Egyptian Board General Surgery flashcards

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

Inguinal canal roof

Formed by the lower fibers of the internal oblique and transversus abdominis muscles; the floor is the inguinal ligament, anterior wall is external oblique aponeurosis, posterior wall is transversalis fascia.

Femoral sheath order

From lateral to medial the femoral sheath contains the femoral artery, femoral vein, and femoral canal; the femoral nerve lies outside the sheath, lateral to the artery.

Recurrent laryngeal nerve injury

Unilateral injury causes hoarseness and weak voice; bilateral injury causes stridor and airway obstruction; the external branch of the superior laryngeal nerve affects pitch.

Collagen maturation timeline

Type III collagen is laid down early and replaced by stronger type I collagen during remodeling; wound strength is about 5% at one week and 70-80% at one year.

Surgical site infection rates

Clean wounds have less than 2% infection risk, clean-contaminated less than 10%, contaminated about 20%, and dirty wounds over 40%; prophylaxis is given within 60 minutes of incision.

Maintenance fluid 4-2-1 rule

Hourly maintenance fluid equals 4 mL/kg for the first 10 kg, plus 2 mL/kg for the next 10 kg, plus 1 mL/kg for each kilogram above 20 kg.

Hemorrhagic shock class III

Blood loss of 30-40% (about 1.5-2 L in a 70 kg adult) causes hypotension, tachycardia, tachypnea, confusion, and markedly reduced urine output; requires blood transfusion.

Parkland burn formula

Give 4 mL of crystalloid per kilogram body weight per percent total body surface area burned in the first 24 hours; half is given in the first 8 hours from the time of injury.

Damage control surgery

Staged approach: stop hemorrhage and contamination, temporary abdominal closure, ICU correction of hypothermia, acidosis, and coagulopathy, then definitive repair at a later operation.

Acute pancreatitis diagnosis

Requires two of three criteria: characteristic epigastric pain radiating to the back, serum lipase greater than three times the upper limit of normal, and imaging findings consistent with pancreatitis.

Murphy sign

Inspiratory arrest during deep palpation of the right upper quadrant under the costal margin; suggests acute cholecystitis and is often evaluated with abdominal ultrasound.

Graham patch repair

Omental patch placed over a perforated duodenal ulcer after primary closure or alone; used for perforated peptic ulcer disease, often with peritoneal lavage and antibiotics.

Post-splenectomy vaccination

Vaccinate against Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b, ideally at least two weeks before elective splenectomy, to prevent overwhelming sepsis.

Papillary thyroid carcinoma

Most common thyroid cancer, spreads via lymphatics, has excellent prognosis, and shows orphan Annie eye nuclei and psammoma bodies on histology; treated with thyroidectomy and selective radioactive iodine.

Primary hyperparathyroidism

Elevated serum calcium with inappropriately normal or high parathyroid hormone; most often a single parathyroid adenoma; localization with ultrasound and sestamibi scan; surgery is curative.

Pheochromocytoma blockade

Alpha-blockade with phenoxybenzamine is started before beta-blockade to prevent unopposed alpha stimulation and hypertensive crisis; metanephrines confirm the diagnosis.

Sentinel lymph node biopsy

Injection of blue dye and radiolabeled colloid to identify the first draining lymph node; used in clinically node-negative breast cancer and melanoma to stage the axilla.

Breslow thickness

Depth of melanoma invasion measured from the granular layer of the epidermis to the deepest tumor cell; determines sentinel node biopsy indication and prognosis.

Ankle-brachial index

Ratio of ankle systolic pressure to brachial systolic pressure; less than 0.9 indicates peripheral arterial disease, and less than 0.4 suggests critical limb ischemia.

Abdominal aortic aneurysm repair

Elective repair is indicated for diameter of 5.5 cm or more, growth over 0.5 cm in six months, or symptoms; endovascular repair is preferred in high-risk patients.

Triangle of safety

Chest tube insertion site bounded by the anterior border of latissimus dorsi, lateral border of pectoralis major, a line above the nipple, and the apex below the axilla.

Pyloric stenosis metabolic picture

Nonbilious projectile vomiting causes loss of hydrogen and chloride, producing a hypochloremic, hypokalemic metabolic alkalosis with paradoxical aciduria; correct fluids before pyloromyotomy.

Intussusception reduction

First-line treatment is air or barium enema reduction in a stable child without peritonitis; surgery is indicated for perforation, peritonitis, or failed enema reduction.

Testicular torsion salvage

Sudden severe scrotal pain with a high-riding testis and absent cremasteric reflex; urgent detorsion and bilateral orchidopexy; salvage falls sharply after six hours of ischemia.

Milan criteria

Liver transplantation eligibility for hepatocellular carcinoma: a single tumor up to 5 cm, or up to three tumors each up to 3 cm, without vascular invasion or extrahepatic spread.

Hyperacute rejection

Preformed antibodies against donor antigens cause graft thrombosis within minutes to hours; prevented by ABO compatibility and a negative crossmatch before transplantation.

Critical view of safety

During cholecystectomy, clear the hepatocystic triangle of fat and fibrous tissue and identify only the cystic duct and cystic artery entering the gallbladder.

Pneumoperitoneum physiology

Carbon dioxide insufflation to 12-15 mmHg causes hypercapnia, respiratory acidosis, reduced venous return, and increased vagal tone; may cause bradycardia and subcutaneous emphysema.

Informed consent elements

Disclosure of diagnosis, procedure nature, risks and benefits, alternatives, and consequences of refusal; the patient must have capacity and consent must be documented.

WHO surgical safety checklist

Three phases: sign-in before induction, time-out before incision, and sign-out before leaving the operating room; reduces surgical morbidity and mortality.

Likelihood ratio formula

Positive likelihood ratio equals sensitivity divided by (1 minus specificity); negative likelihood ratio equals (1 minus sensitivity) divided by specificity; values far from 1 change probability.

Number needed to treat

The reciprocal of the absolute risk reduction; the number of patients who must be treated for one additional patient to benefit from the intervention.