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Surgery Boards Set 2 > Indications > Flashcards

Indications Flashcards

1
Q

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

A

8g/dL

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2
Q

Most common indications ofr emergency endotracheal intubation

A

Altered mental status (GCS<=8)

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3
Q

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

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

CURRENT INDICATIONS AND CONTRAINDICATIONS FOR EMERGENCY DEPARTMENT THORACOTOMY

A

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)

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5
Q

Indications for damage control surgery

A

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

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6
Q

Indications for fasciotomy

A

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

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7
Q

Indications for MRND in submandibular gland tumor

A

N+

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

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8
Q

Indications for RAI in graves

A

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

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9
Q

Indications for Parathyroidectomy in an asymptomatic patient

A

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

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10
Q

Absolute contraindications to breast conservation surgery

A
  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
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11
Q

Indications for anti-reflux surgery

A 
Symptomati patients +/- esophagitis
Structurally defective LES
Young patients with documented reflux
Severe esophagitis
Presence of stricture
Uncomplicated barrett esophagus
(Becomes complicated if high-grade)
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12
Q

Borchardt triad

A

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

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13
Q

Contraindications for curative surgery or resection for esophageal carcinoma

A 
Age > 75
FEV1 < 1.25 AND ef < 40
>20% weight loss
Locally advanced tumor (with signs of invasion)
Distant mets
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14
Q

Indications for Surgery for bleeding PUD

A

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)

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15
Q

THE FORREST CLASSIFICATION FOR ENDOSCOPIC FINDINGS AND REBLEEDING RISKS

A

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.

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16
Q

Indications for aspiration of amoebic abscess

A

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

17
Q

Most common symptom and indication for resection of hemangioma

A

Pain

18
Q

Usual indication for resection of FNH

A

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

19
Q

Indications for liver transplantation

A 
One nodule < 5cms
2 or 3 nodules < 3cms
(-) vascular invasion
(-) extrahepatic spread
Child A,B,C
20
Q

Drug for non-resectable liver tumor

A

Sorafinib

21
Q

Prophylactic cholecystectomy indicated

A

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

22
Q

Prophylactic cholecystectomy NOT indicated

A

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

23
Q

Prophylactic choleecystectomy remains controversial

A

Morbid obesity

After bariatric surgery

24
Q

CRITICAL VIEW OF SAFETY IN LAPAROSCOPIC CHOLECYSTECTOMY

A

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)

25
Q

Contraindications to non-operative mgt of small bowel obstruction

A 
Suspected ischemia
Large bowel obstruction
Closed loop obstruction
Strangulated hernia
Perforatiotn
26
Q

Indications for incidental appendectomy

A

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

27
Q

Indications for surgery for Ulcerative Colitis

A

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

28
Q

Indications for surgery fo crohn’s dse

A

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

29
Q

Indication for total proctocolectomy

A

Toxic megacolon

  • free perforation
  • massive hemorrhage (6-8u of RBC)
  • increasing toxicity
  • progression of colonic dilatation
  • emergency total colectomy is indicated
30
Q

Hallmarks of toxic megacolon

A

Nonobstructive colonic dilatation >6cm

Signs of toxicity

31
Q

Indications for adjuvant chemotherapy for colonic CA

A 
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
32
Q

Indications for adjuvant chemotherapy for recta CA

A

II,III,IV

Stage IIA is TNM 300

33
Q

INDICATIOTNS for neoadjuvant radiation for rectal CA

A

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

34
Q

Describe APR

A

-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

35
Q

What’s the T staging in Colon Cancer?

A

Dunno yet

36
Q

Dominant risk factor for colon cancer

A

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.

37
Q

Is cigarette smoking a risk factor for colon cancer?

A

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

Surgery Boards Set 2 (5 decks)

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