Indications

Question 1

Minimum threshold for patients underogoing cardiac surgery, orthopedic srugery, and with preexisting CVD

Answer 1

8g/dL

Question 2

Most common indications ofr emergency endotracheal intubation

Answer 2

Altered mental status (GCS<=8)

Question 3

Absolute indications for renal exploration for primary repair, or possible total or partial nephrectomies:

Answer 3

1. Expanding, pulsatile, uncontained retroperitoneal hematomas
2. Renal pedicle avulsion
3. Persistent, life-threatening hemorrhage or shock
4. Ureteropelvic junction disruption

Question 4

CURRENT INDICATIONS AND CONTRAINDICATIONS FOR EMERGENCY DEPARTMENT THORACOTOMY

Answer 4

Salvageable postinjury cardiac arrest
• Patients sustaining witnessed penetrating trauma with <15 min of prehospital CPR
• Patients sustaining witnessed blunt trauma with <10 min of prehospital CPR
• Patients sustaining witnessed penetrating trauma to the neck or extremities with <5 min of prehospital CPR

Persistent severe postinjury hypotension (SBP <=60 mmHg)

Question 5

Indications for damage control surgery

Answer 5

Refractory hypothermia (<35)
Profound acidosis (pH < 7.2 or base deficit > 15mmol/L)
Refractory coagulopathy
*goal: to control surgical bleeding and limit GI spillage
*return to the OR within 24-48 hours once tha patient clinically improves

Question 6

Indications for fasciotomy

Answer 6

Gradient Pressure <30mmHg (diastolic P – compartment P)
Absolute compartment P > 30mmHg
Ischemic periods >6 hours
Combined arterial and venous injuries

Question 7

Indications for MRND in submandibular gland tumor

Answer 7

N+

N0, but the risk of LN metastases exceeds 20% (high-grade mucoepidermoid CA)

Question 8

Indications for RAI in graves

Answer 8

Elderly male with small-to-mderate size goiters
Relapse after medical or surgical
When surgery or mes are contraindicated

Question 9

Indications for Parathyroidectomy in an asymptomatic patient

Answer 9

Serum Ca >1mg/dL above upper limits of normal
Life threatening hypercalcemic crisis
Creatinine clearance reduced by 30%
(+) kidney stones
Markedly elevated 24-h urine Ca (>400mg/d)
Decreased bone mineral density (>2.5 SD)
Age less than 50 years

Question 10

Absolute contraindications to breast conservation surgery

Answer 10

1. Prior radiotherapy
2. Pregnant (1st and 2nd tri)
3. Connective tissue disorders (e.g. scleroderma, lupus)
4. Persistently positive margins
5. Multicentric lesions
6. Diffuse microcalcifications

Question 11

Indications for anti-reflux surgery

Answer 11

Symptomati patients +/- esophagitis
Structurally defective LES
Young patients with documented reflux
Severe esophagitis
Presence of stricture
Uncomplicated barrett esophagus
(Becomes complicated if high-grade)

Question 12

Borchardt triad

Answer 12

Gastric volvolus:
Inability to pass an NGT
Retching without actual food regurgitation
Epigastric pain
Gastric volvolus is an absolute indication for emergent surgical intervention.

Question 13

Contraindications for curative surgery or resection for esophageal carcinoma

Answer 13

Age > 75
FEV1 < 1.25 AND ef < 40
>20% weight loss
Locally advanced tumor (with signs of invasion)
Distant mets

Question 14

Indications for Surgery for bleeding PUD

Answer 14

Persistent bleeding /rebleeding after endoscopic therapy
Significant hemorrhage (>4 units/24 hours)
Elderly patients with co-morbidities
Ulcers located at posterior duodenal bulb
and ulcers located at the gastric lesser curvature
High risk of rebleeding based on endoscopic findings (active pulsatile bleeding, visible vessel)

Question 15

THE FORREST CLASSIFICATION FOR ENDOSCOPIC FINDINGS AND REBLEEDING RISKS

Answer 15

Grade Ia: active, pulsatile bleeding - High
Grade Ib: active, non-pulsatile bleeding - High
Grade IIa: nonbleeding visible vessel - High
Grade IIb: adherent clot - Intermediate
Grade IIc: black dot - Low
Grade III: no signs of recent bleeding - Low
*Grade 1a ulcers have >85% risk of rebleeding. Grade III lesions on the other hand have <3% risk of rebleeding.

Question 16

Indications for aspiration of amoebic abscess

Answer 16

Large abscesses
Failure of medical mgt
Superinfectiotn
Abscesses of the left lobe (could perforate into the pleuropericardial space)

Question 17

Most common symptom and indication for resection of hemangioma

Answer 17

Pain

Question 18

Usual indication for resection of FNH

Answer 18

Abdominal pain
Focal Nodular yperplasia
-occurs in young women
-link to oral contraceptives is NOT as clear as that of adenoma
-no spontaneous rupture, no malignant degerneration

Question 19

Indications for liver transplantation

Answer 19

One nodule < 5cms
2 or 3 nodules < 3cms
(-) vascular invasion
(-) extrahepatic spread
Child A,B,C

Question 20

Drug for non-resectable liver tumor

Answer 20

Sorafinib

Question 21

Prophylactic cholecystectomy indicated

Answer 21

Hemoglobinopathies (sickle cell dse)
Hereditary spherocytosis and thalassemia at the time of splenectomy
Transplant recipients (cardiac and lung)

Question 22

Prophylactic cholecystectomy NOT indicated

Answer 22

Diabetic patients
Cirrhotic patients
Transplant pacients (kidney and pancreas)
Procelain gallbladder (incidence rate of GB CANCER is almost 0)
Patients receiveing prolonged TPN
Spinal cord injury

Question 23

Prophylactic choleecystectomy remains controversial

Answer 23

Morbid obesity

After bariatric surgery

Question 24

CRITICAL VIEW OF SAFETY IN LAPAROSCOPIC CHOLECYSTECTOMY

Answer 24

1) the triangle of Calot must be dissected free of fat (without exposing the common bile duct)
2) the base of the gallbladder (at least 1/3) must be dissected off the liver bed (or cystic plate)
3) two structures (and only two, the cystic duct and artery) enter the gallbladder and these can be seen circumferentially (360-degree view)

Question 25

Contraindications to non-operative mgt of small bowel obstruction

Answer 25

``` Suspected ischemia Large bowel obstruction Closed loop obstruction Strangulated hernia Perforatiotn ```

Question 26

Indications for incidental appendectomy

Answer 26

Children about to undergo chemotherapy Disabled individuals Crohn disease (cecum must be healthy Individuals about to travel to remote places Major operations such as urinary bowel diversions

Question 27

Indications for surgery for Ulcerative Colitis

Answer 27

Total proctocolectomy can be curative Active disease unresponsive to medical therapy Risk of cancer (>8 years?) Severe bleeding

Question 28

Indications for surgery fo crohn’s dse

Answer 28

Only for mgt of complications (not for cure of dse since recurrence is common) Resection encompasses the intestine that’s grossly involved with the dse

Question 29

Indication for total proctocolectomy

Answer 29

Toxic megacolon - free perforation - massive hemorrhage (6-8u of RBC) - increasing toxicity - progression of colonic dilatation * emergency total colectomy is indicated

Question 30

Hallmarks of toxic megacolon

Answer 30

Nonobstructive colonic dilatation >6cm | Signs of toxicity

Question 31

Indications for adjuvant chemotherapy for colonic CA

Answer 31

``` Stage II (high-risk stage II) -T4 (T4a connotes stage IIB, T4b connotes stage IIC) -tumor perforation, obsturction -lymphovascular and perineural invasion -poorly differentiated or signet rign types -inadequate margin < 5cm -Inadequate ln harvest < 12 nodes Stage III (at least 1 node positive) Stage IV ```

Question 32

Indications for adjuvant chemotherapy for recta CA

Answer 32

II,III,IV | Stage IIA is TNM 300

Question 33

INDICATIOTNS for neoadjuvant radiation for rectal CA

Answer 33

Locally advanced rectal CA -all T3 lesions and/or -N1 (For persepctive, Stage IIA is 300)

Question 34

Describe APR

Answer 34

-includes the resection of part of the sigmoid colon, rectum, and anus -construction of a PERMANENT end colostomy -indications: 1 perianal skin involvement 2 puborectalis and sphincter involvement 3 fecal incontinence

Question 35

What’s the T staging in Colon Cancer?

Answer 35

Dunno yet

Question 36

Dominant risk factor for colon cancer

Answer 36

Aging is the dominant risk factor for colorectal cancer, with incidence rising steadily after age 50 years. More than 90% of cases diagnosed are in people older than age 50 years.

Question 37

Is cigarette smoking a risk factor for colon cancer?

Answer 37

Cigarette smoking is associated with an increased risk of colonic adenomas, especially after more than 35 years of use.