Pretend we’re at a table, and I’m leaning in with urgency because you absolutely need to get this—like the planet depends on your understanding. These general surgery scenarios are the kind of knowledge that saves lives..
If you're in medicine, nursing, or just a human who wants to understand how your body can break and how we put it back together, this is for you.
1.
Scenario: A 40-year-old woman, overweight, known gallstones, comes in with:
Right upper quadrant (RUQ) pain
Fever
Positive Murphy’s sign (she gasps when you press under the ribs)
Question: What do we do?
🅰️ Discharge with painkillers 🅱️ Start IV fluids, antibiotics, and plan for early laparoscopic cholecystectomy
🅲 Schedule an elective endoscopic procedure
🅳 Advise a high‐fiber diet and follow up in a week
💡 Correct Answer: B – Start IV fluids, antibiotics, and plan for early laparoscopic cholecystectomy.
WHY: This is classic acute cholecystitis, which is an infection of the gallbladder usually caused by a gallstone blocking the cystic duct. This isn't just tummy pain—you’re looking at a potential perforation, gangrene, or sepsis if left untreated.
IV fluids – because she's likely dehydrated from not eating or vomiting
Antibiotics – to treat the infection
Surgery – and don’t wait days or weeks. Early surgery in the same admission gives the best outcomes.
WHY NOT the other answers?
A (Discharge with painkillers) – Are you mad? You’d be sending her home with an infected organ in her gut.(that's what one of my teachers told me in medical school when I goofed by answering with this option)
C (Endoscopy) – ERCP is for bile duct stones, not acute gallbladder infection.
D (High-fiber diet) – Fiber won’t fix an infected gallbladder. That’s like putting a band-aid on a landmine.
2.
Scenario: 18-year-old male.
Sudden, severe scrotal pain
Swelling
High-riding testis
Question: What is the correct management?
🅰️ Wait 24 hours for spontaneous resolution 🅱️ Order a scrotal ultrasound and schedule elective surgery 🅲️ Perform immediate surgical exploration and detorsion
🅳 Prescribe anti-inflammatory medications and bed rest
💡 Correct Answer: C – Perform immediate surgical exploration and detorsion.
WHY: This is a true urological emergency. The spermatic cord is twisted, cutting off blood supply to the testicle. Time is testis.
You’ve got 4 to 6 hours before that testicle dies. Surgery now, or he might lose it. Not tomorrow. NOW.
WHY NOT the others?
A (Wait 24 hours) – That’s a death sentence for the testis.
B (Order ultrasound) – Time spent imaging is time wasted. If the history screams torsion, you cut.
D (Anti-inflammatories) – You can’t medicate blood flow back into a strangled testicle.
3.
Scenario: 70-year-old man, known hernia.
Now painful and can’t push it back in
Nausea
Signs of bowel obstruction
Question: What’s going on and what’s next?
🅰️ Strangulated hernia requiring urgent surgical repair
🅱️ Reducible hernia; schedule elective repair
🅲 Lipoma; advise weight loss
🅳 Hematoma; observe overnight
💡 Correct Answer: A – Strangulated hernia requiring urgent surgical repair.
WHY: A hernia that you could once push in is now stuck, painful, and causing obstruction. This is a strangulated hernia—the bowel inside is dying from lack of blood supply. You need surgery ASAP to prevent necrosis, perforation, and death.
WHY NOT the others?
B (Reducible hernia) – It’s not reducible anymore. That’s why it’s an emergency now.
C (Lipoma) – Lipomas don’t cause obstruction or vomiting.
D (Hematoma) – Hematomas don’t present this way. Plus, this is a known hernia history.
4.
Scenario: 25-year-old man
8 hours of right lower quadrant pain
Nausea
Fever
Tender at McBurney’s point
Question: What’s the next step?
🅰️ Order a colonoscopy 🅱️ Start broad-spectrum antibiotics and schedule a laparoscopic appendectomy
🅲 Advise bed rest and oral analgesics
🅳 Perform an outpatient ultrasound and recheck in 24 hours
💡 Correct Answer: B – Start antibiotics and do a laparoscopic appendectomy.
WHY: This is textbook acute appendicitis. Time is of the essence because the appendix can rupture, leading to peritonitis or abscess. The treatment:
IV antibiotics to reduce bacterial load
Surgical removal – preferably before it bursts
WHY NOT the others?
A (Colonoscopy) – Absolutely dangerous here. You risk perforating an inflamed bowel.
C (Bed rest) – No. The appendix won’t heal with rest.
D (Outpatient ultrasound) – You’re playing with fire. This is not a wait-and-see situation.
5.
A 60-year-old woman who had abdominal surgery in the past now comes in with:
Crampy belly pain
Vomiting
A swollen stomach
Question: What is the most likely cause, and what should be done first?
🅰️ A twisted gut (volvulus); take her to surgery right away
🅱️ Blocked small intestine from scar tissue (adhesions); give IV fluids, put in a tube to drain the stomach, and watch closely
🅲 Appendicitis; remove the appendix with surgery
🅳 Gallstone stuck in the bowel; do an endoscopy (ERCP)
💡 Correct Answer: B – Blocked small intestine from scar tissue (adhesions); give IV fluids, put in a tube to drain the stomach, and watch closely. WHY: This woman has classic signs of small bowel obstruction—crampy pain, vomiting, and abdominal distension. Given her history of prior abdominal surgery, the most likely cause is adhesions (scar tissue bands from previous operations that kink or pull the intestines).
Initial management is non-surgical unless she shows signs of strangulation or peritonitis:
IV fluids – to replace fluid loss from vomiting
Nasogastric tube (NGT) – to decompress the stomach and relieve vomiting
Close observation – for signs that might require surgery later (e.g., fever, worsening pain, no improvement)
WHY NOT the others?
A (Twisted gut/Volvulus) – Volvulus is possible but less likely without specific risk factors (like a long mesentery or prior volvulus).
C (Appendicitis) – Wrong location, wrong symptoms—appendicitis typically presents with lower right abdominal pain.
D (Gallstone ileus/ERCP) – Gallstone ileus is rare and typically affects older patients with gallbladder disease. ERCP is not the first step for bowel obstruction.
🧠 Final Takeaway
If you remember nothing else, remember this:
🆘 Some surgical problems can be life-threatening in HOURS. 🎯 Timely action — not just the right action — saves organs and lives.
🚫 Don’t wait. Don’t guess. Don’t send home.