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OBGYN > 1: GENERAL ENDOSCOPIC PRINCIPLES > Flashcards

1: GENERAL ENDOSCOPIC PRINCIPLES Flashcards

1
Q

Hypovolemic shock: Etiology

A

Decreased fluids

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2
Q

Hypovolemic shock: PE

A

GFlat neck veins, pallor, tachycardia

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3
Q

Distributive shock: Etiology

A

Increased ‘pipe’/vessel size

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4
Q

Distributive shock: Examples

A

Drug induced, sepsis, anaphylaxis

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5
Q

Distributive shock: PE

A

Flat neck veins, pallor, tachycardia

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6
Q

Obstructive shock: Etiology

A

‘Pipe’/Vessel obstruction

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7
Q

Obstructive shock: Examples

A

PE, tension pneumothorax, cardiac tamponade

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8
Q

Obstructive shock: PE

A

Variable, although often JVD but apparently euvolemic

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9
Q

Cardiogenic shock: Etiology

A

Pump problem

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10
Q

Cardiogenic shock: Examples

A

MI, arrythmia, cardiomyopathy

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11
Q

Cardiogenic shock: PE

A

JVD, tachycardia, cyanosis

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12
Q

Benefits LSC over laparotomy

A

Less EBL
Improved post-op pain
Decreased LOS
Faster return to activities
Fewer wound infections

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13
Q

Disadvantages of LSC compared to laparotomy

A

Longer operative time
Higher risk of urinary tract injuries
Higher risk of cuff dehiscence

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14
Q

Indications for laparotomy over LSC

A

Suspected extra-uterine pathology (ex: stage 3 ovarian cancer)
Adnexal masses concerning for cancer
Known or suspected malignancy

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15
Q

Patient considerations for laparotomy over LSC

A

Can patient tolerate increased intraabdominal pressure?
Adhesive disease?
Is patient hemodynamically stable? (THOUGH HEMODYNAMIC INSTABILITY SHOULD NOT BE CONTRAINDICATION TO LSC!!!)

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16
Q

Is hemodynamic instability a contraindication to LSC?

A

NO!!!!

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17
Q

Contraindications to HSC

A

Viable IUP
Pelvic infection
KNOWN cervical or uterine cancer
Inadequate experience or equipment

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18
Q

Support for OR HSC over office procedure

A

Patient intolerance
Severe cervical stenosis
Altered anatomy

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19
Q

Pregnancy test prior to HSC?

A

Delay for 2w after unprotected intercourse

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20
Q

Most important independent RF for malignancy?

A

Age (dramatic increase in malignancy risk after menopause)

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21
Q

RFs for ovarian cancer

A

AGE (most important)
White race
Nulliparity
Early menarche
Late menopause
Endometriosis

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22
Q

Radiologic factors concerning for ovarian malignancy

A

Cyst >10cm
Irregular borders
Papillary/solid components
Associated with ascites

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23
Q

Radiologic findings supportive of benign cyst

A

Thin, smooth walls
Absence of internal blood flow

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24
Q

Incidence of mass in post-menopausal time frame being benign

A

68%

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25
Q

Percent resolution of simple cyst in post-menopausal women

A

70%

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26
Q

Ddx for benign adnexal masses

A

Simple cyst
Cystadenoma
Fibroma
Paraovarian/paratubal cyst
Hydrosalpinx

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27
Q

Most common ovarian cancer

A

Epithelial

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28
Q

Discuss the management of post-menopausal adnexal masses

A

<3cm: No f/u
3cm-5cm: Surveillance, repeat US in 3mo
5-10cm: Surveillance or surgical exploration
>10cm: Surgery
CAVIAT - IF PT HAVING SYMPTOMS OR ELEVATED CA-125: SURGERY REGARDLESS OF SIZE

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29
Q

Risk assessment scoring systems for ovarian cancer

A

US-Based Scoring Systems
Risk of Malignancy Index
Risk of Malignancy Algorithm

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30
Q

Examples of low-risk surgery and peri-operative risk:

A

<1%
Superficial surgery (ex: Bartholin’s)
Minor GYN
Cosmetic/Reconstructive
Breast
Endoscopic
Minor urologic
Dental

31
Q

Examples of intermediate-risk surgery and peri-operative risk:

A

1-5%
Intraperitoneal
Major GYN (ex: hysterectomy, sacrocolpopexy)
Major urologic
Head and neck
Major ortho
Renal transplant
Minor intrathoracic

32
Q

Examples of high-risk surgery and peri-operative risk:

A

> 5%
Major abdominal (anything with risks of major fluid loss)

33
Q

Is there a strict cutt-off of glycemic # to which procedure should be held?

A

No

34
Q

When to hold Metformin

A

48hr prior to procedure (d/t risk of lactic acidosis)

35
Q

When to hold PO glycemic meds other than Metformin prior to surgery

A

Day of

36
Q

When to hold short-acting insulin prior to surgery

A

Day of

37
Q

When to hold long-acting insulin prior to surgery

A

Halve it day of

38
Q

Goal of glycemic control for surgery

A

<180

39
Q

When to hold immunosuppressant meds prior to surgery

A

Consider 1w prior and one week after surgery (after discussing with rheumatologist d/t increased risk of infection)

40
Q

Why do we use stress dose steroids with surgery?

A

To prevent adrenal insufficiency

41
Q

Who needs stress-dose steroids?

A

Patients on Prednisone 5mg QD x3w (or more) within last 6 mo (or equivalent)

42
Q

Equivalent of Prednisone 5mg

A
43
Q

Recommendation for stopping maintenance steroid prior to minor surgery

A

CONTINUE

44
Q

Recommendation for stopping maintenance steroid prior to moderate surgery

A

CONTINUE

45
Q

Recommendation for stopping maintenance steroid prior to major surgery

A

CONTINUE

46
Q

Recommendation for preoperative hydrocortisone prior to minor surgery

A

None

47
Q

Recommendation for preoperative hydrocortisone prior to moderate surgery

A

50mg IV

48
Q

Recommendation for preoperative hydrocortisone prior to major surgery

A

100mg IV

49
Q

Recommendation for preoperative hydrocortisone after minor surgery

A

None- resume maintenance steroid

50
Q

Recommendation for postoperative hydrocortisone after to moderate surgery

A

25mg PO q8hr x24hr, then resume maintenance

51
Q

Recommendation for postoperative hydrocortisone after to major surgery

A

50mg IV q8hr x24hr, then TAPER to maintenance steroid

52
Q

Definition of low risk of symptomatic VTE

A

Minor surgery (<30min) or non-complex LSC surgery in patients with NO additional RFs

53
Q

Definition of moderate risk of symptomatic VTE

A

Minor or LSC surgery in patients WITH additional RFs; Major GYN surgery for benign disease in patients with no additional RFs

54
Q

Definition of high risk of symptomatic VTE

A

Major surgery in patients WITH additional RFs; Major surgery in patients with malignancy

55
Q

Definition of highest risk of symptomatic VTE

A

Major surgery in patients >60yo with cancer, a prior VTE, or both

56
Q

% Definition of very low risk of VTE per Caprini

A

<0.5%

57
Q

% Definition of low risk of VTE per Caprini

A

~1.5%

58
Q

% Definition of moderate risk of VTE per Caprini

A

~3%

59
Q

% Definition of high risk of VTE per Caprini

A

~6%

60
Q

Recommended ppx for ~1% major bleeding complication risk in very low patient risk population

A

No specific ppx

61
Q

Recommended ppx for ~2% major bleeding complication risk in very low patient risk population

A

No specific ppx

62
Q

Recommended ppx for ~1% major bleeding complication risk in low patient risk population

A

Mechanical ppx

63
Q

Recommended ppx for ~2% major bleeding complication risk in low patient risk population

A

Mechanical ppx

64
Q

Recommended ppx for ~1% major bleeding complication risk in moderate patient risk population

A

LDUH, LMWH, OR mechanical ppx

65
Q

Recommended ppx for ~2% major bleeding complication risk in moderate patient risk population

A

Mechanical ppx

66
Q

Recommended ppx for ~1% major bleeding complication risk in high patient risk population

A

LDUH OR LMWH PLUS mechanical ppx

67
Q

Recommended ppx for ~2% major bleeding complication risk in high patient risk population

A

Mechanical ppx until risk of bleeding diminishes and pharm ppx can be added

68
Q

Recommended ppx for ~1% major bleeding complication risk in high risk cancer surgery population

A

LDUH OR LMWH PLUS mechanical ppx AND extended-duration ppx with LMWH

69
Q

Recommended ppx for ~2% major bleeding complication risk in high risk cancer surgery population

A

Mechanical ppx until risk of bleeding diminishes and pharm ppx can be added

70
Q

Recommended ppx for ~1% major bleeding complication risk in high risk patients with LDUH and LMWH are contraindicated or unavailable

A

Fondaparinux or Low-Dose Aspirin PLUS mechanical ppx

71
Q

Recommended ppx for ~2% major bleeding complication risk in high risk patients with LDUH and LMWH are contraindicated or unavailable

A

Mechanical ppx until risk of bleeding diminishes and pharm ppx can be added

72
Q

PALM-COEIN DEFINITION

A

Polyps
Adenomyosis
Leiomyoma
Malignancy

Coagulopathy
Ovulatory
Endometrial
Iatrogenic
Not yet classified

73
Q

RFs for endometrial malignancy

A

Nulliparity
Increasing age
Late menopause
Unopposed estrogen (HRT, obesity, chronic anovulation)
Tamoxifen
Lynch Syndrome
Cowden Syndrome

OBGYN (16 decks)

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