RACS GSSE flashcards

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

Shock index

Heart rate divided by systolic blood pressure. A value above 0.9 suggests occult hypoperfusion in trauma and predicts need for transfusion better than vital signs alone.

Permissive hypotension

Deliberate limitation of fluid resuscitation to a systolic pressure around 80 to 90 mmHg in bleeding trauma patients until haemorrhage control, reducing clot disruption. Contraindicated in traumatic brain injury.

Tranexamic acid in trauma

Antifibrinolytic given as 1 g over 10 minutes within 3 hours of injury, followed by 1 g infused over 8 hours. Reduces mortality from bleeding; benefit falls with delayed administration.

Damage control laparotomy

Abbreviated initial operation to control haemorrhage and contamination, temporary abdominal closure, correction of hypothermia, acidosis and coagulopathy in intensive care, then planned relook for definitive repair.

Lethal triad

The combination of hypothermia, metabolic acidosis and coagulopathy that drives ongoing haemorrhage after major trauma. Management targets rewarming, haemorrhage control and blood product replacement.

Surgical site infection prophylaxis timing

Prophylactic antibiotic should be given within 60 minutes before incision, or within 120 minutes for vancomycin and fluoroquinolones, to achieve adequate tissue levels at the time of incision.

Anastomotic leak presentation

Typically manifests on days 5 to 8 after surgery with tachycardia, fever, ileus, abdominal pain and rising inflammatory markers. CT with water-soluble contrast is the initial investigation.

Wound class contamination

Clean wounds are elective and uninfected; clean-contaminated enters a hollow viscus under control; contaminated involves gross spillage or acute inflammation; dirty wounds contain pus or perforated viscera.

Alvarado score

Clinical score for appendicitis using migratory pain, anorexia, nausea or vomiting, right iliac fossa tenderness, rebound tenderness, fever and leukocytosis. A score of 7 or more supports operative management.

Murphy sign

Arrest of inspiration during deep palpation below the right costal margin, indicating contact between the inflamed gallbladder and the examining hand. Supports a diagnosis of acute cholecystitis.

Courvoisier law

A palpable, non-tender gallbladder with painless jaundice suggests malignant obstruction of the distal common bile duct rather than gallstone disease, because chronic stone disease fibroses the gallbladder.

Charcot triad

Fever with rigors, right upper quadrant pain and jaundice, indicating ascending cholangitis. Requires urgent biliary drainage, usually by ERCP, alongside antibiotics and resuscitation.

Reynolds pentad

Charcot triad plus hypotension and altered mental state, indicating severe suppurative cholangitis with sepsis. Demands emergency biliary decompression after initial resuscitation and antibiotics.

Grey Turner sign

Flank bruising from retroperitoneal haemorrhage, classically in severe acute pancreatitis. It is a late sign and indicates a poor prognosis when present.

Cullen sign

Periumbilical bruising caused by retroperitoneal or intraperitoneal haemorrhage tracking along the falciform ligament. Associated with severe pancreatitis and ruptured ectopic pregnancy.

Ranson criteria

Prognostic scoring in acute pancreatitis using admission values (age, white cell count, glucose, LDH, AST) and 48-hour values (fall in haematocrit, calcium, base deficit, urea, fluid sequestration).

Pancreatitis fluid resuscitation

Balanced crystalloid at approximately 5 to 10 mL/kg per hour with frequent reassessment. Avoid over-resuscitation; prophylactic antibiotics are not indicated in sterile necrotising pancreatitis.

Small bowel obstruction imaging

Supine and erect abdominal radiographs show dilated loops and air-fluid levels; CT with intravenous contrast identifies the transition point, closed-loop obstruction and strangulation requiring urgent surgery.

Strangulated obstruction signs

Persistent pain, tachycardia, fever, peritonism, rising lactate and reduced bowel wall enhancement on CT indicate ischaemia. Requires immediate resuscitation and laparotomy rather than conservative management.

Lower GI bleed localisation

CT angiography localises bleeding at rates above 0.5 mL per minute and allows embolisation. Colonoscopy after rapid preparation is used when bleeding is slower and the patient is stable.

Recurrent laryngeal nerve injury

Unilateral injury causes hoarseness and a weak cough; bilateral injury causes stridor and airway obstruction requiring reintubation or tracheostomy. The nerve is at risk near the ligament of Berry.

Superior laryngeal nerve external branch

Supplies cricothyroid. Injury causes loss of high pitch and voice fatigue. At risk if the superior thyroid artery is ligated far from the gland rather than close to it.

Post-thyroidectomy haematoma

Airway emergency from neck swelling and stridor. Treatment is immediate opening of the wound at the bedside to release the haematoma, then definitive haemostasis in theatre.

Thyroid storm

Severe thyrotoxicosis with fever, tachycardia, agitation and heart failure, often triggered by surgery or infection. Treated with beta-blockade, thionamide, iodine, steroids and supportive care.

Primary hyperparathyroidism

Elevated calcium with an inappropriately normal or raised parathyroid hormone. Most commonly a single adenoma; localised with ultrasound and sestamibi before minimally invasive parathyroidectomy.

Intraoperative PTH criterion

A fall in parathyroid hormone of more than 50 percent ten minutes after excision of the adenoma predicts cure of primary hyperparathyroidism and allows the operation to be concluded.

Triple assessment of breast

Combined clinical examination, imaging with mammography and ultrasound, and core needle biopsy. Together these achieve high diagnostic accuracy for symptomatic breast lumps.

Sentinel lymph node biopsy

Injection of blue dye and radiolabelled colloid around the tumour or areola, then identification of the first draining node. Used for axillary staging in clinically node-negative breast cancer.

Right versus left colorectal cancer

Right-sided tumours more often present with iron-deficiency anaemia and a palpable mass; left-sided tumours more often cause obstruction and altered bowel habit with rectal bleeding.

Rectal cancer local staging

Magnetic resonance imaging of the rectum assesses depth of invasion, mesorectal fascia involvement and nodal status, guiding decisions about neoadjuvant chemoradiotherapy before surgery.

Damage control resuscitation

Strategy in major haemorrhage using minimal crystalloid, balanced blood components approaching a 1:1:1 ratio, permissive hypotension, tranexamic acid and active warming until surgical or radiological haemostasis.

Enhanced recovery after surgery

Multimodal perioperative pathway including carbohydrate loading, avoidance of routine drains and nasogastric tubes, opioid-sparing analgesia, early oral intake and early mobilisation to shorten length of stay.