Surgery Halo-halo 2

Question 1

Remark/s on TP53 mutation

Answer 1

Hapens early in HNSCC (HPV-negative)

Happens late in colorectal CA

Question 2

Synchronous lesions in HNSCC

Answer 2

5-7%

Question 3

5W of post-op fever

Answer 3

POD 1-3: WIND
-atelectasis
-pneumonia (day 3)
^backed up statpearls
W
POD3-4 WATER
-UTI

POD 4-5: WALKING
-DVT/PE
*statpearls:
Thrombophlebitis - POD 5
Pulmonary embolism - POD 7

POD 7+: WOUND
-SSI

Question 4

How to prevent atelectasis post-op

Answer 4

Sit patients greater than 45degrees —> increase in FRC by 700mL or more
Early ambulation and adequate pain control

If mech vent’d, 30-45 degrees, tidal volume 8-10mL/kg will improve pulmonary outcomes

Question 5

Where to do chest tube thoracostomy in PNEUMOTHORAX

Answer 5

5th ICS anterior axillary line
“The anterior chest wall is up to 1 cm thicker than the lateral chest wall, so needle decompression is more effective in the lateral position.” (Schwartz)

“Attempted prehospital needle decompression in the traditional anterior position results in only 50% needle entry into the thoracic cavity.” (Schwartz)

Question 6

Remark/s on atelectasis post-op

Answer 6

It results in a loss of functional residual capacity (FRC) and can PREDISPOSE to pneumonia.

Poor pain control in the postop period contributes to poor inspiratory effort and collapse of the lower lobes in particular (Schwartz)

Question 7

Traditional inclusion criteria for ARDS

Answer 7

Acute onset
Predisposing condition
Pa0c:FiO2 < 200 (regardless of PEEP)
Bilateral infiltrates
Pulmonary artery occlusion pressure <18 mmHg
No clinical evidence of right heart failure
(Table 12-13, Schwartz)

Question 8

Remark/s on RLN injury

Answer 8

Occurs in less than 5% of patients
10% are permanent
Direct laryngoscopy: cord on affected side will be in paramedian position
If not permanent, function may return 1-2 months after injury

Question 9

Remark/s on superior laryngeal nerve injury

Answer 9

Glottic aperture is asymmetrical

Mgt is clinical observation

Question 10

Remark/s on VAP

Answer 10

Occurs in 15-40% of ventilated ICU patients with. A proabability rate of 5% per day , up to 70% at 30 days

Question 11

ARDS classivfication

Answer 11

By PaO2/FiO2
Milde: 300-201 mmHg
Moderate: 200-101 mmHg
Severe: <100 mmHg

Question 12

Recommended tidal volume in ARDS

Answer 12

5-7 mL/kg

Question 13

Extubation

Answer 13

Tobin index
Breaths per min / tidal volume (L)
“Rapid shallow breeathing index”
Best negative predictive instrument
<=105, 70% chances of passing extubation
>105, 80% chances of failing extubation

Question 14

Remark/s on tracheostomy

Answer 14

Decreases pulmonary dead space
Provides for improved pulmonary toilet
When performed before the 10th day of ventilatory support, tracheostomy may decrease 
-the incidence of VAP
-the overall length of ventilator time
-number of ICU patient days

Question 15

Gold standard for diagnosisng PE

Answer 15

Pulmonary angiogram
Alt: spiral CT angiogram
Empiric mgt of heparin infusion

Question 16

Most common arrhythhmia post-op

Answer 16

Atrial fibrillation, POD 3-5
RATE CONTROL is more important than rhythm control
1st line:
Beta blocker
2nd-line: CCB
Unstable: cardioversion

Question 17

Remark/s on VSD

Answer 17

1 month: 80% closure

12 months: 25% closure

Question 18

Remark/s on caroli’s disease

Answer 18

Cystic dilatation of the intrahepatic biliary ducts
Associated with: ⭐️
-biliary lithiasis (33%)
-cholangitis
-biliary abscess 
-cystic renal disease
-absence of cirrhosis
-cholangiocarcinoma (7%)

Question 19

Tx of caroli’s disease

Answer 19

First-line: biliary drainage by ERCP and percutaneous transhepatic cholangiography.

If limited to single lobe, hepatic resection. Liver resection can be considered in a patieht with

• hepatic decompensation or unresponsive recurrent cholangitis
• patient with small (T1 or T2) cholangiocarcinoma

Question 20

Synchronous in colorectal cancer

Answer 20

HNPCC: “the risk of synchronous or metachronous colorectal carcinoma is 40%”

Colorectal carcinoma: “synchronous disease will be present in up to 5% of patients”