Choose how you want to revise

Select Questions

Revise with my preferences. Choose your difficulty or recap questions you've found hard.

Mock tests

Test myself against recent exam themes and ones curated by BMJ’s editorial team of doctors.

Group Learning

Play under a username and join friends or others for 10 questions. Move up of the daily leaderboard.

On the go

Download the app for offline access. Make revision easily fit into your schedule.

Select the best subscription for your exam date

Join 200,000+ OnExamination users who have successfully become medical professionals

Revise with quality questions and detailed explanations



Demo Question

A 45-year-old man is injured in a high-speed road traffic crash. He is haemodynamically unstable and, after initial assessment, is found to have free fluid in the abdominal cavity on FAST scan (focussed abdominal sonography). He is taken to the operating theatre for laparotomy. At laparotomy, the main sources of bleeding are identified (in the mesentery of the small bowel).

The bleeding points are tied off and the injured sections of small bowel stapled off but not reanastamosed. It is apparent there are multiple tiny areas of bleeding, especially in the wound edges, which the surgeons describe as a general ooze.

They close the abdomen, admit the patient to the intensive care unit, and plan to return to theatre to repair the small bowel 24 hours when the patient is more stable.

Which ONE of the following statements best describes the principle of damage control laparotomy?

 Laparotomy performed to reduce contamination

  Laparotomy performed to restore normal physiology

 Laparotomy performed to stop bleeding

 Laparotomy performed when there is acidosis

 Laparotomy performed when there is coagulopathy





Key Learning Point

Damage control laparotomy favours restoration of normal physiology over anatomy



Explanation

A damage control laparotomy is performed when prolonged surgery would worsen physiology. Patients may have a triad of acidosis, hypothermia and coagulopathy. The immediate concern is to stop life-threatening bleeding and reduce contamination (staple off perforated bowel, for example) rather than reconstruct damaged tissue and reanastamose bowel. After 'abbreviated' laparotomy for damage control, the patient is resuscitated in the intensive care unit to correct abnormal physiology (warming up the patient and correcting coagulopathy, for example). Reoperation and reconstruction of anatomy is performed 24 or 48 hours later when physiology is closer to normal.

Smart features to maximise your revision efforts

Daily questions

Keep on track. Set a time that suits you, we will send you a personalised revision question every day.

Revision plans

Turn weaknesses into strengths. Focus on the specialities that will give you the biggest learnings.

Feedback & peer comparison

Indicates how likely you are to pass. Detailed performance graphs show how you’re currently performing and benchmark you against your peers.

Save time and focus on the most important questions

Core questions

Maximise your revision time. Core Questions instantly delivers you the most important questions, ranked by our clinical tutors and your peers.