General Surgery Final Exam Review

Vocabulary and key clinical concepts focused on surgery exam preparation covering endocrinology, trauma, gastrointestinal, and breast surgery terms.

Gold standard for gastric cancer diagnosis

Upper gastrointestinal endoscopy.

Blood at the urethral meatus (post-trauma)

An indication for obtaining a retrograde urethrogram before catheterization, especially with pelvic rami fractures.

Factors that decrease lower esophageal pressure

Chocolate, peppermint, fat, and citrus foods.

Hypokalemia definition

A serum potassium level less than $3.5\,mmol/L$ (some notes define as less than $3.0\,mmol/L$) leading to muscle weakness, myalgia, absent tendon reflexes, and Paralytic Ileus.

Orphan Annie-eye nuclei

A characteristic feature observed in Papillary thyroid cancer.

Treatment for asymptomatic gallstones

Observation is typically the recommended treatment.

Gamma Glutamyl transferase (GGT)

Main value is in verifying that Alkaline Phosphatase (ALP) elevations are due to biliary disease.

Intussusception clinical triad

Red currant jelly stool, bilious vomiting, and a mass in the right iliac fossa.

Comedo growth pattern

A growth pattern seen in Ductal Carcinoma In Situ (DCIS).

Cystosarcoma Phyllodes treatment

Wide excision with a safety margin due to a high tendency for local recurrence.

Barrett’s esophagus

An acquired columnar/intestinal metaplasia of the lower third of the esophageal mucosa caused by acidic and alkaline reflux.

Linorenal ligament

The ligament containing the tail of the pancreas, which must be protected during a splenectomy.

Kussmaul’s breathing

Slow, rapid, deep breathing associated with metabolic acidosis.

Compartment syndrome (most delayed sign)

Pulselessness.

Pemberton’s sign

Facial flushing or congestion caused by pressure on the retrosternal innominate vein and superior vena cava during thyroid enlargement.

Goodsall’s rule

States that any fistula tract anterior to an imaginary line bisecting the anus opens in the midline posteriorly.

Maintenance fluid (Nitrogen requirement)

In non-catabolic surgical patients, requirements are $0.2\,g\,nitrogen/kg/day$. One gram of nitrogen is present in $6.25\,g$ of proteins.

Meckel’s diverticulum

The most common congenital anomaly of the small bowel; commonly contains gastric mucosa as heterotopic tissue.

Hemorrhagic Shock Class II

Characterized by a blood volume loss of $15-30\%$.

Hemorrhagic Shock Class III

Characterized by blood volume loss of $30-40\%$, heart rate higher than $120\,bpm$, and decreased blood pressure.

Gastrinoma triangle boundaries

Junction of the cystic duct and common bile duct, junction of the 2nd and 3rd parts of the duodenum, and the junction of the head and body of the pancreas.

Emphysematous gallbladder

A condition in which intramural gas is seen in the gallbladder, often occurring in diabetic patients with acute cholecystitis.

Triple assessment for breast cancer

History and physical examination, imaging (mammography and/or ultrasound), and biopsy.

BISAP severity index

Severity index for pancreatitis including Blood urea nitrogen ($BUN > 25\,mg/dL$), Impaired mental status, SIRS, Age ($> 60$ years), and Pleural effusion (transcript notes age $> 40$).

Deep inguinal ring position

Located above the midpoint of the inguinal ligament.

Saint’s triad

The coexistence of gallstones, diverticulosis of the sigmoid colon, and hiatus hernia.

Third space loss

Fluid sequestration seen in conditions such as pancreatitis, peritonitis, or burns.

Howell-Jolly bodies

Inclusions in red blood cells seen on blood film following a splenectomy.

Richter's hernia

A hernia where only part of the bowel wall is trapped, leading to strangulation without full intestinal obstruction.

Boerhaave’s syndrome

Spontaneous esophageal perforation typically occurring at the left lower end, confirmed by Gastrografin swallow.

Ventral hernia types

Includes umbilical, para-umbilical, and epigastric hernias.

Pheochromocytoma (MEN-2A)

A component of Sipple syndrome along with Medullary thyroid cancer and Hyperparathyroidism.

Commonest site of breast cancer metastasis

Lumbar vertebra (axial skeleton).

Branchial cyst typical location

Found at the junction of the upper $1/3$ and middle $1/3$ of the anterior border of the sternomastoid muscle.

HIDA scan

The most accurate test for diagnosing cystic duct obstruction in acute cholecystitis.

GCS score calculation (Scenario: Eyes to speech, localize pain, inappropriate words)

A Glasgow Coma Scale score of $10$. ($E=3, M=5, V=2$).