Arab Board Surgery Final Written flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

ASA physical status III

A patient with severe systemic disease that is not incapacitating, such as poorly controlled diabetes, hypertension or chronic obstructive pulmonary disease, which increases operative risk compared with class II.

4-2-1 maintenance fluid rule

Hourly crystalloid maintenance is 4 mL/kg for the first 10 kg of body weight, 2 mL/kg for the next 10 kg and 1 mL/kg for each remaining kilogram.

Postoperative fever timing

Timing suggests the cause: atelectasis or pneumonia on days 1–2, urinary or line infection on days 3–5, wound infection on days 5–7 and deep vein thrombosis after day 7.

Wound tensile strength

Strength is about 5% of normal at one week, 20% at three weeks and 70–80% by three months, and never returns fully to that of uninjured skin.

Alvarado score

A 10-point clinical score for appendicitis covering migratory pain, anorexia, nausea, right iliac fossa tenderness, rebound, fever, leucocytosis and neutrophilia; a score of 7 or more supports appendicectomy.

Graham patch repair

An omental plug sutured over a perforated peptic ulcer to seal the defect after peritoneal lavage, combined with Helicobacter pylori eradication and proton pump inhibitor therapy.

Femoral hernia anatomy

A hernia passing through the femoral canal, below and lateral to the pubic tubercle and medial to the femoral vein, carrying a high risk of strangulation that warrants early repair.

Child-Pugh score

A prognostic score in cirrhosis using bilirubin, albumin, INR, ascites and encephalopathy; classes A, B and C correlate with operative mortality and long-term survival.

Courvoisier's law

Painless jaundice with a palpable, non-tender gallbladder is unlikely to be due to gallstones and usually indicates a periampullary or pancreatic head malignancy.

Atlanta classification

Grades acute pancreatitis as mild, moderately severe (transient organ failure under 48 hours or a local complication) or severe (persistent organ failure beyond 48 hours), which predicts mortality.

Triple assessment

Clinical examination, imaging (ultrasound in younger women, mammography from age 40) and core needle biopsy used together to diagnose a breast lump accurately.

Sentinel lymph node biopsy

Injection of dye and radio-isotope identifies the first draining axillary node; if it is tumour-free, full axillary dissection is avoided, reducing lymphoedema and shoulder morbidity.

Chvostek sign

Twitching of the facial muscles when the facial nerve is tapped in front of the ear, indicating hypocalcaemia, most often after total thyroidectomy with parathyroid injury.

Phaeochromocytoma alpha-blockade

Phenoxybenzamine is given for 10–14 days before surgery to control blood pressure and expand the contracted circulation; beta-blockade is added only afterwards to avoid unopposed vasoconstriction.

Ankle-brachial pressure index

The ratio of ankle to brachial systolic pressure; below 0.9 suggests peripheral arterial disease, below 0.5 critical ischaemia and above 1.3 non-compressible calcified vessels.

Rule of sixes

At six weeks an arteriovenous fistula should have flow above 600 mL/min, a diameter above 6 mm and a depth under 6 mm to be usable for dialysis.

AAA repair threshold

Elective repair of an infrarenal aortic aneurysm is indicated above 5.5 cm in men or 5.0 cm in women, or when growth exceeds 1 cm per year.

Lethal triad

Hypothermia, metabolic acidosis and coagulopathy, which reinforce each other after major trauma and are the rationale for damage control resuscitation and abbreviated surgery.

Beck's triad

Hypotension, distended neck veins and muffled heart sounds, indicating cardiac tamponade, usually from penetrating chest trauma, and requiring pericardiocentesis or thoracotomy.

Parkland formula

Burn resuscitation using 4 mL/kg per percent total body surface area of crystalloid in 24 hours, with half given in the first 8 hours from the time of the burn.

Stage versus grade

Stage describes anatomical extent by TNM while grade describes differentiation; stage is the stronger predictor of survival and drives the choice of treatment.

Tumour markers

CEA for colorectal, CA19-9 for pancreatic, alpha-fetoprotein for hepatocellular carcinoma, CA-125 for ovarian and calcitonin for medullary thyroid cancer; none is diagnostic alone.

Neoadjuvant rectal chemoradiotherapy

Treatment given before surgery for T3 or T4 and node-positive rectal cancer to shrink the tumour, increase sphincter preservation and reduce local recurrence.

Sepsis-3 definition

Life-threatening organ dysfunction caused by a dysregulated host response to infection, defined operationally as a rise of 2 or more points in the SOFA score.

qSOFA

A bedside screen using respiratory rate 22/min or more, systolic blood pressure 100 mmHg or less and altered mentation; two or more criteria predict a poor outcome in suspected infection.

Abdominal compartment syndrome

Sustained intra-abdominal pressure above 20 mmHg with new organ dysfunction, while intra-abdominal hypertension is pressure above 12 mmHg; treatment is decompressive laparotomy.

Pyloric stenosis biochemistry

Projectile non-bilious vomiting causes hypochloraemic, hypokalaemic metabolic alkalosis with paradoxical aciduria; correct with normal saline and potassium before performing pyloromyotomy.

Intussusception reduction

First-line treatment in a stable child is pneumatic or hydrostatic enema reduction under radiological guidance; surgery is needed for peritonitis, perforation or failed reduction.

Meckel's rule of twos

Occurs in 2% of people, 2 feet from the ileocaecal valve, about 2 inches long, with 2 ectopic tissue types, and causes symptoms before age 2 in half of cases.

Compartment syndrome signs

Pain out of proportion, pain on passive stretch, a tense compartment and paraesthesia; pulselessness is late, and emergency fasciotomy is required to prevent muscle necrosis.

Hyperacute rejection

Rejection within minutes to hours due to preformed recipient antibodies against donor antigen, producing graft thrombosis; it is prevented by ABO and cross-match compatibility.

Cushing's triad

Hypertension with a widened pulse pressure, bradycardia and irregular respiration, indicating raised intracranial pressure and impending herniation in a head-injured patient.