ABPS General Surgery cheat sheet

Appendicitis: Alvarado score ≥7 indicates high probability; CT is preferred in adults, while ultrasound is first-line in children and pregnancy.

Adhesive small bowel obstruction: CT identifies the transition point; water-soluble contrast reaching the colon predicts nonoperative resolution.

Upper GI bleeding: Glasgow-Blatchford score 0-1 identifies very low risk; endoscopy within 24 hours after resuscitation; variceal bleeding is treated with octreotide, ceftriaxone, and band ligation.

Perforated peptic ulcer: omental (Graham) patch closure; H. pylori eradication and proton pump inhibitor reduce recurrence.

Colorectal cancer: right hemicolectomy for cecal and ascending colon tumors; at least 12 lymph nodes are needed for adequate staging.

Inguinal hernia: indirect defects are lateral to the inferior epigastric vessels, direct defects medial; femoral hernia lies below the inguinal ligament.

Acute mesenteric ischemia: embolic SMA occlusion typically occurs distal to the middle colic origin, sparing the proximal jejunum; lactate is a late marker.

Anal fissure: most are posterior midline; chronic fissures are treated with lateral internal sphincterotomy.

Achalasia: failure of lower esophageal sphincter relaxation; treatment options include pneumatic dilation, Heller myotomy, and POEM.

Breast conservation: a negative margin is defined as no ink on tumor; whole-breast radiation follows breast-conserving surgery.

Sentinel lymph node biopsy is standard for clinically node-negative invasive breast cancer; Z0011 supports omitting completion axillary dissection for 1-2 positive sentinel nodes after breast conservation and radiation.

HER2-positive breast cancer receives trastuzumab; triple-negative disease receives neoadjuvant pembrolizumab plus chemotherapy.

Melanoma: sentinel node biopsy for tumors >0.8 mm or with ulceration; margins are 1 cm for tumors ≤1 mm and 2 cm for thicker tumors.

Thyroid carcinoma: papillary spreads via lymphatics, follicular via hematogenous routes; medullary carcinoma secretes calcitonin; anaplastic has the worst prognosis.

Primary hyperparathyroidism: sestamibi scan plus ultrasound for localization; intraoperative PTH fall >50% ten minutes after excision predicts cure.

Adrenal incidentaloma: resection is indicated for size >4 cm or functional hormone secretion.

Gastric cancer: D2 lymphadenectomy for resectable disease; perioperative FLOT chemotherapy improves survival.

Soft tissue sarcoma: wide local excision with negative margins; radiation is used for high-grade or close-margin tumors.

Hemorrhagic shock: balanced 1:1:1 transfusion of red cells, plasma, and platelets; tranexamic acid within 3 hours of injury reduces mortality.

Permissive hypotension targets systolic pressure near 90 mmHg until hemorrhage control; it is contraindicated in traumatic brain injury.

FAST examines pericardial, perihepatic, perisplenic, and pelvic windows; a positive FAST in an unstable patient is an indication for laparotomy.

Splenic injury: hemodynamically stable patients are managed nonoperatively; contrast blush is treated with angioembolization.

Pelvic fracture: apply a binder at the greater trochanters; unstable patients may require preperitoneal packing or angioembolization.

Traumatic brain injury: treat intracranial pressure above 22 mmHg; cerebral perfusion pressure target is 60-70 mmHg.

Abdominal compartment syndrome: intra-abdominal pressure >20 mmHg with new organ dysfunction; treatment is decompressive laparotomy.

Burns: Parkland formula gives 4 mL/kg per percent total body surface area in 24 hours; adult urine output target is 0.5 mL/kg/hour.

Necrotizing fasciitis: LRINEC score supports diagnosis; urgent surgical debridement is the primary treatment.

Sepsis: infection plus SOFA increase ≥2; septic shock requires vasopressors for MAP ≥65 mmHg and lactate >2 mmol/L.

Septic shock: 30 mL/kg crystalloid within 3 hours and antibiotics within 1 hour.

ARDS Berlin criteria: PaO2/FiO2 ≤300 with PEEP ≥5 cm H2O and bilateral opacities; tidal volume 6 mL/kg predicted body weight and plateau ≤30 cm H2O.

Prone positioning for 16 hours daily reduces mortality when PaO2/FiO2 is <150.

Restrictive transfusion threshold is hemoglobin <7 g/dL in most critically ill patients.

VTE prophylaxis uses low-molecular-weight heparin unless contraindicated by active bleeding or severe thrombocytopenia.

Hyperkalemia with ECG changes: intravenous calcium, insulin with glucose, albuterol, and dialysis for refractory cases.

Acute kidney injury with hemodynamic instability: continuous renal replacement therapy is preferred over intermittent dialysis.

Delirium screening in ICU uses CAM-ICU; haloperidol does not treat the underlying cause.

AAA repair: elective repair at 5.5 cm in men and 5.0 cm in women, or for rapid growth or symptoms.

Ruptured AAA: permissive hypotension and immediate operative or endovascular repair; CT is avoided in unstable patients.

Carotid endarterectomy: symptomatic 70-99% stenosis; selected symptomatic 50-69% stenosis; aspirin and statin therapy continue perioperatively.

Peripheral artery disease: ankle-brachial index <0.90; critical limb ischemia is suggested by ABI <0.40 or rest pain, ulcer, gangrene.

Acute limb ischemia: heparin immediately; Rutherford class determines viability and urgency of revascularization.

Tension pneumothorax: needle decompression at the second intercostal space midclavicular line or fifth intercostal space anterior axillary line.

Lung cancer: stage I disease treated with lobectomy; mediastinal staging for nodes >1 cm or PET-avid.

Esophageal perforation: broad-spectrum antibiotics, drainage, and early repair; contrast swallow identifies the leak.

Proximal DVT involves popliteal or more proximal veins; anticoagulation is standard, with IVC filter for contraindication.

Revised Cardiac Risk Index predictors: ischemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, renal impairment, high-risk surgery.

Beta-blockers are continued perioperatively; starting high-dose beta blockade on the day of surgery is avoided.

Surgical antibiotic prophylaxis: cefazolin within 60 minutes before incision; re-dose every 4 hours and for significant blood loss.

ERAS principles: multimodal analgesia, early oral feeding, no routine nasogastric tube, and early mobilization.

Malignant hyperthermia: stop triggers and give dantrolene 2.5 mg/kg intravenously.

Local anesthetic systemic toxicity: 20% lipid emulsion 1.5 mL/kg bolus followed by infusion.

PONV risk factors (Apfel): female sex, nonsmoking, history of PONV or motion sickness, postoperative opioids.

Neuraxial anesthesia is contraindicated with coagulopathy or therapeutic anticoagulation; follow ASRA intervals.

Caprini score stratifies VTE risk and guides duration of prophylaxis.

Mild gallstone pancreatitis: cholecystectomy during the same admission reduces recurrence.

Acute pancreatitis: no prophylactic antibiotics; enteral nutrition is preferred over parenteral.

Ascending cholangitis: urgent ERCP with biliary drainage within 24 hours plus antibiotics.

Pancreatic adenocarcinoma: pancreaticoduodenectomy for resectable head tumors; FOLFIRINOX is a standard adjuvant or neoadjuvant regimen.

Hepatocellular carcinoma: Milan criteria for transplantation; one lesion ≤5 cm or up to three lesions ≤3 cm.

Colorectal liver metastases: hepatectomy for resectable disease; 5-year survival improves with complete resection.

Liver trauma: hemodynamically stable patients managed nonoperatively; bile leak treated with ERCP and stenting.

Transplant immunosuppression: tacrolimus is a calcineurin inhibitor; CMV prophylaxis with valganciclovir for high-risk recipients.

Portal hypertension: TIPS for refractory variceal bleeding or refractory ascites.

Hypertrophic pyloric stenosis: hypochloremic, hypokalemic metabolic alkalosis with paradoxical aciduria; correct dehydration and electrolytes before pyloromyotomy.

Intussusception: ileocolic in children; air enema reduction is first-line when no peritonitis or perforation.

Hirschsprung disease: diagnosis by rectal biopsy; treatment is pull-through.

Necrotizing enterocolitis: pneumatosis intestinalis is characteristic; Bell staging guides management.

Congenital diaphragmatic hernia: nasogastric decompression and avoidance of bag-mask ventilation before repair.

Cleft lip repair uses the rule of 10s: 10 weeks of age, 10 lb, 10 g/dL hemoglobin, and 10% weight gain.

Split-thickness skin grafts contract more than full-thickness grafts; both require a vascularized wound bed.

Axial pattern flaps have a named arterial supply; random pattern flaps rely on the subdermal plexus.

Pressure ulcers: stage based on depth; stage III extends to subcutaneous tissue, stage IV to bone or muscle.

Informed consent requires capacity, disclosure of material risks and alternatives, and voluntary decision-making; emergency treatment may proceed without consent.

WHO surgical safety checklist has three phases: sign in before induction, time out before incision, sign out before leaving the operating room.

Medical error disclosure includes explaining what happened, apologizing, describing consequences, and outlining prevention.

Morbidity and mortality conference is a confidential peer-review process analyzing systems causes rather than assigning individual blame.

Conflicts of interest are disclosed to patients, institutions, and journals; financial relationships with industry are reported.

Research ethics: IRB approval, informed consent, equipoise, and the Belmont principles of respect for persons, beneficence, and justice.

NSQIP is a risk-adjusted surgical outcomes registry used for quality improvement and benchmarking.

Impaired physician: report to the state physician health program or licensing board when patient safety is threatened.

Surgical documentation includes indication, findings, procedure performed, complications, and specimens.