Surgery, trauma and emergency medicine is 15% of our bank, 22 to 23 items on a 150-item paper, against 20% in the SMLE and 30 of 150 items at Qatar DHP. It is the domain of sequences: ATLS primary survey, resuscitation, the acute abdomen, and the emergency you must recognise early. The SMLE rates trauma and ATLS topics, bowel obstruction, appendicitis, biliary disease, hernias, burns, compartment syndrome, diabetic foot and necrotising fasciitis at mastery level 3. Gulf heat illness is included.
Weight and expected items
| Source | Share | Items on 150 |
|---|---|---|
| Our bank (editorial) | 15% | 22 to 23 |
| SMLE 2026 blueprint (Surgery) | 20% (can vary by plus or minus 5) | 30 if applied to 150 |
| Qatar DHP GP blueprint | 20% (our arithmetic) | 30 |
Our domain includes emergency medicine topics that the published blueprints place elsewhere or do not name, so a direct comparison is rough. Plan from the larger of the three.
What is tested
| Cluster | Subtopics |
|---|---|
| Trauma | Primary survey and ATLS approach, head, chest and abdominal trauma, pelvic and limb trauma, compartment syndrome, burns, bites, stings and drowning |
| Acute abdomen and digestive surgery | Appendicitis, bowel obstruction, perforation, biliary disease, pancreatitis, liver abscess, hernias and anorectal conditions, colorectal cancer and diverticular disease |
| Other surgery | Breast lumps, screening and nipple discharge; thyroid nodule and neck mass; peripheral arterial disease, acute limb ischaemia and aortic aneurysm; diabetic foot and necrotising soft-tissue infection; urological emergencies |
| Peri-operative | Preoperative assessment, postoperative complications, fever, VTE prophylaxis and wound care |
| Emergency medicine | Anaphylaxis, poisoning and overdose, heat illness, basic and advanced life support |
Guideline points to hold
- Trauma. The ATLS primary survey follows ABCDE. FAST looks for free fluid. Tranexamic acid is given within 3 hours in major haemorrhage.
- Anaphylaxis. Adrenaline IM 0.5 mg (500 micrograms, 0.5 mL of 1 mg/mL) for adults and children over 12, repeated after 5 minutes, in the lateral thigh. Lower doses apply to younger children.
- Sepsis. Antimicrobials within 1 hour for septic shock, at least 30 mL/kg crystalloid in the first 3 hours for hypoperfusion, noradrenaline first line, MAP 65 mmHg.
- Paracetamol overdose. N-acetylcysteine guided by the treatment line, or immediately if the overdose is staggered or the time is unknown.
- Heat illness. Heat stroke is the most serious form: core temperature above 40 degrees Celsius with central nervous system dysfunction such as confusion, seizure or coma. Treat with immediate cooling (cold or ice-water immersion if possible, wet skin, air circulation, cold packs to the neck, armpits and groin), ABC support and intravenous fluids. Antipyretics do not work. Heat exhaustion has normal mentation. Risk factors include age, dehydration, obesity, alcohol and drugs that impair sweating, such as anticholinergics.
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Approaching the acute abdomen
Acute abdomen stems are solved by location, character and the one sign that separates surgical from medical. Start with the stability of the patient, since a shocked patient changes the order of everything. Then place the pain: right iliac fossa suggests appendicitis, upper right quadrant suggests biliary disease, a colicky central pain with vomiting and distension suggests obstruction, and a sudden rigid abdomen suggests perforation. Decide what the first test is, usually bloods and an imaging choice that suits the likely cause and the patient, and what the first action is: fluids, analgesia, antibiotics, nil by mouth, or theatre. Hernias and anorectal conditions follow the same logic with a different question: reducible or strangulated, urgent or elective.
Burns and the peri-operative patient
Burns items test classification by depth and extent and the fluid resuscitation principle: replace the large fluid losses early in major burns and monitor the response by urine output. Peri-operative items ask you to prepare a patient, such as stopping or continuing a drug, assessing risk and deciding what to optimise, or to recognise a postoperative complication from its timing: early bleeding, a fever in the first days, a wound problem later. VTE prophylaxis is a recurring theme. Read the stem for the bleeding risk and renal function before choosing the agent.
Three typical traps
- Breaking the sequence. In trauma, the obvious injury is rarely the first thing to treat. Airway with cervical spine protection comes before breathing, and breathing before circulation. A distracting wound in the stem is the test.
- Imaging an unstable patient. A haemodynamically unstable trauma patient needs resuscitation and a bedside assessment such as FAST, not a trip to the scanner. The stem's blood pressure is the clue.
- Pain out of proportion. In a limb after trauma or a diabetic foot with systemic upset, severe pain, tense swelling or rapid spread points to compartment syndrome or necrotising infection, both time-critical. Do not be reassured by a modest skin appearance.
How to revise it
- Rehearse ABCDE aloud until you can do it for a head injury, a chest injury and a burn without hesitation.
- Do the acute abdomen as a table: pain site and character, signs, first test, first action.
- Learn emergencies as sequences: anaphylaxis, sepsis, poisoning, heat stroke. For each, write the first three actions.
- Cover the small surgical topics quickly: breast, thyroid, vascular and urology each need the red flag and the right referral.
- Use mixed timed sets from week 6, since this domain rewards speed.
See also sepsis and ACLS, urology and musculoskeletal and the numbers table.
Frequently asked questions
How much surgery is on the Gulf GP exams?
Our bank gives it 15%. The SMLE blueprint gives Surgery 20%, and Qatar DHP lists 30 of 150 items.
What does the ATLS primary survey follow?
ABCDE, with FAST for free fluid, and tranexamic acid within 3 hours in major haemorrhage.
Is heat illness tested?
It is in our subtopics for the Gulf context. Know heat stroke (core temperature above 40 degrees Celsius with CNS dysfunction, treated with immediate cooling) versus heat exhaustion (normal mentation).
What is the adrenaline dose for adult anaphylaxis?
500 micrograms (0.5 mL of 1 mg/mL) IM in the lateral thigh, repeated after 5 minutes if needed.
Do I need to learn the UAE midday break rule?
No. It is public-health context for heat illness, and it is reported to change each year. Learn the clinical features instead.