General Gyn Flashcards
1
Q
What is important history for gyn patients
A
- Pregnancy history
- menstrual history
- abnormal pap smears
- menopausal status
- vaginal bleeding
2
Q
What should the physical exam entail
A
- Complete physical exam, including pelvic exam
- Speculum exam
- Bimanual exam
- Should focus on disease extent inferiorly int o the vagina, lateral extent into parametria, posterior extension into uterosacral ligament, rectum
- Palpation of the inguinal and supraclavicular region
3
Q
Describe general workup
A
Labs: CBC/CMP, pregnancy test if premenapausal
Biopsy of the lesion
Imaging: CT CAP, MRI of the pelvis (PET is possible)
Consider HIV testing and smoking cessation counselling
4
Q
How do you simulate a gyn patient?
A
- Headfirst, vac loc bag
- Full and empty bladder scans
- Consider IV contrast
- Fuse with MRI
If there was vaginal extent on exam, then gold/carbon fiducial markers should be placed
5
Q
What is the dose constraint to bladder?
A
V45<35%
6
Q
What is the dose constraint to small and large bowel
A
V40<30%
V45<150cc
7
Q
What is the dose constraint to rectum?
A
V45<60%
V40<80%
8
Q
What is the dose constraint to bone marrow?
A
V10<90-95%
9
Q
What is the dose constraint to femoral heads?
A
V40<15%
10
Q
What is the dose constraint to kidney?
A
V20<33%
V15<50%
11
Q
What are the expected early toxicities of RT?
A
- Diarrhea
- urinary burning
- GI upset
- skin erythema
- fatigue
12
Q
What are the expected late toxicities of RT?
A
- Vaginal scarring/narrowing,
- fistula formation
- bowel obstruction
- bladder damage
- rectal bleeding
- osteopenia leading to insufficiency fractures
13
Q
What does follow up entail?
A
- 3 month PET
- Q3 month exam for 1-2 years with imaging
- Q6 months years 2-3 with scans
- Annually during years 4-5 with scans
