General/GYN (Kane) Exam 3 Flashcards
1
Q
When was laparoscopy first used for the diagnosis of gynecologic conditions?
a) 1950s
b) 1960s
c) 1970s
d) 1980s
A
c) 1970s
Slide 2
2
Q
In which decade was laparoscopic cholecystectomy developed?
a) 1960s
b) Late 1970s
c) Late 1980s
d) Late1990s
A
c)Late 1980s
Slide 2
3
Q
Which procedure is considered minimally invasive?
a) Laparoscopy
b) Laparotomy
A
a) Laparoscopy
Slide 2
4
Q
What are the two main purposes of intraperitoneal insufflation of CO₂?
a) Decrease blood flow and increase pain
b) Identification of intraperitoneal space and room to work
c) Increase pressure and decrease blood supply
d) Reduce inflammation and increase blood supply
A
b) Identification of intraperitoneal space and room to work
Slide 3
5
Q
What substances are released at the onset of pneumoperitoneum?
a) Insulin and glucagon
b) Adrenaline and noradrenaline
c) Catecholamines and vasopressin
d) Endorphins and dopamine
A
c) Catecholamines and vasopressin
Kane: if he really is in the peritoneum, see pressure increases on the abdomen during initial insufflation and then the body releases catecholamines, vasopressin, and see huge increase in SVR because of the pressurized great vessels
Slide 3
6
Q
What effect does creating a pneumoperitoneum have on arterial vasculature?
a) Dilation of arterial vasculature
b) Compression of arterial vasculature
c) Increased blood flow
d) No effect
A
b) Compression of arterial vasculature
Slide 3
7
Q
What is the maximum intra-abdominal pressure (IAP) recommended during the creation of a pneumoperitoneum?
a) 10 mm Hg
b) 15 mm Hg
c) 20 mm Hg
d) 25 mm Hg
A
c) 20 mm Hg
Slide 3
8
Q
Which of the following pulmonary effects are associated with increased PaCO₂ during laparoscopy? select 3
a) Decreased FRC
b) Increased PIP
c) Increased FRC
d) Development of atelectasis
A
a) Decreased FRC - tidal volume drops
b) Increased PIP
d) Development of atelectasis - if you didn’t adjust for hypoventilation
Slide 4
9
Q
Which of the following statements are true about lung compliance during laparoscopy?
a) It increases by 30-50%
b) It decreases by 30-50%
c) It remains unchanged
d) It contributes to easier lung expansion
A
b) It decreases by 30-50%
diaphragm cannot drop and lungs cannot expand
Slide 4
10
Q
How long does it typically take for absorbed PaCO₂ levels to plateau during laparoscopy?
a) 5-10 minutes
b) 10-15 minutes
c) 15-20 minutes
d) 20-25 minutes
A
b) 10-15 minutes
increased PaCO2 due to absorption of CO2 that plateaus in 10-15 mins
Slide 5
11
Q
Which factor is considered when deciding on treatment for increased PaCO₂ during laparoscopy? (2)
a) Increase Vm
b) Early case vs. late case
c) Patient’s age
d) Type of anesthetic used
A
a) Increase Vm
b) Early case vs. late case
Kane: If early on the case and your CO2 at 50-55, you want to adjust that and you want to blow OFF that CO2 ; If towards at end of the case and increase CO2 is more than you’d like to be, you may choose to leave it so pt. will be stimulated to breath
Slide 5
12
Q
Which of the following are potential pulmonary complications during laparoscopy? (3)
a) Subcutaneous emphysema
b) Pneumothorax
c) Pneumomediastinum
d) Pulmonary edema
A
a) Subcutaneous emphysema
b) Pneumothorax
c) Pneumomediastinum
possibility can stick trocars through belly and into the chest 🙁
Slide 6
13
Q
What are pulmonary complications from insufflation during laparoscopic prodecures? (select 3)
a) Gas embolism
b) Endobronchial intubation
c) Pulmonary fibrosis
d) Subcutaneous emphysema
A
a) Gas embolism
b) Endobronchial intubation
d) Subcutaneous emphysema
Slide 6
14
Q
What is a common cause of subcutaneous emphysema and pneumothorax during laparoscopy?
a) High intra-abdominal pressure
b) Improper placement of trocars
c) Overuse of anesthesia
d) Patient’s pre-existing conditions
A
b) Improper placement of trocars
*pneumothorax requires CT
Slide 7
15
Q
How long does it typically take for subcutaneous emphysema and pneumothorax to resolve?
a) 10-20 minutes
b) 20-30 minutes
c) 30-60 minutes
d) 60-90 minutes
A
c) 30-60 minutes
Slide 7
16
Q
Which of the following should be monitored when managing subcutaneous emphysema and pneumothorax? (select 2)
a) Blood pressure
b) Heart rate
c) Ventilation
d) Oxygenation
A
c) Ventilation
d) Oxygenation
Slide 7
17
Q
What causes a gas embolism during insufflation?
a) Gas infused directly into the abdominal cavity
b) Gas infused directly into a vessel
c) High oxygen levels
d) Low atmospheric pressure
A
b) Gas infused directly into a vessel
Kane: In vessel = massive embolism can lose the patient
Slide 8
18
Q
True or False
A gas lock in the vena cava can enhance venous return.
A
False
A gas lock in the vena cava can obstruct venous return.
Laparoscopic Surgery
Slide 8
19
Q
Which cardiac issues are a sign of gas embolism? (4)
a) Atrial fibrillation
b)Tachycardia
c) Hypotension with increased CVP
d) Ventricular hypertrophy
e) Cardiac dysrhythmias
f) Millwheel murmur
A
b)Tachycardia
c) Hypotension with increased CVP
e) Cardiac dysrhythmias
f) Millwheel murmur
Laparoscopic Surgery
Slide 9
20
Q
Which of the following are diagnostic signs of gas embolism? (Select 2)
a) Hypoxemia
b) Bradycardia
c) Decreased ETCO₂
d) Hypercapnia
A
a) Hypoxemia -better seen on ABG
c) Decreased ETCO₂
Laparoscopic Surgery
Slide 9
21
Q
Which of the following is a common treatment step for gas embolism during laparoscopy?
a) Increase insufflation pressure
b) Cessation of insufflation/release of pneumoperitoneum
c) Initiate CPR
d) Induce hypothermia
A
b) Cessation of insufflation/release of pneumoperitoneum
Slide 9
22
Q
Laparoscopic Surgery
Which of the following treatments are appropriate for gas embolism? (Select all that apply)
a) Trendelenburg position
b) Fluid bolus
c) Increase oxygen intake to 100%
d) Aspiration of air
e) Vasopressor support
A
All of the above
a) Trendelenburg position - put pt. in left lateral tilt with head down -keep bubble in right heart and prevent from going into lungs
b) Fluid bolus
c) Increase oxygen intake to 100%
d) Aspiration of air -if pt has a central line
e) Vasopressor support
Slide 9
23
Q
True or False
The use of vasopressors is contraindicated in the treatment of gas embolism
A
False
The use of vasopressors is a treatment of gas embolism.
Kane: Vasopressor support b/c C.O. decline
Slide 9
24
Q
What anatomical change can lead to endobronchial intubation during laparoscopy? (select 2)
a) Diaphragm depression
b) Diaphragm elevation
c) Carina displacement cephalad
d) Tracheal dilation
A
b) Diaphragm elevation
c) Carina displacement cephalad
Slide 10
25
Which steps are involved in monitoring for and adjusting endobronchial intubation? (select 3)
a) Monitor position of the ETT
b) Increase insufflation pressure
c) Auscultate bilateral breath sounds
d) Use pulse oximetry to monitor oxygenation
a) Monitor position of the ETT
c) Auscultate bilateral breath sounds
d) Use pulse oximetry to monitor oxygenation - O2 saturation dip down
*PIP can shoot up if tube hitting carina
*
| Laparoscopic Surgery
## Footnote
Slide 10
26
At what intra-abdominal pressure (IAP) do hemodynamic effects typically occur during laparoscopy?
a) < 5 mm Hg
b) > 10 mm Hg
c) > 15 mm Hg
d) > 20 mm Hg
b) > 10 mm Hg
## Footnote
Slide 11
27
Which of the following is a hemodynamic effect of increased IAP during laparoscopy?
a) Increased cardiac output
b) Decreased cardiac output
c) Decreased arterial pressure
d) Decreased SVR/PVR
b) Decreased cardiac output
## Footnote
Slide 11
28
Increased IAP during laparoscopy can lead to increased: (select 2)
a) Cardiac output
b) Arterial pressure
c) Venous return
d) SVR/PVR
b) Arterial pressure
d) SVR/PVR
## Footnote
Slide 11
29
How long do the hemodynamic effects typically last after they occur during laparoscopy?
a) Several seconds
b) Several minutes
c) Several hours
d) Several days
b) Several minutes
## Footnote
Slide 11
30
Which of the following are used as vasodilating agents to treat hemodynamic effects during laparoscopy? (Select 4)
a) Vapor
b) Nitroglycerin
c) Cardene
d) Remifentanil
e) Epinephrine
a) Vapor
b) Nitroglycerin
c) Cardene
d) Remifentanil
*use something short acting since hemodynamic instability usually resloves in several minutes*
**V**ital **N**umbers **C**ontrol **R**ates
| ..Kane also said Esmolol, not on slide though
## Footnote
Slide 12
31
Which of the following statements is true regarding cardiac arrhythmias during laparoscopy?
a) They correlate strongly with the level of PaCO₂.
b) They do not correlate with the level of PaCO₂.
c) They are caused by hyperventilation.
d) They are prevented by increasing insufflation pressures.
b) They do not correlate with the level of PaCO₂.
## Footnote
Slide 13
32
What can cause reflex increases in vagal tone, potentially leading to cardiac arrhythmias during laparoscopy? (select 3)
a) Hyperventilation
b) Peritoneal stretch
c) Electro-cautery
d) Stretch of fallopian tubes
e) Nephrectomy
b) Peritoneal stretch
c) Electro-cautery
d) Stretch of fallopian tubes
| esp correlate to YOUNG FEMALES
## Footnote
Slide 13
33
What are two methods to manage or prevent cardiac arrhythmias caused by increased vagal tone during laparoscopy?
a) Decrease ventilation rate and increase fluid intake
b) Increase PaCO₂ levels and administer atropine
c) Limit insufflation pressures and administer glycopyrrolate
d) Increase insufflation pressures and administer epinephrine
c) Limit insufflation pressures and administer glycopyrrolate
## Footnote
Slide 13
34
Which of the following complications can occur in the head-down (Trendelenburg) position during laparoscopy? (Select 4)
a) Facial/pharyngeal/laryngeal airway edema
b) Decreased central venous pressure (CVP)
c) Increased intraocular pressure
d) Altered pulmonary mechanics
e) Increased intracranial pressure
a) Facial/pharyngeal/laryngeal airway edema
c) Increased intraocular pressure
d) Altered pulmonary mechanics -* Decreased FRC, TLV, compliance*
e)increased intracranial pressure
## Footnote
Slide 14
35
What are the hemodynamic effects of the head-up (reverse Trendelenburg) position during laparoscopy? (Select 3)
a) Decreased cardiac output
b) Venous stasis
c) Increased cardiac output
d) Favorable ventilation
a) Decreased cardiac output
b) Venous stasis
d) Favorable ventilation
## Footnote
Slide 14
36
In the head-down (Trendelenburg) position during laparoscopy, what happens to central venous pressure (CVP) and cardiac output (CO)?
a) CVP and CO decrease
b) CVP and CO increase
c) CVP increases, CO decreases
d) CVP decreases, CO increases
b) CVP and CO increase
## Footnote
Slide 14
37
Which nerve is commonly at risk of injury due to overextension of the arm during surgery?
a) Ulnar nerve
b) Median nerve
c) Brachial plexus
d) Radial nerve
c) Brachial plexus
| need adequate shoulder support
## Footnote
Slide 15 Laproscopic
38
Which nerve is commonly at risk of injury in the lithotomy position?
a) Femoral nerve
b) Peroneal nerve
c) Sciatic nerve
d) Tibial nerve
b) Peroneal nerve
## Footnote
Slide 15
39
What is a potential complication of the lithotomy position besides nerve injury?
a) Deep vein thrombosis
b) Compartment syndrome
c) Pulmonary embolism
d) Compartment embolism
b) Compartment syndrome
## Footnote
Slide 15 Laproscopic
40
Which of the following must laparoscopy demonstrate compared to laparotomy? (Select 3)
a) More rapid recovery
b) Increased complication rates
c) Better maintenance of hemostasis
d) Less risk
a) More rapid recovery
c) Better maintenance of hemostasis
d) Less risk
## Footnote
Slide 16
41
What are the benefits of laparoscopy compared to laparotomy? (Select 2)
a) Decreases postoperative pain
b) Increases postoperative pain
c) Decreases postoperative nausea/vomiting
d) Increases postoperative pulmonary dysfunction
a) Decreases postoperative pain
c) Decreases postoperative nausea/vomiting
***and Less pulmonary dysfunction (but not none)***
## Footnote
Slide 16
42
Which type of injury accounts for 30-50% of serious complications during laparoscopy?
a) Vascular injuries
b) Burns
c) Intestinal injuries
d) Infections
c) Intestinal injuries
*perforations, CBD injury; May remain undiagnosed*
| cbd-common bile duct injury
## Footnote
Slide 17
43
Which of the following are potential vascular complications of laparoscopy? (Select 2)
a) Retroperitoneal hematomas
b) Superficial vein thrombosis
c) Great vessel injury
d) Varicose veins
a) Retroperitoneal hematomas *often insidious*
c) Great vessel injury *emergent*
## Footnote
Slide 17
44
Burns account for what percentage of complications during laparoscopy?
a) 5-10%
b) 10-15%
c) 15-20%
d) 20-25%
c) 15-20%
## Footnote
Slide 17
45
# True or False
The risk of infection during laparoscopy is very high.
False
The risk of infection during laparoscopy is very small
## Footnote
Slide 17
46
Which of the following conditions contraindicate the use of laparoscopy? (Select 3)
a) Increased intracranial pressure (ICP)
b) Hypertension
c) Trauma
d) Hydrocephalus
a) Increased intracranial pressure (ICP)
c) Trauma
d) Hydrocephalus
and tumor
## Footnote
Slide 17
47
What are the key components of anesthesia management for laparoscopy? (Select 3)
a) Preoperative medications
b) Controlled ventilation
c) Positioning
d) Type of surgical incision
a) Preoperative medications -ei albuterol versed
b) Controlled ventilation -normal ETCO2, volume,RR
c) Positioning - *Kane- put EKG stickers on the back for breast cases*
## Footnote
Slide 18
48
Which type of anesthesia is commonly used for laparoscopy?
a) Regional anesthesia
b) Local anesthesia
c) General endotracheal anesthesia (GETA)
d) Sedation
c) General endotracheal anesthesia (GETA)
- some providers use LMA (more in Britain)
## Footnote
Slide 18
49
Controlled ventilation during laparoscopy aims to maintain which parameter within normal range?
a) PaO₂
b) ETCO₂
c) pH
d) Blood pressure
b) ETCO₂
*Volume vs RR*
## Footnote
Slide 18
50
# True or False
An orogastric tube (OGT) or nasogastric tube (NGT) is used during laparoscopy to decompress the stomach.
True
*Kane: place NGT if need post-op after laparoscopy"
Laparotomy
Post op ileus common → will need NGT post op
OGT more so for during the case
## Footnote
Slide 18
51
What treatments are given during laparoscopy? Select 3
a) IVF
b) Narcotics
c) NMBD
d) ASA
a) IVF for hemodynamic changes
(tailor amount for young vs elderly)
b) Narcotics
c) NMBD
use crystalloids
elderly + bowel prep = extra dehydration, may also consider albumin
## Footnote
Slide 18
52
# True or False
Oxygen is usually not required postoperatively of Laparoscopy unless there are respiratory complications.
False
*Pt. goes to PACU with O2*
## Footnote
Slide 19
53
What is the most important complication that should be prevented after laparoscopy?
a) prevent infection
b) enhance wound healing
c) prevent nausea and vomiting
d) reduce swelling
c) prevent nausea and vomiting
## Footnote
Slide 19
54
What type of pain is/are mostly treated postoperatively after laparoscopy?
Select 2
a) surgical pain
b) acute pain
c) referred pain
d) visceral pain
a) surgical
c) referred
## Footnote
Slide 19
55
What should be discussed with patients preoperatively to help manage their postoperative pain after laparoscopy?
a) Dietary restrictions
b) Referred pain
c) Exercise routines
d) Social activities
b) Referred pain
*Kane: Most pt. have pain on right shoulder
During embryonic stage, the nerve that supply shoulder and diaphragm are together and so shoulder pain occurs d/t to belly pain*
## Footnote
Slide 19
56
According to the Surgical Care Improvement Project, when should antibiotics be administered prior to surgery?
a) Within 24 hours
b) Within 2 hours
c) Within 1 hour
d) Within 6 hours
c) Within 1 hour
*document that it is given"
## Footnote
Slide 20
57
Beta blockers should be given within what time frame in relation to surgery to comply with the Surgical Care Improvement Project guidelines?
a) Within 1 hour
b) Within 6 hours
c) Within 12 hours
d) Within 24 hours
d) Within 24 hours
## Footnote
Slide 20
58
What is the target body temperature that should be maintained during surgery according to the Surgical Care Improvement Project?
a) Less than 36°C
b) Greater than or equal to 36°C
c) Exactly 37°C
d) Between 35°C and 37°C
b) Greater than or equal to 36°C/96.8
59
When should the "time out" procedure be performed in relation to the surgical incision?
a) After the incision
b) During the incision
c) Prior to the incision
d) At the end of the surgery
c) Prior to the incision
## Footnote
Slide 20
60
What is the primary purpose of a biopsy in breast surgery?
a) To remove the entire breast
b) To excise a breast lesion with margins
c) To remove axillary lymph nodes
d) To perform breast reconstruction
b) To excise a breast lesion with margins
## Footnote
Slide 23
61
A lumpectomy (partial mastectomy) involves the removal of which size of breast lesion?
a) 0.5-1 cm
b) 1.5-2 cm
c) 2.5-5 cm
d) 5-7 cm
c) 2.5-5 cm
## Footnote
Slide 23
62
Which procedure involves the removal of the breast and nipple without lymph node involvement?
a) Biopsy
b) Lumpectomy
c) Simple mastectomy
d) Radical mastectomy
c) Simple mastectomy
*No lymph node involvement or poor surgical risk*
## Footnote
Slide 23
63
Which structures are removed in a **modified** radical mastectomy?
a) Only the breast and nipple
b) Breast, nipple, and axillary lymph nodes
c) Entire breast, nodes, and pectoralis muscle
d) Breast, nipple, and pectoralis muscle
b) Breast, nipple, and axillary lymph nodes
| can have +/- reconstruction
## Footnote
Slide 23
64
A radical mastectomy includes the removal of (select 3)?
a) nodes
b) entire breast
c) Pectoralis muscle
d) Breast lesion with margins
a) nodes
b) entire breast
c) Pectoralis muscle
## Footnote
Slide 23
65
Which of the following are part of the preoperative evaluation for breast surgery? (Select 4)
a.) Evaluation of renal function
b.) Preop meds
c.) SCIP antibiotics
d.) Evaluation of cardio/pulm
e.) Pregnancy tests
| Slide 24-27
B, C, D, E,
66
Which of the following are methods used intraoperatively during Bx vs. Mastectomy vs. Reconstruction? (Select 4)
a.) Wire localization
b.) Local vs LMA
c.) SLN mapping
d.) Postoperative oxygen
e.) frozen section
| S 24-27
A, B, C,E
*Wire localization -Wire is to help locate small lesions
Local vs LMA - Small procedure (bx)+ minimal position changes ⇒ local & LMA
Mastectomy/reconstruction + positioning ⇒ req ETT
SLN mapping (sentinal lymph node maping) -To figure out if cancer in breast or it has gone to lymph nodes & is metastasizing
Frozen section -Dye is absorbed into lymph system and travels to primary lymph node and follow the drainage pattern. Surgeon removes lymph nodes till no more cancer cells.
67
What should be evaluated if the patient received radiation/chemotherapy prior to surgery?
a) Renal function
b) Cardio/pulmonary function
c) Gastrointestinal function
d) Neurological function
| S 24-27
b) Cardio/pulmonary function
| Breast Procedures
68
Which agent used in Sentinel Lymph Node mapping can cause a rare anaphylaxis?
a) Methylene blue
b) Indigo carmine
c) Lymphazurin
d) Fluorescein
| S 24-27
c) Lymphazurin
69
Intraoperative pain control for breast surgeries can be managed using short-acting vs. _______ narcotics and multi-modal approaches including __________ blocks.
| S 24-27
* long-acting
* paravertebral
Lots of nerves in breast! Be careful of **long thoracic nerve** --> can result in a winged scapula = debilitating pain & bad shoulder movement - the shoulder falls away from the posterior chest
70
A common method for breast reconstruction is the _______ flap, which uses muscle and skin from the abdominal area.
| S 24-27
TRAM (Transverse rectus abdominus myocutaneous)
## Footnote
Slide 27
71
Preoperative medications, SCIP antibiotics, and _______ tests are essential parts of the preoperative evaluation for Breast Surgeries.
| S 24-27
Pregnancy
## Footnote
Slide 24
72
Which of the following are reconstruction methods mentioned? (Select 4)
a.) Tissue expander
b.) Latissimus dorsi myocutaneous (LDM) flap
c.) Transverse rectus abdominus myocutaneous (TRAM) flap
d.) Deep inferior epigastric perforators (DIEP) flap
e.) Free flap from the thigh
| S 24-27
A, B, C, D
tissue expander - inject NS into breast tissue
## Footnote
slide 27
73
Match the following complications that can arise from Sentinel Lymph Node mapping using different dyes? (Select 3)
a.) Renal insufficiency (Methylene blue)
b.) Sulfa allergy reaction (Indigo carmine)
c.) *rare* Anaphylaxis (Lymphazurin)
## Footnote
Slide 25
74
Which type of anesthesia is mentioned as a possibility for breast biopsy vs. mastectomy vs. reconstruction?
a) Epidural anesthesia
b) Local vs LMA
c) Spinal anesthesia
d) Conscious sedation
| S 24-27
b) Local vs LMA
## Footnote
Slide 25
75
Which of the following are characteristics of the Latissimus dorsi myocutaneous (LDM) flap used in breast reconstruction? (Select 2)
a.) Uses muscle and skin from below the scapula
b.) Cut away as a pedicle graft and tunneled through axilla
c.) Cut away and tunneled through abdomen
d.) Denervates abdomen
A, B
Does not risk being avascular, looks natural, doesn't take a long time
| most commonly done
## Footnote
Slide 27
76
Which of the following are characteristics of the Transverse rectus abdominus myocutaneous (TRAM) flap? Select 3.
a.) Uses abdominal muscle, sub-q, and skin
b.) Remains attached to native blood supply
c.) Skin and fat removed from abdomen without muscle
d.) Uses muscle and skin from below the scapula
e.) Mesh prosthesis to abdomen
A, B, E
Women like it,it makes them feel skinny ;)
However, because it pulls muscle from the belly there is less support in that area & can end up with abdominal hernia if no mesh added
## Footnote
Slide 27
77
Which reconstruction method involves the removal of skin and fat from the abdomen without using muscle, thereby preserving abdominal strength?
a) Latissimus dorsi myocutaneous (LDM) flap
b) Transverse rectus abdominus myocutaneous (TRAM) flap
c) Deep inferior epigastric perforators (DIEP) flap
d) Tissue expander
c) Deep inferior epigastric perforators (DIEP) flap
| *Denervates abdomen. Very vascular heals nicely, but not as much volume
## Footnote
Slide 27
78
Which type of breast reconstruction is cut away as a pedicle graft and tunneled through the axilla?
a) Tissue expander
b) Latissimus dorsi myocutaneous (LDM) flap
c) Transverse rectus abdominus myocutaneous (TRAM) flap
d) Deep inferior epigastric perforators (DIEP) flap
b) Latissimus dorsi myocutaneous (LDM) flap
## Footnote
Slide 27
79
Which of the following are indications for Nissen fundoplication? (Select 3)
a.) To increase lower esophageal sphincter pressure
b.) Complications from GERD
c.) Ingestion of too many antacids
d.) Failure or unwillingness to commit to medication
| S 28-31
A, B, D
*Complications from GERD include:
Stricture
Aspiration pneumonia
Esophageal ulcerations
Barrett’s esophagus*
## Footnote
Slide 29
80
What is the primary purpose of Nissen fundoplication?
a) To decrease stomach size
b) To increase lower esophageal sphincter pressure
c) To remove esophageal tumors
d) To bypass the esophagus
| S 28-31
b) To increase lower esophageal sphincter pressure
| Wrap stomach around esophagus to increase pressure
## Footnote
Slide 29
81
Which positioning is used intraoperatively for Nissen fundoplication?
a) Prone, high lithotomy
b) Supine, low lithotomy, reverse Trendelenburg
c) Lateral decubitus
d) High Fowler's position
b) Supine, low lithotomy, reverse Trendelenburg
## Footnote
Slide 31
82
Proton pump inhibitors (PPIs) such as _______, ________, __________ and ___________ are used preoperatively to decrease acid production by blocking ATPase in parietal cells.
* the prazoles... nexium, prevacid, protonix, prilosec
| preop- Nissen fundoplication
## Footnote
Slide 30
83
Prokinetic drugs like _______ and domperidone are used preoperatively to strengthen the LES and increase gastric emptying.
metoclopramide
| Nissen fundoplication
preop -
## Footnote
Slide 30
84
Intraoperatively, an _______ (___fr) is used to dilate the esophagus during Nissen fundoplication.
* esophageal dilator
* 60 Fr
## Footnote
Slide 31
85
# Nissen fundoplication
Intraoperatively, for a nissen fundoplication, which of the following are necessary? Select 4.
a) GETA/RSI
b) SCIP antibiotics
c) OGT
d) Esophageal constrictor
e) Preop meds
**a, b, c, e**
a) GETA/RSI - will always be an RSI due to risk of aspiration from GERD
c) OGT - to decompress
86
Stricture, Aspiration pneumonia, Esophageal ulcerations and
Barrett’s esophagus area all complications of _________.
GERD
## Footnote
Slide 29
87
What is the purpose of the esophageal dilator used intraoperatively during Nissen fundoplication?
a) To remove esophageal polyps
b) To strengthen the esophageal wall
c) To dilate the esophagus and ensure the wrap is not too tight
d) To measure esophageal pH
c) To dilate the esophagus and ensure the wrap is not too tigh
## Footnote
Slide 31
88
Documented esophageal _______ is an important preoperative consideration for Nissen fundoplication.
hyperacidity
## Footnote
Slide 30
89
Which of the following are indications for a cholecystectomy? (Select 2)
a.) Symptomatic cholelithiasis
b.) Symptomatic cholecystitis
c.) Asymptomatic gallstones
d.) Pancreatitis
| S 32-35
a.) Symptomatic cholelithiasis
b.) Symptomatic cholecystitis
## Footnote
Slide 33
90
Which of the following preoperative considerations are important for cholecystectomy? (Select 3)
a.) Many are emergent with a full stomach
b.) Use of prokinetics
c.) Administration of Bicitra
d.) NPO status for 24 hours
A, B, C
**A- make them an RSI
## Footnote
Slide 34
91
What are the typical characteristics of patients with symptomatic cholecystitis referred to as the "5 F's"?
a) Female, fifty, fair, full, fat
b) Female, forty, fair, flatulent, fat
c) Female, forty, fit, flatulent, fat
d) Female, fifty, fair, flatulent, fat
b) Female, forty, fair, flatulent, fat
## Footnote
slide 33
92
Which position is commonly used during a cholecystectomy?
a) Supine, high lithotomy
b) Prone, reverse Trendelenburg
c) Supine, reverse Trendelenburg, left tilt
d) Lateral decubitus, right tilt
c) Supine, reverse Trendelenburg, left tilt
## Footnote
Slide 35
93
During intraoperative cholangiography (IOC), _______ is used to manage sphincter of Oddi spasm.
glucagon
*Oddi of spasm is caused by opiods and dye not dispersing
| Causes relaxation and helps w spread of dye
## Footnote
Slide 35
94
Which of the following conditions might require endoscopic retrograde cholangiopancreatography (ERCP) during a cholecystectomy?
a) Cholecystitis
b) Choledocholithiasis
c) Pancreatitis
d) Gastritis
b) Choledocholithiasis
## Footnote
Slide 35
95
What is the purpose of intraoperative cholangiography (IOC) during a cholecystectomy?
a) To visualize the stomach
b) To monitor cardiac function
c) To visualize the bile ducts and check for stones
d) To measure blood pressure
c) To visualize the bile ducts and check for stones
## Footnote
Slide 35
96
For cholecystectomy intraoperative management, an orogastric tube (OGT) is placed to _______ the stomach.
| S 32-35
decompress
| Cholecystectomy
side note also make them GETA
## Footnote
Slide 35
97
Which structures form the boundaries of the Triangle of Calot for a cholecystectomy ? (Select 3)
a.) Cystic duct
b.) Common hepatic duct
c.) Cystic artery
d.) Common bile duct
e.) Inferior Liver border
| 32-35
a.) Cystic duct
b.) Common hepatic duct
e.) Inferior Liver border
| Cholecystectomy
## Footnote
Slide 32
98
Which of the following are indications for a splenectomy? (Select 4)
a.) Immune thrombocytopenic purpura (ITP)
b.) Lymphoma
c.) Hemolytic anemia
d.) Trauma
e.) Chronic pancreatitis
a.) Immune thrombocytopenic purpura (ITP)
b.) Lymphoma
c.) Hemolytic anemia
d.) Trauma
## Footnote
Slide 37
99
Which of the following preoperative considerations are important for patients undergoing splenectomy? (Select 4)
a.) Pneumococcal vaccination
b.) Meningococcal vaccination
c.) H. influenza vaccination
d.) Hepatitis B vaccination
e.) Evaluate left lower lobe atelectasis
a.) Pneumococcal vaccination
b.) Meningococcal vaccination
c.) H. influenza vaccination
e.) Evaluate lower lobe atelectasis - *spleen could be a little larger, might be more complicated d/t hematoma.* Lobe can also not be able to expand because spleen is large
*Vaccines should be given 1 week preop if NOT emergent surgery*
Spleen wont be able to protect against these organisms
## Footnote
Slide 38
100
Which intraoperative position is typically used for splenectomy?
a) Supine with head elevated
b) 45 degree Left lateral decubitus with kidney rest and table flexed
c) 45 degree Right lateral decubitus with kidney rest and table flexed
d) 60 degree Right lateral decubitus with kidney rest and table flexed
c) 45 degree Right lateral decubitus with kidney rest and table flexed
| *also make sure GETA and extra IV access
## Footnote
Slide 39
101
What is the primary difference between a Type and Cross test and a Type and Screen test?
a) Type and Cross only determines blood type, while Type and Screen identifies antibodies
b) Type and Screen is more specific for blood transfusion than Type and Cross
c) Type and Cross determines blood type and identifies antibodies, while Type and Screen only determines blood types
d) There is no significant difference between the two tests
| S 36-39
c) Type and Cross determines blood type and identifies antibodies, while Type and Screen only determines blood types
| obtain for splenectomy
## Footnote
Slide 39
102
Which of the following are indications for a bowel resection? (Select all that apply)
a.) Ulcerative colitis
b.) Crohn's disease
c.) Diverticular disease
d.) Cancers
e.) Ischemic bowel
| S 40-43
all the above
## Footnote
Slide 41
103
Which of the following preoperative preparations are important for bowel resection? (Select 5)
a.) Bowel prep
b.) Mu-opioid antagonists
c.) Preoperative warming
d.) Gabapentin, acetaminophen, scopolamine
e.) Gatorade
f.) Prokinetics
| S 40-43
a.) Bowel prep
b.) Mu-opioid antagonists
** ERAS**
Belly surgies complicated = fluid shifts & infections
c.) Preoperative warming - no shivering uses too much energy
d.) Gabapentin, acetaminophen, scopolamine
e.) Gatorade -
*Pre-operative warming to reduce shivering*
| Bowel loses fluid quickly - keep wet,covered,maintain temp= hypovolemic
## Footnote
Slide 42
104
Which mu-opioid antagonist is mentioned for use preoperatively in bowel resection to prevent postoperative ileus?
a) Naloxone
b) Alvimopan (Entereg)
c) Naltrexone
d) Methylnaltrexone
b) Alvimopan (Entereg)
*Alvimopan attaches to receptors on bowel. It must be given prior to any other narcotics.*
*It prevents narcotics from attaching to the bowel receptors and can reduce incidence of ileus*
*Prevent ileus from lasting longer and lets patient leave quicker after surgery*
## Footnote
Slide 42
105
Preoperative medications for bowel resection may include gabapentin, acetaminophen, and _______ to help manage pain and nausea.
scopolamine
*Preop - consider also GETA, OG/NGT, SCIP antibiotics, post op pain control - TAP block or lumbar epidural
## Footnote
Slide 42
106
Which intraoperative position is commonly used for bowel resection?
a) Prone
b) Supine or low lithotomy
c) Left lateral decubitus
d) High Fowler's
b) Supine or low lithotomy
*Frequent position changes*
## Footnote
Slide 43
107
A consequence of the bowel prep is dehydration. Intraoperatively ____ or _____ should be given.
| S 40-43
* Crystalloids
* Albumin
Albumin>Crystalloid
*Also consider hetastarch, plasmalyte – more osmolarity*
## Footnote
Slide 43
108
An Appendectomy is considered for suspected _________.
Appendicitis
109
All patient's having an Apendectomy are considered a _____ stomach and will receive an ______ induction.
* Full
* RSI
Decreased peristalsis
Use GETA
| Bc usually emergent = inflammation
## Footnote
Slide 46
110
Appendicitis patients will be dehydrated due to ______ and _______.
| S 44-46
* fever
* nausea and vomiting
## Footnote
Slide 46
111
Lab work before an Appendecomy will show (Select 3)
a.) hemodilution
b.) hemoconcentration
c.) elevated BUN
d.) elevated creatinine
e.) normal creatinine
| S 44-46
b.) hemoconcentration
c.) elevated BUN
e.) normal creatinine
*Creatinine will be normal (d/t dehydration NOT kidney issues)*
## Footnote
Slide 46
112
Which position is commonly used for a patient undergoing surgery for appendicitis?
a) Supine, arms at the side, trendelenburng
b) Supine, left arm tucked, trendelenburg
c) Supine, arms extended, reverse tburg
d) Supine, right arm tucked, reverse tburg
b) Supine, left arm tucked, trendelenburg
*Both surgeons stand on the same side during surgery. Tucking one arm allows them more room and prevent injury to the left arm if it were to be extended*
## Footnote
Side 47
113
Which of the following are used during an appendectomy?
(Select 2)
A. SCIP antibiotics
B. NGT
C. OGT
D. No SCIP antibiotics
A. SCIP antibiotics
C. OGT
## Footnote
Slide 47
114
Which of the following procedures is characterized by a slow weight loss of 55% excess over 5 years and is easily removed?
a) Sleeve Gastrectomy
b) Gastric Bypass
c) Lap Banding
d) Lap Bypass
c) Lap Banding
## Footnote
Slide 48
115
Which bariatric procedures are known for rapid initial weight loss? Select 2
a) Lap Banding
b) Sleeve Gastrectomy
c) Gastric Bypass
d) Lap Gastrectomy
Both b and c
*Sleeve gastrectomy is not EASILY reversible while the gastric bypass is NOT reversible at all.*
*Gastric bypass if for patients that need to lose >300lbs quickly*
## Footnote
Slide 48
116
Which procedure has the potential complication of band erosion?
a) Sleeve Gastrectomy
b) Gastric Bypass
c) Lap Banding
d) Sleeve banding
c) Lap Banding
*Has an access port to blow up a balloon, it adjusts how big your stomach is/how much food goes through*
*Loss of weight is slower, or you can still overeat and not lose weight*
| Pro:quick procedure, no suture line, no altered nutrients
## Footnote
Slide 48
117
In which procedure are nutrients not affected, but suture line issues and overeating can be complications?
a) Lap Banding
b) Sleeve Gastrectomy
c) Gastric Bypass
d) Gastric Gastrectomy
b) Sleeve Gastrectomy
## Footnote
Slide 48
118
Which bariatric procedure involves the highest risk of malabsorption?
a) Sleeve Gastrectomy
b) Gastric Bypass
c) Lap Banding
d) Gastric Banding
b) Gastric Bypass
Missing absorption spots for vitamins + proteins bc sx close to descending colon/rectum
## Footnote
Slide 48
119
Which bariatric procedure involves two suture lines and protein/nutrients ARE affected?
a) Lap Banding
b) Sleeve Gastrectomy
c) Gastric Bypass
d) None of the above
c) Gastric Bypass *aka Roux-en-Y*
*higher incidence of peritonitus with the double suture line*
*Overtime, surgery has improved by not resecting very much intestine and nutrient absorption has improved*
| Pro:Lose weight fast!
## Footnote
Slide 48
120
Which bariatric procedures are known for not affecting nutrients? Select 2
a) Lap Banding
b) Sleeve Gastrectomy
c) Gastric Bypass
d) Lap Gastrectomy
a) Lap Banding
b) Sleeve Gastrectomy -Cut a sleeve, long straight narrow piece of stomach off
Sleeve gastrectomy helps with weight loss, uses one incision instead of 2
## Footnote
Slide 48
121
Which of the following comorbidities is NOT listed as an indication for bariatric surgery in morbidly obese patients?
a) Hypertension (HTN)
b) Diabetes
c) Sleep apnea
d) Osteoarthritis
e)asthma
d) Osteoarthritis
## Footnote
Slide 49
122
Bariatric surgery is indicated for patients with a BMI greater than _________ with comorbidities:
a) 25
b) 30
c) 35
d) 40
c) >35
*AND a BMI >40 with NO co-morbidities is also indicated for bariatric surgery*
## Footnote
Slide 49
123
Which of the following medications should be reviewed preoperatively for bariatric surgery patients due to their potential impact on surgery?
a) Appetite suppressors
b) Appetite stimulants
c) Antibiotics
d) Ointments
a) Appetite suppressors
*Garlic, ginko, ginseng*
| Stop all the G supplements = bleeding
## Footnote
Slide 50
124
What are key factors in ventilating bariatric patients before induction of anesthesia? (2)
a) Increase nitrogen levels
b) De-nitrogenate
c) Limit oxygen intake
d) Use only room air
e) Preoxygenate well
b) De-nitrogenate
e) Preoxygenate well
| Beautiful airway but will desat quick
:(
## Footnote
Slide 50
125
Which condition is commonly undiagnosed in bariatric patients and must be considered preoperatively?
a) Hypertension
b) OSA
c) Diabetes
d) COPD
b) OSA
## Footnote
Slide 50
126
What is a critical preoperative consideration for assessing the airway in bariatric patients?
a) Placing them in supine
b) Limit preoperative sedation
c) Increase fluid intake
d) Ensure fasting for 4 hours
b) Limit preoperative sedation
*They most of the time have beautiful class I airway. They have trouble oxygenation in supine position.*
## Footnote
Slide 50
127
# True or False
VTE prophylaxis is not important in bariatric surgery
FALSE
*VTE is critical for bariatric surgery*
## Footnote
Slide 50
128
During bariatric surgery, the patient is often placed in reverse Trendelenburg or with the head of the bed up 30 degrees to ensure ________.
a) Good preoxygenation
b) Better vocal cord visualization
c) Reduced bleeding
d) Faster recovery
a) Good preoxygenation
| Ramp these pt up!
## Footnote
Slide 51
129
For obese patients undergoing bariatric surgery, ________ anesthesia and rapid sequence induction (RSI) are used because they do not tolerate the supine position well.
a) Local
b) Spinal
c) GETA
d) Regional
c) GETA
Induction based on end point
*Put patients on a wedge, stack towels to ensure their chin is ABOVE the sternal notch*
| RAMP
## Footnote
Slide 51
130
What should be removed before placing the calibration tube for lap band bariatric surgery?.
a) JP drain
b) Chest tube
c) Foley catheter
d) Orogastric tube
d) Orogastric tube
## Footnote
Slide 51
131
Which of the following are long-term concerns for bariatric surgery patients? (Select 3)
a) Diarrhea
b) Dysphagia
c) Weight gain
d) Protein malabsorption
e) Hyperthyroidism
a) Diarrhea
b) Dysphagia - *mostly with the lap band surgery - pt feels like food isn't going past it. In the office they can let the gastric band balloon down a little*
d) Protein malabsorption -Less contact time, less bile/pancreatic enzymes
## Footnote
Slide 52
132
Which vitamins are commonly malabsorbed after bariatric surgery? Select 2
a) Vitamin A, D, C and B6
b) Vitamins A, D, E, K
c) Vitamin B1, B12 and folic acid
d) Vitamin B3, B5 and calcium
e) B12 and calcium
b) Vitamins A, D, E, K
e) B12 and calcium
*Less contact time, less bile/pancreatic enzymes*
## Footnote
Slide 52
133
________ is a common reason for converting from laparoscopic surgery to laparotomy due to the difficulty in visualizing and navigating the surgical area. Select 4
a) Obesity
b) Clear anatomy
c) Bleeding
d) Successful staple firing
e) Adhesions (scar tissue)
f) Unclear anatomy
a) Obesity
c) Bleeding
d) Adhesions (scar tissue)
f) Unclear anatomy
## Footnote
Slide 54
134
The inability to ________ the patient during laparoscopic surgery may require conversion to open surgery.
a) Sedate
b) Ventilate
c) Position
d) Medicate
b) Ventilate
*Especially in obese patients in trendelenburg. + insufflation *
## Footnote
Slide 54
135
A ________ can necessitate the conversion from laparoscopic surgery to open surgery due to equipment malfunction.
a) Successful staple firing
b) Patient stability
c) Clear anatomical view
d) Staple misfire
b) Staple misfire
## Footnote
Slide 54
136
Indications for exploratory laparotomy due to failed laparoscopic surgery include ________, abdominal catastrophes, and staging.
a) Trauma
b) Infection
c) Elective surgery
d) Tumor removal
a) Trauma
## Footnote
Slide 55
137
What type of anesthesia is generally used for vaginal sling procedures?
a) Local anesthesia
b) Spinal anesthesia
c) General anesthesia
d) Epidural anesthesia
c) General anesthesia *usually with LMA and no muscle relaxant*
## Footnote
Slide 68
138
The term "stress urinary leak point" refers to:
a) The point at which the bladder spontaneously empties
b) The pressure at which leakage occurs due to abdominal pressure
c) The time it takes for urine to leak after physical activity
d) The volume of urine leaked during stress
b) The pressure at which leakage occurs due to abdominal pressure
## Footnote
Slide 67
139
Intraoperatively, ________ is needed for retraction and less pain when converting from laparoscopic to laparotomy surgery.
a) Epidural anesthesia
b) Spinal anesthesia
c) GETA
d) NMBD
d) NMBD
*Profound muscle relaxation *
## Footnote
Slide 55
140
What type of anesthesia can be used when converting from laparoscopic to laparotomy? (Select 2)
a) Spinal anesthesia
b) Epidural anesthesia
c) GETA
d) Local anesthesia
b) Epidural anesthesia - *consider placing in postop.. *
c) GETA
*Also consider multi-modal pain control*
## Footnote
Slide 55
141
Which intraoperative measure is used to prevent ileus in exploratory laparotomy patients?
a) Foley catheter
b) Epidural placement
c) Nasogastric tube (NGT)
d) Intravenous fluids
c) Nasogastric tube (NGT)
## Footnote
Slide 55
142
According to the SCIP protocol, why is it important to keep the patient warm during surgery?
a) To prevent infection
b) To ensure rapid recovery
c) To manage pain
d) To prevent hypothermia
d) To prevent hypothermia
*SCIP protocol*
## Footnote
Slide 55
143
PONV is more common in patients undergoing ________.
a) Laparoscopy
b) Minor procedures
c) Dental surgery
d) Cataract surgery
a) Laparoscopy *or Laparotomy*
## Footnote
Slide 57
144
________ anesthetics are associated with a higher incidence of PONV.
a) Local
b) Regional
c) Volatile
d) Intravenous
c) Volatile
## Footnote
Slide 57
145
Which of the following is NOT a risk factor for PONV?
a) Female gender
b) Laparoscopy or Laparotomy
c) Use of volatile anesthetics
d) Use of non-opioid analgesics
d) Use of non-opioid analgesics
*Being Female and the use of opioids can cause PONV*
## Footnote
Slide 57 -Gynecological Surgery Specifics
146
What does the abbreviation D&C stand for in medical terminology?
a) Dilatation and Curettage
b) Diagnosis and Cessation
c) Drainage and Cleansing
d) Dissection and Cauterization
a) Dilatation and Curettage
*This surgery may be combined with other procedures (hysteroscopy, conization) *
For young lady post-C section bleeding or old lady endometrial cancer w/ bleeding
## Footnote
Slide 58
147
A D&C procedure is used to remove the ________ lining of the uterus.
a) Muscular
b) Endometrial
c) Cervical
d) Peritoneal
b) Endometrial
## Footnote
Slide 59
148
D&C can diagnose and treat bleeding from the ________ or cervix.
a) Ovaries
b) Uterus
c) Fallopian tubes
d) Vagina
b) Uterus
## Footnote
Slide 59
149
If retained products of conception are present, consider the risks of ________ and blood loss.
a) Infection
b) Hyperglycemia
c) Hypertension
d) Sepsis
d) Sepsis
## Footnote
Slide 59
150
During a D&C procedure, the patient is typically placed in the ________ position.
a) Supine
b) Prone
c) Lithotomy
d) Lateral
c) Lithotomy
*Peroneal Nerve Injury!!*
***Table** – foot of the bed goes down – make sure the hands and fingers are not trapped*
## Footnote
Slide 60
151
________ anesthesia is commonly used during a D&C procedure.
a) Local
b) Spinal
c) General
d) Regional
c) General
*May be combined with other procedures (hysteroscopy, conization) *
## Footnote
Slide 60
152
Postoperatively, patients may experience ________ pain, but typically not much pain medication is given.
a) Severe
b) Crampy
c) Sharp
d) Constant
b) Crampy
## Footnote
Slide 60 D& C
153
SCIP antibiotics are generally not used during D&C unless requested by surgery or if there is a presence of ________.
a) Clean urine sample
b) Cloudy urine
c) No signs of infection
d) Normal urine output
b) Cloudy urine indicating a UTI
*..or if the surgeon has a preference*
## Footnote
Slide 60
154
Bradycardia and vagal response during a D&C procedure might be caused by:
a) Over sedation
b) A Tenaculum pinching the cervix
c) High blood pressure
d) Excessive blood loss
b) A tenaculum *pinching on the cervix*
| ....doesn't look painful at all right?
## Footnote
Slide 60
155
To manage bleeding during a D&C, ________ IV may be administered.
a) Epinephrine
b) Lidocaine
c) Pitocin
d) Furosemide
c) Pitocin -* IV 20units – treats bleeding*
## Footnote
Slide 60/61
156
What does the abbreviation D&E stand for?
a) Dilatation and Evacuation
b) Diagnosis and Examination
c) Drainage and Extraction
d) Dissection and Elimination
a) Dilatation and Evacuation
## Footnote
Slide 61
157
A D&E procedure is used for ________ or accidental miscarriage.
a) Menstrual regulation
b) Birth control
c) Abortion
d) Fertility treatment
c) Abortion
## Footnote
Slide 61
158
The guidelines for D&E procedures vary by ________, and practitioners must abide by federal regulations.
a) Hospital
b) Doctor
c) State
d) Patient
c) State
## Footnote
Slide 61
159
For pregnancies between ________ weeks, a counseling and waiting period, as well as parental involvement, may be required for a D&E.
a) 10-12
b) 15-18
c) 20-24
d) 25-28
c) 20-24
*Counseling/Waiting period
Parental involvement - in some state the pregnant person may become emancipated*
## Footnote
Slide 61
160
If the patient becomes febrile and shows signs and symptoms of sepsis 3-4 days post-D&E, ________ should be administered.
a) Painkillers
b) Antipyretics
c) Antibiotics
d) Antivirals
c) Antibiotics
**SCIP protocol**
## Footnote
Slide 61
161
Pitocin is secreted from the ________.
a) Adrenal cortex
b) Thyroid gland
c) Neuro-hypophysis
d) Pancreas
c) Neuro-hypophysis
## Footnote
Slide 62
162
The primary function of Pitocin is to stimulate ________.
a) Heart rate
b) Uterine contraction
c) Blood pressure
d) Respiratory rate
b) Uterine contraction
## Footnote
Slide 62
163
Pitocin is similar to ________, which increases water reabsorption from the glomerular filtrate.
a) Oxytocin
b) Epinephrine
c) Vasopressin
d) Insulin
c) Vasopressin
## Footnote
Slide 62
164
Hysteroscopy allows examination of the ________ cavity.
- a) Vaginal
- b) Endometrial
- c) Abdominal
- d) Cervical
- b) Endometrial
## Footnote
slide 64
165
One of the purposes of a hysteroscopy is to investigate ________ bleeding.
- a) Postpartum
- b) Intra-uterine
- c) Menopausal
- d) Post-coital
- b) Intra-uterine
## Footnote
Slide 64
166
During a hysteroscopy, the uterus is inflated with__________/ ________ solution or sorbitol. Select 2
- a) Dextrose
- b) Lactated Ringer's
- c) Distilled water
- d) Saline
b) Lactated Ringer's
d) Saline
## Footnote
Slide 64
167
Sorbitol used for uterine inflation during a hysteroscopy can cause ________ if used in excess.
a) Hypernatremia
b) Hypokalemia
c) Sugar deficiencies
d) Dehydration
c) Sugar deficiencies
*..excess of fructose and possible seizures*
## Footnote
Slide 64
168
What is a potential bad effect of using normal saline during a hysteroscopy?
a) It can cause dehydration.
b) It carries a current
c) It increases the risk of infection.
d) It can cause hypoglycemia.
b) It carries a current
*If the doctor cauterizes inside the uterus it could carry current to other bodily structures and burn them*
## Footnote
Slide 64
169
Which type of anesthesia is generally preferred for hysteroscopy? Select 2
a) General anesthesia
b) Paracervical block
c) Spinal anesthesia
d) Pudendal block
a) General anesthesia - *preferred (LMA)*
b) Paracervical block
## Footnote
Slide 65
170
What are some intraoperative considerations for a hysteroscopy procedure? (Select 3)
a) Post-op pain
b) Monitoring for bradycardia
c) Administering SCIP antibiotics
d) Excessive bleeding
a) Post-op pain -* discomfort in bladder - feel like they need to pee, not a lot of pain*
b) Monitoring for bradycardia
c) Administering SCIP antibiotics
## Footnote
Slide 65
171
Stress urinary incontinence (SUI) is due to loss of muscle support often affects which anatomical structures?
a) Ovaries and fallopian tubes
b) Uterus and cervix
c) Bladder neck and pelvic floor
d) Vagina and urethra
c) Bladder neck and pelvic floor
## Footnote
Slide 67
172
Which groups of women are commonly affected by the need for sling procedures due to stress incontinence? (Select 2)
a) Older, multiparous women
b) Menopausal , college athletes
c) Menopausal, multiparous
d) Nulliparous, college athletes
a) Older, multiparous women
d) 1/4 Nulliparous, college athletes *- jumping sports*
| Loose muscle stability =stress incontinence &require sling
## Footnote
Slide 67
173
What percentage of women may require sling procedures for stress urinary incontinence (SUI)?
a) 5-10%
b) 15-60%
c) 20-40%
d) 50-70%
b) 15-60%
*Stress urinary leak point
(abdominal leak point pressure)*
## Footnote
Slide 67
174
What material is commonly used in sling procedures for stress incontinence and is non-absorbable?
a) Polyester mesh
b) Prolene mesh
c) Silk mesh
d) Nylon mesh
b) Prolene mesh
| Use of mesh with needles on each side to make a sling to pull up parts.
## Footnote
Select 67
175
Why might patients experience postoperative pain after sling procedures?
a) Due to intubation
b) Due to needles
c) Due to anesthesia wearing off
d) Due to dehydration
b) Due to needles
*Kane - we took two big huge hurken needles and stick them in places where they don't normally have poke holes*
## Footnote
Slide 67
176
In which position is the patient typically placed for a vaginal sling procedure?
a) Supine
b) Prone
c) Lithotomy
d) Lateral
c) Lithotomy
## Footnote
Slide 68
177
# True or False
SCIP antibiotics are given during vaginal sling cases
TRUE
To prevent infection *due to non-sterile environment...aka the vagina*
## Footnote
Slide 68
178
Which of the following statements are true regarding the intraoperative considerations for treating condyloma? Select 3.
a.) Lithotomy position is recommended.
b.) Local anesthesia is preferred.
c.) General anesthesia is used.
d.) Laser masks are optional.
e) Smoke evacuation is necessary.
a.) Lithotomy position is recommended.
c.) General anesthesia is used.
e) Smoke evacuation is necessary.
*Oropharyngeal condyloma can be in supine position. - LMA can be used
Rectal condylomas can be put in prone - ETT can be used*
| S 70
179
In the treatment of condyloma, it is important to use ______ masks and ensure ______ evacuation of plume.
* laser
* smoke
*Smoke evacuation – special enclosed suction machine to suck up the burned “plume”. *
| S 70
180
Which of the following are causes of a weakened pelvic floor leading to the need for repair -cele procedures? (3)
a.) Delivery
b.) Aging
c.) Previous pelvic surgery
d.) Obesity
e.) Hormonal imbalances
a.) Delivery - *long pushing/lots of force - repair postponed…*
b.) Aging -*elderly*
c.) Previous pelvic surgery
| S 72
181
Which type of prolapse is associated with the anterior pelvic wall?
A) Enterocele
B) Rectocele
C) Cystocele
D) Uterine prolapse
C) Cystocele
*bladder herniates through vaginal wall*
| S 72
182
Which of the following are other types of pelvic organ prolapse?
a.) Penilocele
b.) Rectocele
c.) Enterocele
e.) Vaginocele
b.) Rectocele - *Posterior prolapse – the large intestine (rectum) pushes against and moves the back wall of the vagina outside.
c.) Enterocele - when the small bowel presses against and moves the upper wall of the vagina outside*
| S 72
183
What type of anesthesia is used for repair procedures of the pelvic floor?
A) Local anesthesia
B) General anesthesia
C) Regional anesthesia
D) No anesthesia
B) General anesthesia
*ETT (2-3hrs ) vs. LMA (minor prolapse, quick surgery)*
| S 73
184
The intraoperative considerations for repair procedures include positioning the patient in the ______ position and inserting a ______ catheter.
* Lithotomy
* Foley -*>2hr procedure*
| S 73
185
Which of the following are types of hysterectomy? Select 3
a.) Partial hysterectomy
b.) Total hysterectomy
c.) Total hysterectomy with removal of ovaries and fallopian tubes
d.) Subtotal hysterectomy
e.) Radical hysterectomy
a.) Partial hysterectomy -*removal of just the uterus*
b.) Total hysterectomy - *removal of Uterus and cervix*
c.) Total hysterectomy with removal of ovaries and fallopian tubes - *and cervix*
| S 74
186
What does the acronym BSO stand for in the context of surgical procedures?
A. Bilateral Salpingectomy and Oophorectomy
B. Bilateral Surgical Omentectomy
C. Bilateral Sympathetic Operation
D. Bilateral Septal Osteotomy
A. Bilateral Salpingectomy and Oophorectomy
## Footnote
Slide 74
187
Which of the following incisions are used for abdominal hysterectomy?
A) Vertical midline
B) Pfannenstiel
C) Subcostal
D) McBurney
B) Pfannenstiel
*Pfannesnstiel is more common, aka bikini cut. Can also do a midline incision, but not normally done.*
*Mostly supine position*
## Footnote
S 75
188
What does LAVH stand for?
A. Laparoscopic assisted vaginal hysterectomy
B. Lateral assisted vaginal hysterectomy
C. Laparoscopic abdominal vaginal hysterectomy
D. Laparoscopic assisted vascular hysterectomy
A. Laparoscopic assisted vaginal hysterectomy
*small incisions in the belly and then everything comes out the vagina*
*Can be supine and lithotomy position*
## Footnote
Slide 75
189
The two approaches for performing a hysterectomy are the ______ approach, involving an incision in the abdomen, and the ______ approach, which involves removal through the vaginal canal.
* Midline
* Vaginal *all through the vagina and only lithotomy position*
| S 75
190
What is the preferred type of anesthesia for a hysterectomy?
A) Local anesthesia
B) General anesthesia
C) Spinal anesthesia
D) Epidural anesthesia
B) General anesthesia -*ETT*
| S 76
191
A common cause of bradycardia during a hysterectomy is _______ , and the medication that should be readily available to treat this is _______ .
A. pulling on ureter tubes and cervix; atropine
B. pulling on fallopian tubes and cervix; glycopyrrolate
C. pulling on fallopian tubes and cervix; epinephrine
D. pulling on fallopian tubes and cervix; midazolam
B. pulling on fallopian tubes and cervix; glycopyrrolate (robinul)
## Footnote
S 76
192
Which of the following intraoperative considerations are correct for a hysterectomy procedure?
A. Foley catheter; antibiotics not required; bowel prep
B. Foley catheter; antibiotics are required; possible bowel prep
C. Foley catheter; antibiotics are not required; no bowel prep
D. Foley catheter; antibiotics are required; bowel prep is always required.
B. Foley catheter *is placed for surgeries lasting more than 2 hours*; antibiotics are required *according to SCIP guidelines*; possible bowel prep *depends on the surgeon or patient history*
## Footnote
Slide 76
193
Which of the following are advantages of robotic surgery? Select 3
a.) Improved dexterity
b.) 3-dimensional vision
c.) Reduced operating room time
d.) Increased precision
e.) Lower cost
f.) 4-dimensional vision
a.) Improved dexterity
b.) 3-dimensional vision
d.) Increased precision
| S 78
194
# True or False
The one disadvantage of using the Robot for surgery is the added operating room time
True
*– big learning curve, how to dock the robot, learning how to move the arms**
## Footnote
Slide 78
195
When was robotic surgery first used in gynecology for fallopian tubal anastomoses?
A) 1995
B) 1999
C) 2003
D) 2007
B) 1999
| S 78
196
Which of the following is a requirement for robotic surgery as mentioned in the intraoperative slide?
A) Local anesthesia
B) General anesthesia
C) Spinal anesthesia
D) No anesthesia
B) General anesthesia
| S 79
197
Why is fluid restriction important during robotic surgeries?
A. To prevent dehydration
B. Patient is positioned upside down
C. To enhance muscle relaxation
D. To avoid excessive urination
B. Because the patient is positioned upside down, and *fluid can follow gravity causing edematous airways*
## Footnote
S 79
198
Which of the following are considerations for robotic surgeries?
Select 2
A. Regional anesthesia
B. Frequent repositioning of the patient
C. SCIP antibiotics
D. Good muscle relaxation
E. No muscle relaxation
C. SCIP antibiotics
D. Good muscle relaxation
## Footnote
Slide 79
