Iraqi Board General Surgery flashcards

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

Anion gap formula

Anion gap equals sodium minus the sum of chloride and bicarbonate; normal is 8 to 12 mmol/L. A raised gap indicates unmeasured anions such as lactate, ketones, or uremic toxins.

Collagen type III

Type III collagen is laid down early in wound healing as thin, disorganized fibers in granulation tissue. It is later replaced by stronger type I collagen during remodeling.

C fibers

Unmyelinated slow-conducting nociceptive fibers carrying dull, burning pain. They are the most sensitive to local anesthetic blockade and the last to recover after regional anesthesia.

Surgical site infection timing

Surgical site infection is defined as infection within 30 days of surgery, or within 90 days when an implant is placed, involving the incision or deep tissues.

4-2-1 maintenance fluid rule

Hourly maintenance crystalloid 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 thereafter.

Permissive hypotension

In hemorrhagic shock before hemorrhage control, a lower systolic target (around 80–90 mmHg) is used to avoid dislodging clots, except in traumatic brain injury where perfusion must be maintained.

Charcot triad

Fever, jaundice, and right upper quadrant pain indicate ascending cholangitis from common bile duct obstruction. Reynolds pentad adds septic shock and altered mental status, marking severe disease needing urgent biliary drainage.

Pringle maneuver

Compression of the hepatoduodenal ligament occludes hepatic arterial and portal venous inflow to control liver bleeding. Clamp time is limited to avoid ischemic injury, typically under 30 minutes.

Forrest classification

Endoscopic grading of peptic ulcer bleeding: Ia spurting, Ib oozing, IIa visible vessel, IIb adherent clot, IIc flat spot, III clean base. Grades Ia to IIb need endoscopic hemostasis.

Child-Pugh score

Grades cirrhosis severity using bilirubin, albumin, prothrombin time or INR, ascites, and encephalopathy. Class A has good operative risk; class C carries high perioperative mortality.

Recurrent laryngeal nerve injury

Unilateral injury causes hoarseness and weak voice from vocal cord paralysis. Bilateral injury causes stridor and airway obstruction, often requiring immediate reintubation or tracheostomy.

Pheochromocytoma blockade order

Alpha blockade with phenoxybenzamine is started first to control hypertension, followed by beta blockade for tachycardia. Giving a beta blocker first risks unopposed vasoconstriction and hypertensive crisis.

Sentinel lymph node biopsy

Injection of blue dye and radiolabeled colloid identifies the first draining node. Its histology predicts regional spread in breast cancer and melanoma, sparing unnecessary axillary dissection.

Ankle-brachial index

Ratio of ankle systolic pressure to brachial systolic pressure. Normal is 0.9 to 1.3; below 0.9 indicates peripheral arterial disease; above 1.3 suggests calcified, non-compressible vessels.

Virchow triad

Three factors promoting venous thrombosis: venous stasis, endothelial injury, and hypercoagulability. Each is assessed when deciding on prophylaxis and duration of anticoagulation.

Brescia-Cimino fistula

A radiocephalic arteriovenous fistula created at the wrist for hemodialysis access. It is the preferred first access because of low infection risk and good long-term patency.

Tension pneumothorax signs

Tracheal deviation away from the affected side, distended neck veins, absent breath sounds, and hypotension. It is a clinical diagnosis treated immediately by needle decompression, never by waiting for imaging.

FAST examination

Focused assessment with sonography for trauma examines pericardial, perihepatic, perisplenic, and pelvic windows for free fluid. A positive scan in an unstable patient prompts immediate laparotomy.

Parkland formula

For burns, give 4 mL/kg body weight per percent total body surface area of lactated Ringer solution in 24 hours, with half given in the first 8 hours from the time of injury.

R0 resection

Microscopically negative resection margins with no residual tumor cells. It is the goal of curative cancer surgery, in contrast to R1 microscopic and R2 macroscopic residual disease.

Tumor lysis syndrome

Rapid tumor cell death releases intracellular contents, causing hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia. Prevention uses hydration and allopurinol or rasburicase in high-risk patients.

Hypertrophic pyloric stenosis

Infants aged 3 to 6 weeks present with nonbilious projectile vomiting and hypochloremic hypokalemic metabolic alkalosis. Correct electrolytes first, then perform pyloromyotomy.

Intussusception

Telescoping of proximal bowel into distal bowel in children aged 6 to 18 months, causing colicky pain and red currant jelly stool. Ultrasound shows a target sign; air enema reduces it.

Biliary atresia

Neonatal obstruction of extrahepatic bile ducts causing persistent jaundice with direct hyperbilirubinemia and acholic stools. Kasai portoenterostomy before 60 days improves native liver survival.

Kanavel signs

Four signs of flexor tenosynovitis: fusiform finger swelling, tenderness along the flexor sheath, finger held in flexion, and pain on passive extension. Treatment is surgical drainage and antibiotics.

Skin graft survival phases

Split-thickness grafts survive first by imbibition of plasma, then inosculation of vessels, then revascularization. Grafts fail from hematoma, infection, shear, or inadequate recipient bed.

Glasgow Coma Scale

Scores eye opening (1–4), verbal response (1–5), and motor response (1–6), totaling 3 to 15. A score of 8 or less indicates need for airway protection and intubation.

Cushing reflex

Hypertension with bradycardia and irregular respiration signals raised intracranial pressure and impending herniation. It requires urgent decompression and measures to lower intracranial pressure.

Epidural hematoma

Blood between skull and dura, usually from middle meningeal artery injury, appearing lens-shaped on CT. A lucid interval may precede deterioration; treatment is urgent craniotomy and evacuation.

Malignant hyperthermia

Hypermetabolic crisis triggered by volatile anesthetics and succinylcholine in susceptible patients, causing hyperthermia, rigidity, and acidosis. Treatment is dantrolene, cooling, and supportive care.

Gustilo-Anderson classification

Grades open fractures by wound size, soft tissue injury, and contamination. Grade I is clean and under 1 cm; grade III is heavily contaminated or has vascular injury requiring repair.

Informed consent elements

Valid consent requires capacity, adequate disclosure of diagnosis, procedure, risks, benefits, and alternatives, plus voluntary agreement. It must be documented before the procedure, not after.