Nwscrs 2017 Saturday

Please choose the correct answer below. YOU MUST RECEIVE A PASSING SCORE OF 75% OR MORE TO RECEIVE SELF-ASSESSMENT CREDITS FOR THIS SESSION. You may retake the test as many times as you need to achieve the passing score. 

Can Ethics be Taught in SurgeryPresenter: Piroska KoparWhat does the term “Social Contract” refer to with regard to the relationship between patients and physicians?

• A.

  The explicit agreement between physicians and members of society that a physician will never practice medicine without full transparency.

• B.

  The implicit agreement between physicians and society according to which physicians will make resource allocation decisions for patients instead of leaving this task to non-physicians.

• C.

  The explicit agreement between physicians and members of society that informed consent will always be respected.

• D.

  The implicit agreement between physicians and society according to which physicians will practice medicine with the highest ethical standards and society will accord them respect and compensation accordingly.

What are the four classic principles of Medical Ethics?

• A.

  Autonomy, Beneficence, Justice, Paternalism

• B.

  Autonomy, Non – maleficence, Beneficence, Justice

• C.

  Autonomy, Non – maleficence, Professionalism, Justice

• D.

  Beneficence, Non – maleficence, Professionalism, Justice

What does the term “therapeutic misconception” mean in reference to the interaction between a patient and a physician scientist?

• A.

  The physician conducting the research study is under the assumption that his patient would rather enroll in the study than be excluded from a potential chance to get better.

• B.

  The patient is mistakenly under the assumption that her physician will no longer care for her to the same degree if she refuses to enroll in the physician’s research study.

• C.

  The patient is mistakenly under the assumption that the research study that she is enrolling in is for her own benefit rather than for the benefit of future patients and science.

• D.

  The patient and the physician are both mistakenly under the assumption that the research study will definitely be therapeutic.

What are some of the key elements of being a “Professional” in the context of the history of medical ethics?

• A.

  Specialized knowledge, Self regulation, Lifelong learning, Honesty

• B.

  Transparency, Expertise, Respectful of the law, Nonjudgmental

• C.

  Specialized knowledge, Honesty, Nonjudgmental, Well rounded

• D.

  Politically active, Respectful of the law, Well – informed, Skillful

A QUANTITATIVE RISK-BENEFIT ANALYSIS OF PROPHYLACTIC SURGERY PRIOR TO EXTENDED-DURATION SPACEFLIGHTPresenter: Danielle Carroll, MDA 37 year-old astronaut with no significant medical history is preparing for an exploratory mission to Mars. In your office, she inquires as to the current recommendation for undergoing prophylactic appendectomy prior to departing. What do you tell her?

• A.

  The evidence strongly supports prophylactic appendectomy, but not cholecystectomy, before long-duration missions in austere environments.

• B.

  The evidence is strongly against any prophylactic surgery whatsoever.

• C.

  Further studies should be conducted to prior to making any strong recommendations, but there appears to be no benefit to prophylactic surgery.

• D.

  The evidence strongly supports prophylactic cholecystectomy, but not appendectomy, before long-duration missions in austere environments.

Searching for Darkness in the Black Hole: Is there a role for high resolution anoscopy surveillance after wide local excision of anal melanoma?Presenter: Ryan ClarkSurgical management of anal melanoma is controversial. What is a proposed method of minimally invasive surgical management?

• A.

  APR

• B.

  Wide local transanal excision

• C.

  Cryoablation

• D.

  LAR

Effect of Body Mass Index on Recurrence of Rectal Prolapse After Surgical RepairPresenter: Kristin BuschA 57-year-old female presents to your office for rectal prolapse. Her BMI is 41 kg/m2. She has evidence of full thickness rectal prolapse on exam. How would you counsel the patient regarding her risk of recurrence in regards to her current BMI?

• A.

  She may have a decreased risk of recurrent rectal prolapse after surgical repair given her current BMI.

• B.

  Her current BMI will likely have no influence on her risk of recurrent rectal prolapse after surgical repair.

• C.

  She may have an increased risk of recurrent rectal prolapse after surgical repair given her current BMI.

• D.

  You would try to actively avoid discussing her BMI as well as her risk of recurrence after surgical repair during today’s visit.

Management of the Difficult StomaPresenter: Beck, David, EAbdominal wall modification

• A.

  Requires the assistance of a plastic surgeon

• B.

  Has a low incidence of wound complications

• C.

  Is helpful in morbidly obese patients

• D.

  Can not be combined with other procedures

Ventral Mesh Rectopexy: Making the Pelvic Floor Great AgainPresenter: Jill ClarkA 59-year-old woman presents to you for prolapsing hemorrhoids.  She mentions that she had radiation for cervical cancer 20 years ago.  She reports that with the assistance of laxative teas, she has 2-3 bowel movements weekly that are firm and require som 

• A.

  Recommend that she maintain her current bowel regimen.

• B.

  Advise that mesh erosion risks in the application of ventral mesh rectopexy for rectal prolapse are negligible and that ventral mesh rectopexy with synthetic mesh is the optimal treatment option for her.

• C.

  Offer her the option of either manually reducing the prolapse as needed versus considering laparoscopic posterior suture rectopexy.

• D.

  Have her consider evaluation for a pessary as a non-operative treatment option.

Surgical Treatment of Internal Intussusception and Rectal Prolapse: Choosing the Right Operation for the Right PatientPresenter: Liliana Bordeianou89 year old female with significant medical comorbidities and a frozen abdomen presents with rectal prolapse, uterine prolapse and vaginal laxity. She is in lots of pain and is considering surgical options. You review the limited literature and advise considering the following surgery:

• A.

  Laparoscopic ventral rectopexy and hysteropexy

• B.

  Perineal proctectomy, vaginal hysterectomy and colpocleisis

• C.

  Open suture resection rectopexy, hysterectomy

• D.

  Laparoscopic suture rectopexy and hysterectomy

54 year old  female presents with severe long standing constipation. She is also now noticing new fecal incontinence and  a 4 cm full thickness rectal prolapse upon straining. She has had no prior surgeries. Anorectal physiology testing does not show a transit disorder, or obstructed defecation due to paradoxical contractions of puborectalis. She has low normal anal pressures. On defecography, she has a large enterocele that appears to prolapse through the anus. She does not have visible uterine or vaginal prolapse on the physical exam. She tried biofeedback and is still symptomatic. She is looking for the repair that would have the highest chance of fixing her prolapse, constipation and fecal incontinence symptoms.You review the limited literature and advise considering the following surgery:

• A.

  Laparoscopic suture rectopexy

• B.

  Laparoscopic resection rectopexy

• C.

  Laparoscopic ventral rectopexy

• D.

  Perineal rectal prolapse repair

62 year old female presents after a failed perineal repair for rectal prolapse (Delorme). She is incontinent, and has a large patulous anus. Her anal sphincter tone is very low. Her defecography suggests a stable anterior compartment.  She asks you about the benefit of proceeding with a repeat perineal repair vs. an abdominal operation, with an especial focus on her chance of having improved continence.  You summarize the current consensus comparing perineal and abdominal repairs as follows:  

• A.

  Perineal repairs are associated with higher rates of fecal incontinence

• B.

  Abdominal repairs are associated with higher rates of fecal incontinence

• C.

  Data comparing abdominal and perineal repairs is inconclusive, recent randomized trial suggested and many meta-analyzes showed that both approaches seem to offer similar functional outcomes

• D.

  Perineal proctectomy with a levatorplasty offers better continence than a Delorme repair.

41 yo female presents to your office with report of severe constipation. She has paradoxical EMGs, a small rectocele that does not protrude past the introitus, and intrarectal intussusception on defecography. In addition, defecography shows a small enterocele. You advise:

• A.

  Biofeedback and medical management

• B.

  Resection rectopexy (lap or open)

• C.

  Ventral rectopexy

• D.

  Stapled transanal rectal resection (STARR)

Development of Expert Times for Endoscopy Simulator Tasks in Preparation for the Fundamentals of Endoscopic Surgery ExamPresenter: Heather E Hoops MDSkills required on the FES exam include all of the following EXCEPT:

• A.

  Navigation

• B.

  Retroflexion

• C.

  Loop reduction

• D.

  Insufflation

Resident knowledge of benign anal diseases: how general surgery compares to other disciplinesPresenter: Katherine KelleyA 25-year-old female with chronic constipation presents to clinic with two months of pain with bowel moments and bright red blood seen on toilet paper when wiping. On exam, there is a posterior tear in the anoderm. What initial treatment should be offered?

• A.

  Fiber supplementation/water

• B.

  Steroid cream

• C.

  Excision

• D.

  Botox

Colorectal Anastomotic Staplers: Cost vs. EfficacyPresenter: Toby Muniz, MD Which of the following statements regarding bowel anastomotic stapling is correct:

• A.

  There exists clear data supporting the superiority of one stapling brand over another wtih reference to anastomotic leak rates

• B.

  Anastomtic leaks are a trivial complication of bowel surgery

• C.

  Certain technical features of a stapling device may cause a higher or lower risk for anastomotic leak

• D.

  There are no quantifiable scoring systems to predict anastomotic leak in a patient

Reducing Colorectal SSI: Results of an Institution-Wide Standardization ProtocolPresenter: Daniel Herzig, MD The most effective intervention to reduce surgical site infections after colorectal surgery is:

• A.

  Mechanical and antibiotic bowel prep

• B.

  Maintaining normothemia

• C.

  Giving the right antibiotic at the right time

• D.

  A bundle of interventions standardized for all procedures