CSHK Part 1 MCQ key terms

A surgical incision made through the abdominal wall to access the peritoneal cavity, used for emergency exploration or elective procedures. It may be midline, paramedian, or transverse depending on the indication.

A staged approach in severely injured or physiologically unstable patients: initial abbreviated operation to control haemorrhage and contamination, followed by intensive care resuscitation and later definitive reconstruction.

Failure of a surgical join between two bowel or other luminal ends, allowing luminal contents to escape. Presents with peritonitis, sepsis, or abscess, typically days after surgery, and often requires reoperation or drainage.

Mechanical or functional blockage of intestinal transit causing colicky pain, vomiting, distension, and absolute constipation. Managed with resuscitation, nasogastric decompression, and surgery when strangulation or closed-loop obstruction is suspected.

Twisting of a segment of bowel on its mesenteric axis, producing closed-loop obstruction and risk of ischaemia. Sigmoid and caecal volvulus are classic sites; sigmoid volvulus may be decompressed endoscopically if there is no gangrene.

An abnormal tract between bowel lumen and skin, often arising after anastomotic breakdown or as a complication of Crohn disease. Management centres on sepsis control, nutrition, skin protection, and delayed definitive surgery.

Intestinal necrosis from inadequate blood supply, whether arterial occlusion, venous thrombosis, or non-occlusive hypoperfusion. Pain out of proportion to examination is characteristic; urgent laparotomy and resection are usually required.

Extracorporeal circulation that diverts venous blood to an oxygenator and returns it to the arterial system, allowing the heart to be stopped and opened. Requires systemic heparinisation and careful management of coagulation and perfusion.

Delivery of a cold or warm potassium-rich solution into the coronary circulation to arrest the heart and protect the myocardium during cardiac surgery. Given antegrade via the aortic root or retrograde via the coronary sinus.

Clamping of the ascending aorta during cardiac surgery to isolate the coronary circulation and permit cardioplegia delivery and a bloodless operative field. Clamp time correlates with myocardial ischaemic injury.

Progressive accumulation of air in the pleural space with one-way valve effect, causing rising intrathoracic pressure, mediastinal shift, and obstructive shock. Requires immediate needle or finger thoracostomy followed by chest drain, without waiting for imaging.

Fracture of three or more consecutive ribs in two or more places, creating a free segment that moves paradoxically with respiration. Associated with underlying pulmonary contusion and respiratory failure.

A tube inserted into the pleural space to evacuate air, blood, or fluid and restore negative pressure, typically connected to an underwater seal. Position and swinging/bubbling are checked; removal follows cessation of leak and low output.

A 3-to-15 scoring system assessing eye opening, verbal response, and motor response. A score of 8 or less generally indicates need for airway protection; serial scores guide neurosurgical escalation.

Pressure within the rigid skull, normally below about 15 mmHg in adults. Sustained elevation reduces cerebral perfusion pressure and risks herniation; managed with head elevation, osmotherapy, sedation, and sometimes decompressive craniectomy.

Mean arterial pressure minus intracranial pressure; the driving pressure for cerebral blood flow. Targets are typically 60-70 mmHg, achieved by supporting blood pressure and controlling intracranial pressure.

Bleeding between skull and dura, usually from middle meningeal artery injury, classically with a lucid interval after head trauma. Biconvex on CT; urgent craniotomy is needed for expanding collections.

Bleeding into the subarachnoid space, most often from a ruptured berry aneurysm, presenting with sudden severe headache. Diagnosed by CT then lumbar puncture if CT is negative; treated with nimodipine and aneurysm securing.

Abnormal accumulation of cerebrospinal fluid within the ventricular system, raising intracranial pressure and enlarging ventricles. May be obstructive or communicating; treated with shunt or endoscopic third ventriculostomy.

Hypertrophy of the pyloric muscle in infants, typically presenting at 3-6 weeks with projectile non-bilious vomiting and a palpable olive. Hypochloraemic hypokalaemic metabolic alkalosis is corrected before pyloromyotomy.

Telescoping of proximal bowel into distal bowel, commonest at 6-18 months, causing colicky pain, vomiting, and redcurrant-jelly stool. Diagnosed and often reduced by air or contrast enema; surgery if peritonitis or failed reduction.

Green-stained vomiting in a neonate, a red flag for intestinal obstruction such as malrotation with midgut volvulus. Requires urgent surgical assessment and upper gastrointestinal contrast study rather than routine feeding advice.

Failure of normal embryonic intestinal rotation and fixation, leaving the midgut on a narrow mesenteric pedicle predisposed to volvulus. May present with bilious vomiting in infancy; treated by urgent Ladd procedure.

Failure of one or both testes to reach the scrotum, present from birth. Managed with orchidopexy, usually within the first year or two, to reduce risk of torsion, trauma, malignancy, and impaired fertility.

Rotation of the testis on its spermatic cord causing ischaemia, presenting with acute scrotal pain and a high-riding testis. A surgical emergency; detorsion and bilateral fixation are performed, with salvage falling with delay.

Inflammation of the epididymis, usually infective, causing gradual scrotal pain with tenderness and possible urinary symptoms. Distinguished from torsion by clinical features and Doppler flow; treated with antibiotics and analgesia.

Non-malignant enlargement of the prostatic transition zone causing lower urinary tract symptoms, retention, or recurrent infection. Managed with lifestyle measures, alpha blockers, 5-alpha reductase inhibitors, or surgery such as transurethral resection.

Sudden inability to void with a painful distended bladder, often from prostatic enlargement, constipation, or drugs. Relieved by urethral or suprapubic catheterisation, with monitoring for post-obstructive diuresis.

A glycoprotein produced by prostatic tissue, measured in serum as a screening and monitoring marker for prostate cancer. Raised in benign enlargement, prostatitis, and after instrumentation, so interpretation needs clinical context.

A stone within the ureter causing severe colicky flank-to-groin pain, haematuria, and possible obstruction. Small stones often pass spontaneously; larger or infected obstructed systems need urgent decompression by stent or nephrostomy.

Transfer of epidermis and part or all of dermis from a donor site to a recipient bed, requiring adequate vascularity for take. Split-thickness grafts are more reliable but contract; full-thickness grafts give better colour and texture match.

Transfer of tissue with its own blood supply to cover defects, used when a graft bed is poor or deeper structures need protection. Classified by blood supply as random, axial, or free microvascular flaps.

Classification of thermal injury as superficial, partial thickness, or full thickness, based on appearance, sensation, and capillary refill. Determines whether healing is spontaneous or requires excision and grafting.

A resuscitation guide giving 4 mL of crystalloid per kilogram body weight per percent total body surface area burned in the first 24 hours, half in the first 8 hours from injury. Used for adults with major burns.

Dilatation of the abdominal aorta to at least 3 cm, usually infrarenal and related to atherosclerosis. Risk of rupture rises with diameter; surveillance is used for small aneurysms and repair for large or symptomatic ones.

Exclusion of an aortic aneurysm by a stent-graft deployed inside the lumen via femoral access, avoiding a major abdominal incision. Requires suitable anatomy and lifelong imaging surveillance for endoleak and migration.

Tearing of the aortic intima allowing blood to track within the media and create a false lumen, presenting with abrupt severe chest or back pain. Type A involves the ascending aorta and needs emergency surgery.

Chronic limb-threatening ischaemia with rest pain, ulceration, or gangrene from inadequate arterial perfusion. Requires urgent revascularisation by bypass or angioplasty, plus risk-factor control, to avoid amputation.

Raised pressure within a closed fascial compartment compromising perfusion, causing pain out of proportion and pain on passive stretch. Limb-threatening; requires urgent fasciotomy rather than elevation alone.