1. Melanoma margins based on Breslow's depth: 

-Melanoma in situ: 0.5-cm margins

-Melanoma with Breslow's thickness <2 mm: 1.0-cm margins

-Melanoma with Breslow's thickness ≥2.0 mm: 2.0-cm margins

2. Sentinel node biopsy based on Breslow's depth: If the Breslow depth is <0.75 mm (or 1mm by some more liberal guidelines), sentinel node biopsy is not necessary as the risk of spread is very low. 

3. The sun should never set on a complete bowel obstruction. If they are partially obstructed, you can NPO/NG/IVF wait it out, but if it's entirely obstructed (obstipation) with a mechanical cause, you should go to the OR. 

4. Very high (>104) fever within 24 hours postop-- must rule out gas-forming would infection. Within first 12 hours, most likely to be C. perfrigens or group A strep. Atelectasis unlikely to cause this high of a fever unless its very extensive. 

5. Postoperative hemoptysis: likely due to PE, other causes: bronchitis, pneumonia, TB, cancer. If the hemoptysis is long-standing, it's most likely to be due to malignancy (or some sort of vasculitis), if the first episode is postop, likely PE. 

6. Postoperative acute hypotension and hypoxia: big PE, MI, tension pneumothorax. ABCs, auscultation should r/o the pneumothorax. Enzymes, EKG, D-dimer.
7. Elective surgery in someone with pulmonary disease:
-If they smoke, they should quit; 6-8 weeks of abstinence is necessary before statistically significant differences in postop pulmonary outcomes.
-Green sputum: rule out pneumonia by getting CXR, listening to lungs. If those are OK, then its' likely just a bronchiits. Give antibiotics, do surgery after the abx are done and the disease resolves. If it seems more like pneumonia (decreased breath sounds on exam, consolidation on CXR, vital sign changes-- tachypnea, tachycardia, decreased sats) then work up and treat the pneumonia before proceeding with surgery.
-Open > Lap surgery in CO2 retainers, as lap surgery adds more CO2 to blood.
-Hemoptysis: rule out cancer. CT +/- bronchoscopy.
-ABGs are good to determine the extent of pulmonary disease; pCO2 > 45 associated with increased perioperative mortality
8. Emergency surgery in someone with pulmonary disease: 
-If someone looks pretty sick and could have pneumonia, get a CXR
-preoperative bronchodilators, limited time on anesthesia, aggressive early postoperative ambulation, IS use, postop pulmonary preventative care.
9. Predictors of cardiac complications after vascular surgery: 
-Q waves on EKG (indicates transmural MI-- non-q-wave MIs are more likely subendothelial, and may progress to transmural during surgery. Workup with thallium stress test to see areas of ischemia, may need revascularization before surgery)
-Ventricular ectopy bad enough to need treatment (>5 PVCs/minute associated with increased perioperative mortality)
-Angina
-Diabetes needing medications
-Age > 70
10. Prophylactic antiobiotics: not necessary in clean wounds, necessary in clean-contaminated and contaminated wounds.