Surgery-II Medbank Lecture Note Flashcards

Comprehensive set of 1000 vocabulary cards covering Cardiothoracic, Abdominal, Genitourinary, and Oncological surgery based on Medbank 3rd Edition transcript.

Empyema with loculated collection management

Thoracotomy and decortication is required to remove the fibrous peel and enable lung re-expansion.

Gold standard for non-traumatic spontaneous pneumothorax

Tube thoracostomy.

Most common mediastinal tumor

Thymoma, accounting for approximately $25\%$ of cases, typically in the anterior mediastinum.

Major complication of pneumonectomy

Bronchopleural fistula, associated with high morbidity and mortality.

Principal investigation for detecting lung cancer

Chest X-ray (CXR) with PA and lateral views.

Initial management of traumatic shock with bruising

Fluid resuscitation and Ultrasound ($\text{FAST}$) to detect free fluid.

Characteristic of Small Cell Lung Cancer (SCLC)

Greater response rate to chemotherapy compared to NSCLC.

Adjuvant therapy for Stage I NSCLC

Not indicated after complete resection as curative surgery offers the best long-term survival.

Diagnostic and therapeutic intervention for massive hemoptysis

Bronchoscopy, allowing direct visualization and potential intervention.

Most common type of lung carcinoma

Adenocarcinoma.

Thoracic outlet syndrome surgical options

First rib resection, scalenectomy, cervical rib excision, or release of fibromuscular bands.

Most common primary pleural tumor

Malignant mesothelioma.

Tumor Marker for Hepatocellular Carcinoma

$\text{AFP}$ (alpha-fetoprotein).

Best imaging modality for detailed bone anatomy

$CT$ Scan.

Standard investigation for lung cancer metastases

$CT$ scan of the chest and abdomen (targets liver and adrenals).

Treatment of choice for early-stage lung cancer

Lobectomy.

Initial investigation for suspected subcutaneous emphysema

$X$-ray.

Lichtenstein hernioplasty

Preferred procedure for young patients with reducible inguino-scrotal hernia due to low recurrence.

Management of infantile inguinal hernia

Herniotomy (removal of patent processus vaginalis).

Strangulated paraumbilical hernia symptoms

Irreducibility, tenderness, and persistent vomiting.

Patent vitello-intestinal duct

Cause of intermittent watery or purulent discharge from the umbilicus.

Direct inguinal hernia anatomy

The hernia sac is medial to the inferior epigastric vessels.

Richter's hernia

Hernia in which only a portion of the bowel wall circumference is trapped.

Littre's hernia

Hernia containing a Meckel's diverticulum.

Post-hernia surgery fluid collection

Seroma (sterile fluid developing days after surgery).

Epiplocele

A hernia where the sac contains omentum.

Maydl's hernia

A retrograde strangulation of a bowel loop inside the abdomen while two loops are in the sac.

Mayo technique

Double-breasted flap repair of the rectus sheath for paraumbilical hernias $< 2\,cm$.

Sliding hernia

Hernia where a portion of a retroperitoneal organ (e.g., bladder or colon) forms part of the sac.

Sportsman's hernia investigation

$MRI$ is the best tool to distinguish occult hernia from orthopedic injury.

Heller's Myotomy

Surgical treatment for Achalasia cardia.

Nissen Fundoplication

$360^{\circ}$ gastric wrap for the treatment of GORD.

Nutcracker Esophagus

High amplitude coordinated contractions exceeding $180\,mmHg$.

Barrett's Esophagus

Intestinal metaplasia of the esophageal mucosa (replacement of squamous with columnar epithelium).

Boerhaave Syndrome

Spontaneous transmural perforation of the esophagus following forceful vomiting.

Graham Omental Patch

Standard surgical repair for a perforated duodenal ulcer.

H. pylori Triple Therapy

Amoxicillin + Clarithromycin + Proton Pump Inhibitor ($PPI$).

Gastric Outlet Obstruction ($GOO$)

Characterized by projectile vomiting, succussion splash, and hypochloremic hypokalemic metabolic alkalosis.

Zollinger-Ellison Syndrome

Gastrin-secreting tumor causing severe peptic ulceration; confirmed by hypergastrinemia and gastric acidity.

Billroth II Gastrectomy

Partial gastrectomy with gastrojejunostomy; involves a blind-ended duodenal stump.

Gastrointestinal Stromal Tumor ($GIST$)

Mesenchymal tumor treated with Imatinib (tyrosine kinase inhibitor).

Courvoisier’s Law

A palpable gallbladder in a jaundiced patient is unlikely to be due to stones (more likely malignancy).

Child-Pugh Classification

Assesses liver cirrhosis severity using Bilirubin, Albumin, $INR$, Ascites, and Encephalopathy.

Amoebic Liver Abscess symptoms

Right upper quadrant pain, tender hepatomegaly, and "anchovy sauce" pus.

Hydatid Cyst "Water Lily" Sign

Indicates detached endocyst membranes floating within the cyst fluid.

$$TIPSS$$

Transjugular Intrahepatic Portosystemic Stent Shunt (used for refractory variceal bleeding).

Budd-Chiari Syndrome

Obstruction of hepatic venous outflow presenting with hepatomegaly, ascites, and abdominal pain.

Overwhelming Post-Splenectomy Infection ($OPSI$)

Severe sepsis caused by encapsulated bacteria like Streptococcus pneumoniae.

Kehr's Sign

Referred pain to the left shoulder due to splenic rupture/diaphragmatic irritation.

Charcot’s Triad

RUQ pain, fever, and jaundice (indicates acute cholangitis).

Reynold’s Pentad

Charcot’s triad plus hypotension and altered mental status.

Grey Turner's Sign

Bruising of the flanks indicating retroperitoneal hemorrhage in necrotizing pancreatitis.

Cullen's Sign

Periumbilical bruising associated with severe acute pancreatitis.

Ranson Criteria at Admission

Age $> 55$, $WBC > 16,000$, Glucose $> 11\,mmol/L$, $AST > 250$, $LDH > 350$.

Hirschsprung’s Disease

Congenital aganglionosis of the distal colon causing neonatal intestinal obstruction.

Meckel’s Diverticulum Rule of 2s

$2\%$ of population, $2$ inches long, $2\,feet$ from ileocecal valve, $2$ types of ectopic tissue.

Intussusception Target Sign

Characteristic concentric ring appearance seen on Ultrasound or $CT$ scan.

Volvulus

Torsion of the bowel around its mesentery, often presenting with a "coffee bean" sign on X-ray.

Alvarado Score components

$\text{MANTREL}$: Migration, Anorexia, Nausea, Tenderness, Rebound, Elevation of temp, Leukocytosis, Shift to left.

Hartmann’s Procedure

Proctosigmoidectomy with end colostomy and closure of the rectal stump.

Fistula-in-ano Goodsall’s Law

Determines the path of the fistula tract based on the position of the external opening relative to the transverse anal line.

Fournier’s Gangrene

Necrotizing fasciitis of the perineum and scrotum; a surgical emergency.

Pillonidal Sinus

Acquired chronic inflammation in the natal cleft, often containing hair.

Wilms’ Tumor (Nephroblastoma)

Commonest childhood renal malignancy; presents as a large abdominal mass.

Extracorporeal Shock Wave Lithotripsy ($ESWL$)

Non-invasive treatment for renal stones $< 2\,cm$.

Staghorn Calculus

Large stone branching into calyces, usually composed of struvite (Triple Phosphate).

Peyronie's Disease

Fibrous plaque in the tunica albuginea causing penile curvature and painful erections.

Priapism

Persistent, painful erection lasting $> 4\,hours$ unrelated to sexual stimulation.

Orchidopexy

Surgical fixation of an undescended testis into the scrotum.

Gubernaculum

Mesenchymal structure that guides testicular descent from the abdomen to the scrotum.

Seminoma

Most common and highly radiosensitive germ cell tumor of the testis.

Teratoma

Testicular tumor composed of multiple germ layers; targets para-aortic lymph nodes.

Varicocele

Dilatation of the pampiniform venous plexus, often described as a "bag of worms."

Hydrocele

Fluid collection between the layers of the tunica vaginalis; transilluminates on examination.

Allograft

Organ or tissue transplant between genetically different members of the same species.

HLA Incompatibility

Most common cause of transplant graft rejection.

Cold Ischemic Time for Kidney

Maximum safe storage duration is approximately $36\,hours$.

Intensity Modulated Radiation Therapy ($IMRT$)

Advanced radiation technique minimizing dose to surrounding sensitive organs.

Adjuvant Chemotherapy

Treatment given after the primary surgical procedure to kill remaining cancer cells.

Neoadjuvant Therapy

Treatment (chemo/radiation) given before surgery to shrink a tumor.

TNM Staging System

Classification based on Tumor size, Node involvement, and Metastasis presence.

Whipple’s Procedure

Pancreaticoduodenectomy; used for tumors in the head of the pancreas.

Honeymoon period of transplantation

The early post-operative period of good graft function before potential rejection.

Sentinel Pile

Skin tag found at the distal end of a chronic anal fissure.

Dumping Syndrome

Complication after gastric surgery; rapid gastric emptying causing osmotic shifts and hypoglycemia.

Pseudo-obstruction (Ogilvie Syndrome)

Massive colonic dilation without mechanical obstruction in ill/bedridden patients.

Phimosis

Inability to retract the prepuce over the glans penis.

Mesenteric Lymphadenitis

Common differential diagnosis for appendicitis in children, often following viral infection.

Pseudo-pancreatic Cyst

Fluid collection in the lesser sac following pancreatitis, lacking an epithelial lining.

Moynihan’s Hump

Tortuous right hepatic artery often confused for the cystic artery during cholecystectomy.

Calot's Triangle

Boundaries: Cystic duct, Common hepatic duct, and Inferior border of the liver.

Murphy’s Sign

Inspiratory arrest on deep RUQ palpation; indicates acute cholecystitis.

Riedel’s Thyroiditis associated condition

Retroperitoneal fibrosis.

Trans-urethral Resection of the Prostate ($TURP$)

Gold standard surgical procedure for benign prostatic hyperplasia.

Gleason Score

Grading system for prostate cancer based on architectural patterns under histology.

Bursa of Omental Sac (Lesser Sac)

Space posterior to the stomach and anterior to the pancreas where pseudocysts form.

Cystic Artery origin

Typically a branch of the Right Hepatic Artery.

Lithiasis

The formation of stony concretions (calculi) in the body.

DMSA Scan

Used for static renal imaging to assess functional parenchyma and scars.

MAG3 Scan

Used for dynamic renal imaging to assess vascularity and drainage.