CSHK Part 2 EMQ flashcards

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

Wound healing phases

Haemostasis, inflammation, proliferation, and remodelling. Collagen III is replaced by type I during remodelling; maximum tensile strength is about 80% of uninjured tissue.

Mass closure suture ratio

Suture length to wound length ratio of at least 4:1 reduces incisional hernia and dehiscence risk in midline laparotomy closure.

Antibiotic prophylaxis timing

Give within 60 minutes before incision; repeat at twice the drug half-life or after major blood loss. Vancomycin and fluoroquinolones need 120 minutes.

Murphy sign

Inspiratory arrest on palpation of the right upper quadrant during deep inspiration, suggesting acute cholecystitis.

Courvoisier law

A palpable, non-tender gallbladder with painless jaundice suggests malignant obstruction, usually pancreatic head or periampullary cancer, rather than gallstones.

Triple assessment of breast

Clinical examination, imaging (mammography and ultrasound), and core biopsy with histology and receptor status for suspected breast cancer.

Revised cardiac risk index

Predicts major cardiac events after non-cardiac surgery using ischaemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, creatinine >177 micromol/L, and high-risk surgery.

qSOFA criteria

Screening for sepsis: respiratory rate 22 or more, altered mentation, and systolic blood pressure 100 mmHg or less. Two or more suggest organ dysfunction.

Postoperative fever causes

Wind (atelectasis, pneumonia), water (urinary infection), wound (infection), walk (DVT), wonder drugs (drug fever), and what (abscess or leak).

ATLS primary survey

Catastrophic haemorrhage control, Airway with cervical spine protection, Breathing, Circulation with haemorrhage control, Disability, and Exposure with prevention of hypothermia.

Haemorrhagic shock classes

Class I under 15% loss; II 15-30% with tachycardia; III 30-40% with hypotension and altered mentation; IV over 40% with profound shock.

FAST scan

Focused assessment with sonography for trauma, examining pericardial, perihepatic, perisplenic, and pelvic windows for free fluid in unstable patients.

PONV risk factors

Female sex, non-smoking status, history of PONV or motion sickness, and postoperative opioids. Multimodal prophylaxis reduces risk.

Oliguria definition

Urine output below 0.5 mL/kg/h. Check catheter patency, fluid status, and bladder scan to exclude obstruction before assuming renal cause.

Delirium screening tools

4AT or CAM. Common after hip fracture; treat pain, hypoxia, infection, constipation, and drugs; avoid restraint.

Tension pneumothorax signs

Tracheal deviation away from affected side, absent breath sounds, distended neck veins, and hypotension. Needle decompression is immediate, followed by chest drain.

Parkland formula

4 mL/kg per percent total body surface area of crystalloid in first 24 hours, half in first 8 hours, for burns resuscitation.

Damage control surgery

Abbreviated laparotomy to control haemorrhage and contamination, temporary closure, ICU correction of hypothermia, acidosis, and coagulopathy, then definitive surgery.

Sepsis six

Within 1 hour: oxygen, blood cultures, IV antibiotics, IV fluids, lactate measurement, and urine output monitoring.

ARDS Berlin criteria

Acute onset, bilateral infiltrates, PaO2/FiO2 300 or less on PEEP 5 or more, and respiratory failure not fully explained by cardiac failure.

Compartment syndrome signs

Pain out of proportion, pain on passive stretch, and tense compartment. Pulses may remain palpable. Fasciotomy is urgent when pressure exceeds 30 mmHg.

Restrictive transfusion threshold

Transfuse when haemoglobin is below 70 g/L, or below 80 g/L in cardiac disease. Give one unit at a time and reassess.

VAP prevention bundle

Head-up 30-45 degrees, daily sedation hold, oral chlorhexidine, subglottic suction, and avoidance of unnecessary circuit changes.

Perioperative glycaemic target

Target 6-10 mmol/L. Hyperglycaemia worsens infection and outcomes; use variable-rate IV insulin in critical illness.

R0 resection

No tumour cells at the resection margin. R1 is microscopic margin involvement; R2 is macroscopic residual tumour. Aim for R0.

High-output stoma

Output above 1.5 L/day, risking dehydration and electrolyte loss. Manage with antimotility agents, fluid replacement, and dietitian input.

Hinchey classification

Grades diverticulitis complications: I pericolic abscess, II pelvic abscess, III purulent peritonitis, IV faecal peritonitis. Grades III and IV need surgery.

Testicular torsion

Surgical emergency with sudden severe testicular pain. Urgent exploration and bilateral fixation are required; salvage falls with delay.

Beck triad

Hypotension, distended neck veins, and muffled heart sounds, suggesting cardiac tamponade. Treat with pericardiocentesis or thoracotomy.

Lethal triad

Hypothermia, acidosis, and coagulopathy in major trauma. Prevent with warming, haemorrhage control, and balanced blood product resuscitation.

Local anaesthetic toxicity

Perioral tingling, seizures, and arrhythmias. Stop injection, secure airway, and give 20% lipid emulsion per protocol.

Malignant hyperthermia

Triggered by volatile anaesthetics and suxamethonium. Features include hyperthermia, rigidity, and rising ETCO2. Treat with dantrolene and cooling.