; refer major burns, inhalation injury, and circumferential burns.
- Trauma: primary survey ABCDE before history.
Worked example
A 22-year-old man has 18 hours of abdominal pain that began centrally and moved to the right iliac fossa, with fever 38.1°C and rebound tenderness. Reasoning: the migration and peritoneal signs suggest appendicitis. Keep him nil by mouth, give intravenous fluids and analgesia, and arrange surgical review. An Alvarado score of 8 supports the diagnosis but does not replace examination.
Traps
- Withholding analgesia before surgical review.
- Treating a tender irreducible hernia as a strain.
- Missing torsion because the urine shows a few white cells.
- Underestimating burn size in children.