Iran General Surgery Board Exam key terms

A staged operative strategy in severely injured or physiologically deranged patients in which only hemorrhage control and contamination containment are performed at the first operation, temporary abdominal closure is applied, and definitive repair is deferred until physiology is corrected.

The self-reinforcing combination of hypothermia, metabolic acidosis, and coagulopathy that develops after major trauma and hemorrhage, worsening bleeding and predicting death unless hemorrhage control and active rewarming are achieved promptly.

A resuscitation approach that deliberately accepts a systolic blood pressure below normal (roughly 80-90 mmHg) until surgical hemorrhage control, aiming to limit clot disruption and dilutional coagulopathy in bleeding trauma patients, and is avoided in traumatic brain injury.

A preplanned institutional system for delivering large volumes of blood products rapidly in hemorrhagic shock, using balanced ratios of red cells, plasma, and platelets, minimizing crystalloid, and including calcium replacement and temperature control.

A rapid bedside ultrasound examination of the pericardium and dependent abdominal and pleural spaces for free fluid in hemodynamically unstable injured patients, used to decide whether immediate operative exploration or further imaging is required.

Organ dysfunction caused by sustained intra-abdominal pressure above 20 mmHg with new impairment of respiratory, renal, or cardiovascular function, treated by decompressive laparotomy or other measures to reduce intra-abdominal volume.

A sustained or repeatedly elevated intra-abdominal pressure of 12 mmHg or more, graded in four stages, which impairs venous return, ventilation, and renal perfusion and may progress to abdominal compartment syndrome.

A technique using a negative-pressure dressing or mesh-mediated traction to cover an open abdomen after damage control or decompression, protecting viscera, limiting fluid loss, and allowing planned re-exploration or delayed fascial closure.

A multidisciplinary perioperative care pathway combining preoperative counseling, avoidance of prolonged fasting and mechanical bowel preparation, opioid-sparing multimodal analgesia, early feeding, and early mobilization to shorten length of stay and reduce complications.

A set of evidence-based perioperative measures, including appropriate and timely prophylactic antibiotics, skin antisepsis, normothermia, glycemic control, and avoidance of unnecessary shaving, that together reduce the incidence of wound infection.

Administration of an appropriate antibiotic, usually a single dose given within 60 minutes before incision and redosed for long operations or major blood loss, to prevent infection at the operative site rather than to treat established infection.

A three-variable intraoperative score (estimated blood loss, lowest mean arterial pressure, and lowest heart rate) that predicts major postoperative complications and need for critical care after general surgery.

Preoperative optimization of a patient's functional reserve through exercise, nutritional support, smoking cessation, and correction of anemia or comorbidity, intended to improve tolerance of surgery and reduce postoperative complications.

The combined use of agents and techniques with different mechanisms, such as regional blocks, acetaminophen, nonsteroidal drugs, and opioids, to achieve better pain control with fewer opioid-related adverse effects.

Acute hypoxemic respiratory failure with bilateral pulmonary infiltrates developing within six hours of transfusion, attributed to donor antibodies or bioactive mediators, and managed with supportive ventilation and avoidance of fluid overload.

Acute onset of severe hypoxemia with bilateral radiographic opacities not fully explained by cardiac failure, arising from alveolar-capillary injury; managed with lung-protective ventilation, prone positioning, and treatment of the underlying cause.

Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection, identified clinically by an acute rise of two or more SOFA points; septic shock adds vasopressor need and elevated lactate despite fluid resuscitation.

The physical elimination of the focus of infection, such as drainage of an abscess, debridement of necrotic tissue, or repair of a perforated viscus, without which antibiotics alone cannot resolve a surgical infection.

Necrotizing fasciitis of the perineum and genitalia, usually polymicrobial and commoner in diabetes, presenting with pain out of proportion, crepitus, and rapid necrosis; treatment is urgent radical debridement plus broad-spectrum antibiotics.

A rapidly spreading infection of fascia and subcutaneous tissue with necrosis and systemic toxicity, characterized by severe pain, skin changes, gas, and hemodynamic instability, requiring immediate surgical debridement and broad-spectrum antimicrobial therapy.

A low-bicarbonate acidosis with elevated unmeasured anions, calculated as sodium minus chloride minus bicarbonate; in surgical patients it suggests lactic acidosis, ketoacidosis, renal failure, or toxin ingestion and guides resuscitation monitoring.

Production of acidic urine despite systemic metabolic alkalosis, classically in gastric outlet obstruction with vomiting, where aldosterone-driven renal sodium conservation and potassium and hydrogen excretion worsen hypokalemia and alkalosis.

An abnormal communication between the bowel and the skin, most often after surgery, managed with sepsis control, skin protection, nutritional support, and somatostatin analogues, with spontaneous closure possible in a minority.

Malabsorption and fluid, electrolyte, and micronutrient losses resulting from extensive intestinal resection, requiring parenteral nutrition and gradual enteral adaptation, with intestinal lengthening or transplantation in selected cases.

Spontaneous full-thickness rupture of the esophagus, typically after forceful vomiting, causing severe chest pain, subcutaneous emphysema, and mediastinitis; early diagnosis and operative or endoscopic repair are essential for survival.

A motility disorder with failure of lower esophageal sphincter relaxation and absent peristalsis, causing dysphagia to solids and liquids, treated by pneumatic dilation, laparoscopic Heller myotomy, or peroral endoscopic myotomy.

Infection of the mediastinal connective tissue, arising from esophageal perforation, dental or neck infection, or after cardiac surgery, and treated with drainage, debridement, and prolonged antibiotics.

Obstructive jaundice caused by extrinsic compression of the common hepatic duct by a stone impacted in the cystic duct or gallbladder neck, often with cholecystocholedochal fistula, and carrying high risk of bile duct injury at surgery.

Infection of the biliary tree, usually from obstruction, presenting with fever, jaundice, and right upper quadrant pain; treatment combines antibiotics, resuscitation, and urgent biliary drainage by endoscopic or percutaneous route.

A noninvasive magnetic resonance technique that images the biliary and pancreatic ducts without contrast injection, used to detect stones, strictures, and anatomical variants and to plan operative or endoscopic intervention.

Deterioration of liver synthetic and excretory function after resection, defined by elevated bilirubin and coagulopathy on or after postoperative day five, and predicted by future liver remnant volume and function.

Preoperative occlusion of the portal venous supply to the segment to be resected, inducing hypertrophy of the future liver remnant so that major hepatectomy can be performed with lower risk of postoperative liver failure.

Pleural effusion in a patient with cirrhosis, usually right-sided and caused by passage of ascitic fluid through diaphragmatic defects, managed with sodium restriction, diuretics, and thoracentesis or a transjugular shunt.

Autonomous aldosterone secretion, usually from an adrenal adenoma or bilateral hyperplasia, causing hypertension with hypokalemia and suppressed renin; lateralization testing determines whether adrenalectomy is appropriate.

A catecholamine-secreting tumor of adrenal medullary chromaffin cells causing paroxysmal hypertension, palpitations, and sweating; preoperative alpha blockade is mandatory to prevent intraoperative hypertensive crisis.

The clinical state of chronic glucocorticoid excess, from exogenous steroids or an adrenal or pituitary tumor, producing central obesity, striae, hyperglycemia, and poor wound healing; adrenalectomy requires perioperative steroid coverage.

Identification and removal of the first draining lymph node or nodes using blue dye or radiotracer to stage the regional basin with less morbidity than full dissection, standard in clinically node-negative breast cancer.

Removal of axillary levels I and II nodes for proven nodal metastasis or failed sentinel mapping, providing regional control and staging at the cost of lymphedema, shoulder dysfunction, and nerve injury.

Combining breast-conserving resection with plastic surgical reshaping techniques to allow wider excisions with acceptable cosmesis, often with contralateral symmetry procedures and radiotherapy planning.

Accumulation of protein-rich interstitial fluid from impaired lymphatic drainage, causing limb swelling and fibrosis, managed with compression, exercise, skin care, and surgery in selected refractory cases.

Compression of the brachial plexus, subclavian vein, or subclavian artery in the scalene triangle or costoclavicular space, causing pain, weakness, or venous thrombosis; treatment ranges from physiotherapy to scalenectomy or rib resection.

Chronic limb-threatening ischemia with rest pain, ulceration, or gangrene from severe arterial occlusive disease, requiring urgent revascularization by bypass or endovascular means to avoid amputation.

A permanent dilation of the infrarenal aorta to at least 3 cm, usually asymptomatic and degenerative, monitored by ultrasound and repaired by open or endovascular technique when diameter or growth rate exceeds thresholds.

Exclusion of an aortic aneurysm by a stent graft delivered through the femoral arteries, avoiding laparotomy but requiring surveillance for endoleak, graft migration, and limb occlusion.

Projectile nonbilious vomiting in a 3-6 week old infant with a palpable olive and hypochloremic hypokalemic metabolic alkalosis, confirmed by ultrasound and treated by pyloromyotomy after correcting dehydration and electrolytes.

Progressive fibro-obliteration of the extrahepatic bile ducts in infancy causing cholestatic jaundice and cirrhosis, treated by Kasai portoenterostomy early in life and often requiring liver transplantation.

Telescoping of a proximal bowel segment into the distal segment, typically ileocolic in infants, causing colicky pain, vomiting, and red-currant stool; reduction is by air or contrast enema unless peritonitis or perforation is present.

Surgical wrapping of the gastric fundus around the distal esophagus to restore lower esophageal sphincter competence, most often performed laparoscopically for refractory gastroesophageal reflux disease with or without hiatal hernia.

A congenital diaphragmatic hernia through the anterior parasternal foramen, often right-sided and frequently asymptomatic, repaired surgically when symptomatic or when bowel or liver is contained.

A percutaneously created channel between hepatic and portal veins via the jugular route, decompressing portal hypertension to control variceal bleeding or refractory ascites, at the cost of encephalopathy and shunt dysfunction.

A spring-loaded needle used to insufflate the abdomen at a chosen entry point during laparoscopy, intended to reduce injury to intra-abdominal organs before trocar placement.

Artificial insufflation of carbon dioxide into the peritoneal cavity to create working space for laparoscopy, which raises intra-abdominal pressure and can alter ventilation, venous return, and renal perfusion.

A transparent-entry laparoscopic port that allows direct visualization of abdominal wall layers during insertion, reducing the risk of injury to bowel and vessels compared with blind trocar placement.

The process of disclosing diagnosis, proposed intervention, material risks, alternatives, and consequences of refusal to a competent patient, who then authorizes treatment voluntarily and without coercion.

Withholding information from a patient when disclosure is judged likely to cause serious harm; it is narrowly applied, must be documented, and does not remove the need for consent from the patient or a lawful surrogate.

The professional duty to inform a patient of preventable harm and its consequences, explain what happened, apologize, and describe corrective steps, as required by safety and regulatory standards in many jurisdictions.

The clinical confirmation of irreversible cessation of all brain function, requiring documented cause, absence of brainstem reflexes and respiratory drive, and exclusion of confounding factors such as drugs, hypothermia, and metabolic derangement.

The standards that determine suitability of a brain-dead or circulatory-death donor, including age, infection, malignancy, organ function, and ischemia time, which guide allocation and expected graft survival.

An immune reaction in which donor lymphocytes attack recipient tissues, classically after hematopoietic transplantation but also reported after transfusion or transplantation of lymphocyte-rich organs, causing rash, diarrhea, and liver injury.

The pathological assessment of whether tumor extends to the cut edge of a resection specimen, reported as negative or positive, which guides decisions about re-excision, radiotherapy, and prognosis.