FPMRS one-liners Flashcards
1
Q
What are the branches of the anterior division of the internal iliac artery?
Following parietal to visceral (ventral/posterior) (8): Umbilical artery (medial umbilical ligament distally), obturator, superior vesicle, inferior vesicle, uterine artery, middle rectal, internal pudendal, inferior gluteal
A
Following parietal to visceral (ventral/posterior) (8): Umbilical artery (medial umbilical ligament distally) obturator Superior vesicle Inferior vesicle Uterine artery Middle rectal Internal pudendal Inferior gluteal
2
Q
What are the branches of the posterior division of the internal iliac artery?
Iliolumbar, lateral sacral, superior gluteal (I LOVE SEX)
A
Iliolumbar
Lateral sacral
Superior gluteal
(I LOVE SEX)
3
Q
What provides the primary support to the uterus?
A
Uterosacral and cardinal ligaments
4
Q
Injury to which nerve will result in loss of the patellar reflex?
A
Femoral nerve
5
Q
Which nerves are at risk for injury for a patient in candy cane stirrups?
A
Femoral, peroneal, tibial
6
Q
Which nerves are at risk for injury with a transverse or Pfannenstiel incision?
A
Ilioinguinal, iliophygastric, genitofemoral
7
Q
Which nerves are at risk for patient in a frog-legged position?
A
Femoral, obturator, lateral femoral cutaneous
8
Q
Which nerves are at risk from self-training retractor blades?
A
Femoral
9
Q
Which level of Delancey support best describes apical support?
A
Level 1
10
Q
Which nerve is most at risk for injury during placement of the sutures for sacrospinous ligament fixation?
A
Sciatic nerve
11
Q
What muscles make up the levator ani?
A
Iliococcygeus
Pubococcygeus
Puborectalis muscles
12
Q
What muscles make up the pelvic diaphragm?
A
The levator ani (iliococcygeus, pubococcygeus, puborectalis muscles), and the coccygeus muscles
13
Q
What is the embryologic origin of the uterus?
A
Paramesonephric ducts
14
Q
What is the embryologic origin for the fallopian tubes?
A
Paramesonephric ducts
15
Q
What is the embryologic origin for the proximal 1/3 vagina?
A
Paramesonephric ducts
16
Q
What is the embryologic origin for the distal 2/3 vagina?
A
Urogenital sinus
17
Q
What is the embryologic origin for the Trigone?
A
Mesonephric ducts
18
Q
What is the embryologic origin for the ureters?
A
Mesonephric ducts
19
Q
What is the embryologic origin for the renal pelvis/calcyces?
A
Mesonephric ducts
20
Q
What is the embryologic origin for the posterior proximal urethra?
A
Mesonephric ducts
21
Q
What is the embryologic origin for the bladder?
A
Urogenital sinus
22
Q
What is the embryologic origin for the urethra?
A
Urogenital sinus
23
Q
What is the embryologic origin for the rectum?
A
Cloaca
24
Q
What is the embryologic origin for the kidney?
A
Metanephros
25
What is the embryologic origin for Gartner’s duct cyst?
Mesonephric ducts
26
What is the embryologic origin for Hydatid cysts of Morgagni?
Paramesonephric ducts
27
What is the embryologic origin for the ovaries?
Gonadal ridge
28
What is the embryologic origin for the Mullerian ducts?
Paramesonephric ducts
29
What is the embryologic origin for the Wolffian ducts?
Mesonephric ducts
30
What is the embryologic origin for the clitoris?
Genital tubercle
31
What other organ systems are typically at risk for accompanying congenital anomalies in a patient with mullerian agenesis?
Urinary tract, skeletal
32
What is the Weigert-Meyer rule?
In complete ureteral duplication, the upper pole moiety inserts medially and inferiorly to the lower pole moiety. The lower pole moiety inserts lateral and superiorly
33
Fecal incontinence: What is the recto-anal inhibitory reflex?
Involuntary IAS relaxation in response to rectal distension, allowing some rectal contents to descent into the anal canal where it is brought into contact with specialized sensory mucosa to detect consistency
34
Fecal incontinence: what is the recto-anal excitatory reflex?
An initial, semi-voluntary contraction of the EAS and puborectalis which in return prevents incontinence following the RAIR
35
Fecal incontinence: What happens to the anorectal angle during voluntary squeeze?
It becomes more acute, from 90 degrees at rest to 70 degrees with a squeeze
36
Fecal incontinence: What happens to the anorectal angle during defecation?
It becomes more obtuse, from 90 degrees at rest to 110-130 degrees during defecation
37
Fecal incontinence: Which component of the anal sphincter complex contributes to the majority of the anal resting tone?
The internal anal spinster may contribute 50-86% of the anal canal resting tone
38
Fecal incontinence: What is the best imaging modality to differentiate from functional anatomic/nerve integrity of the anal sphincter?
Endoanal ultrasound
39
Fecal incontinence: What is the best imaging modality to assess rectal emptying?
Defacography
40
Fecal incontinence: What is the best method to evaluate resting and squeeze pressure of the rectum?
Anorectal manometry
41
Fecal incontinence: What is the best method to assess the electrical activity of the pelvic floor muscles?
Pudendal nerve latency testing
42
Fecal incontinence: Which is the more effective sphincter repair - on overlapping or end-to-end?
Both are equally effective
43
Fistulas: What is the most common cause of ureterovaginal fistulas?
Benign GYN surgery
44
Fistulas: What is the most common cause of rectovaginal fistulas?
Obstetrical trauma
45
Fistulas: In the developed world, what is the most common cause of vesicovaginal fistula?
Pelvic surgery (eg hysterectomy)
46
Fistulas: What is the blood supply for an interposing Martius fat pad?
The external pudendal artery, a branch of the obturator artery and the internal pudendal artery
47
Fistulas: Which is a useful imaging adjunct to identify a urethrovaginal fistula?
Tratner catheter (double balloon)
48
Fistulas: Which type of hysterectomy has the lowest post-operative vesicovaginal fistula complication rate?
Vaginal hysterectomy
49
Fistulas: Which type of hysterectomy has the highest post-operative fistula complication rate?
Laparoscopic hysterectomy
50
Fistulas: Which inflammatory bowel disease has the highest association with rectovaginal fistulas?
Crohn’s disease
51
Hematuria: What is the definition of asymptomatic microscopic hematuria (AMH)?
> 3 RBCs/hpf from a “properly collected urinary specimen in the absence of an obvious benign cause
52
Hematuria: What is the AUA recommended radiologic work up for asymptomatic microscopic hematuria?
CT urography, cystoscopy
53
Hematuria: How often should a patient be worked up for persistent AMH noted on annual confirmatory microscopic UA?
Every 3-5 years
54
Neurology: What are the FDA approved indication for sacral neuromodulation?
Fecal incontinence, refractory urge urinary incontinence, refractory urgency/frequency, idiopathic non-obstructive urinary retention
55
Neurology: What are the corresponding neural responses to wire placement in the sacral foramen S2 for sacral neuromodulation?
S2 = contraction of the anal sphincter and plantar flexion and lateral rotation of the lower extremity
56
Neurology: What are the corresponding neural responses to wire placement in the sacral foramen S3 for sacral neuromodulation?
S3 = bellowing of the anal sphincter and plantar flexion of the great toe
57
Neurology: What are the corresponding neural responses to wire placement in the sacral foramen S4 for sacral neuromodulation?
S4 = bellowing of the anal sphincter and no lower extremity movement
58
Neurology: Which nerve innervates the IAS?
Autonomic nervous system = enteric plexus (parasympathetic inhibits tone and sympathetic = hypogastric contributes to tone)
59
Neurology: Which nerve innervates the EAS?
Pudendal
60
Neurology: What is the innervation for the Detrusor muscle?
Sympathetic via hypogastric nerve and parasympathetic via pelvic nerves
61
Neurology: What is the innervation for the urethral smooth muscle?
Sympathetic
62
Neurology: What is the innervation for the striated urethral sphincter?
Pudendal
63
Neurology: What is the neurotransmitter for the sympathetic nervous system?
Norepinephrine
64
Neurology: What is the neurotransmitter for the parasympathetic nervous system?
Acetylcholine
65
Neurology: Onuf’s nucleus is found in what level of the spinal cord?
S2-4
66
Neurology: Which cholinergic muscarinic neuroreceptors predominate in the detrusor?
M2, M3
67
Neurology: Which nervous system predominates for micturition?
Parasympathetic
68
Neurology: Which nervous system predominates for storage?
Sympathetic
69
Painful bladder syndrome: What is the pathognomonic cystoscopic finding in painful bladder syndrome (PBS)?
Hunner’s ulcers
70
Painful bladder syndrome: what are first-line treatments for PBS?
Dietary and behavioral modifications
71
Painful bladder syndrome: what are second-line treatments for PBS?
PFMT, medication
72
Painful bladder syndrome: what are third-line treatments for PBS?
Cystoscopic hydro-distension
73
Painful bladder syndrome: what are fourth-line treatments for PBS?
Neuromodulation
74
Pelvic Organ Prolapse: Discuss the POP-Q system
Aa, Ba/gh, pb, tvl/Ap, Bp -> then add up for staging
75
Pelvic Organ Prolapse: What are some space-filling pessaries?
Gelhorn, donut, cube, or inflatoball
76
Pelvic Organ Prolapse: What are some support pessaries?
Gehrung, continence ring, continence dish
77
Pelvic Organ Prolapse: What is the vessel most likely injured during a procedure involving the sacrospinous ligament?
Pudendal, inferior gluteal
78
Pelvic Organ Prolapse: What is the vessel most likely injured during a Colposacropexy procedure?
Paraspinous veins, middle sacral artery
79
Pelvic Organ Prolapse: What is the vessel most likely injured during a Burch colposuspension procedure?
Paraurethral venous plexus
80
Pelvic Organ Prolapse: Which nerve is most likely injured during a procedure involving the sacrospinous ligament?
Sciatic or pudendal nerves
81
Pelvic Organ Prolapse: Which nerve is most likely injured during a colposacropexy procedure?
Parasympathetic plexus
82
Pelvic Organ Prolapse: Which nerve is most likely injured during a Burch colposuspension procedure?
Obturator nerve
83
Pelvic Organ Prolapse: What is the primary support to the uterus?
Uterosacral and cardinal ligament complex
84
Pelvic Organ Prolapse: Which type of mesh is used for POP repair?
Type 1 polypropylene, macroporous, monofilament
85
Surgical complications: What are the common sites of ureteral injury?
Clamping the IP ligament during BSO, clamping the uterine arteries and calming the uterosacral and cardinal ligaments
86
Surgical complications: How is a distal ureteral injury repaired?
Ureteroneocystostomy
87
Surgical complications: How is a ureteral injury above the pelvic brim repaired?
Transureteroureterostomy
88
Surgical complications: How long do you drain a bladder base injury?
For at least 7 days and until objective proof (cystoscopy or CT urogram) verifies the integrity of the repair
89
Urinary incontinence: what is the most sensitive test for stress urinary incontinence?
Standing stress test
90
Urinary incontinence: What is the basic evaluation for urinary incontinence?
Focused history, physical examination, objective demonstration of SUI, assessment of post-void residual volume, and urinalysis with possible urine culture
91
Urinary incontinence: What is the most likely source of bleeding encountered during a retropubic MUS?
Paraurethral venous plexus
92
Urinary incontinence: What is the most likely source of bleeding encountered during a obturator MUS?
Obturator vein branch
93
Urinary incontinence: Botox is FDA approved for which type of urinary incontinence?
Idiopathic overactive bladder
94
Urinary incontinence: What is the point of fixation for the vaginal during a Burch retropubic urethropexy?
Cooper’s or iliopectineal ligament
95
Urinary incontinence: What is the most accurate measurement of urethral mobility?
Q-tip or cotton swab test
96
Urinary incontinence: What are the first-line therapies for the treatment of OAB?
Behavioral therapy, pelvic floor muscle, training, weight loss, and bladder control strategies
97
Urinary incontinence: What are the second-line therapies for the treatment of OAB?
Medications, botox injections
98
Urinary incontinence: What are the third-line therapies for the treatment of OAB?
Neuromodulation
99
Urinary incontinence: What are the first-line therapies for the treatment of SUI?
Pelvic floor muscle training, anti-incontinence pessaries, weight loss, surgery
100
Urinary incontinence: What is the definition of SUI?
UI that occurs simultaneous with an increase in intra-abdominal pressures in the absence of detrusor contractions
101
Urinary incontinence: What is the definition of OAB?
Bothersome urinary urgency, usually accompanied by frequency and nocturia with or without urge incontinence, in the absence of infections or other pathology
102
Urethral diverticulum: What is the most common cancer in a urethral diverticulum?
Adenocarcinoma
103
Urethral diverticulum: Which is the best imaging technique to identify a urethral diverticulum?
T2-weighted MRI
104
Urinary tract infections: What is the most common causative organism for a UTI?
E. Coli
105
Urinary tract infections: What is the second most common causative organism for a UTI?
Staphylococcus saprophyticus
106
Urinary tract infections: What is the definition of a recurrent UTI?
> 2 UTI during a 6 month period or > 3 UTI during the past 12 moths separated by at least two weeks or involve documentation of successful treatment of the first infection
107
Urinary tract infections: What is a relapsing UTI?
A recurrent UTI with the same bacteria within 2 weeks of treatment of the original infection
108
Urinary tract infections: What are the recommended antibiotics for empiric treatment of UTI?
Nitrofurantoin (100 mg BID for 5 days), TMP/SMX (160/800 mg BID for 3 days), fosfomycin (3g PO once), beta-lactam agents (3-7 days)
109
Urinary tract infections: What is the definition of asymptomatic bacteriuria?
2 consecutive voided urine specimens with isolation of the same bacteria strain in quantitative counts 10^5 cfu/mL or a single catheterized urine specimen with 1 bacterial species isolated in a quantitative count 10^2 cfu/mL and the absence of UTI symptoms
110
Urinary tract infections: What is the definition of a UTI?
A urine culture with > 100,000 CFU of < 2 bacteria AND one sign of symptoms of cystitis (urgency, frequency, dysuria, suprapubic tenderness, fever > 38 C) with no other cause
