General surgery for the AMC exam
The acute abdomen, hernias, biliary and pancreatic disease, bowel obstruction and anorectal conditions. The AMC wants safe initial assessment, resuscitation and knowing when to call the surgeon.
High-yield points
Appendicitis: periumbilical pain migrating to the right iliac fossa, anorexia, fever; ultrasound first in children and pregnancy, CT in most adults.
Biliary colic vs cholecystitis: fever, raised WCC and positive Murphy's sign suggest cholecystitis; ultrasound is the first test.
Ascending cholangitis (Charcot's triad: fever, jaundice, RUQ pain) needs antibiotics and urgent biliary drainage.
Acute pancreatitis: lipase over 3x the upper limit; common causes are gallstones and alcohol; early fluids and analgesia, severity by organ failure.
Bowel obstruction: 'drip and suck' (IV fluids, NG tube), CT to find cause; strangulation needs surgery.
Irreducible, tender hernia is a surgical emergency (strangulation).
Uncomplicated diverticulitis in a well patient can often be managed without antibiotics; complicated cases need CT and admission.
Mesenteric ischaemia: pain out of proportion to examination, often with AF.
India vs Australia
Where the answer the AMC marks correct differs from what’s usually taught in Indian MBBS.
| Aspect | India (MBBS)What you learn in MBBS | Australia (AMC)What the exam marks as correct |
|---|---|---|
| Acute abdomen | Clinical diagnosis with ultrasound; surgery principles as taught. | Largely the same: appendicitis, cholecystitis and obstruction are diagnosed and managed similarly. |
| Infective causes | Abdominal TB, amoebic liver abscess and typhoid perforation are common. | Rare, mainly in migrants or travellers. Hydatid disease can still occur in rural sheep-farming areas. |
| Elective referral | Patient often goes directly to a surgeon. | GP refers. Public elective surgery waiting lists use urgency categories 1-3 (within 30, 90 or 365 days), or private care. |
| Antibiotic prophylaxis | Postoperative antibiotic courses of several days are common. | Single pre-incision dose (usually cefazolin) per eTG; prolonged postoperative courses are not recommended. |
Acute abdomen
India (MBBS)
Clinical diagnosis with ultrasound; surgery principles as taught.
Australia (AMC): what the exam expects
Largely the same: appendicitis, cholecystitis and obstruction are diagnosed and managed similarly.
Infective causes
India (MBBS)
Abdominal TB, amoebic liver abscess and typhoid perforation are common.
Australia (AMC): what the exam expects
Rare, mainly in migrants or travellers. Hydatid disease can still occur in rural sheep-farming areas.
Elective referral
India (MBBS)
Patient often goes directly to a surgeon.
Australia (AMC): what the exam expects
GP refers. Public elective surgery waiting lists use urgency categories 1-3 (within 30, 90 or 365 days), or private care.
Antibiotic prophylaxis
India (MBBS)
Postoperative antibiotic courses of several days are common.
Australia (AMC): what the exam expects
Single pre-incision dose (usually cefazolin) per eTG; prolonged postoperative courses are not recommended.