GU/GYN Flashcards
Right sided varicocele vs left sided varicocele.
Next best step when diagnosed a right sided varicocele?
Left sided varicocele are common due to unique angle of the spermatic vein/renal vein confluence. 90 degree angle
Right varicocele enters the IVC. In supine position the varicocele should decompress. If not, concerned for abdominal mass
Next best step: CTAP to r/o abdominal mass
What are the three natural narrowing in ureter?
Ureteropelvic junction (at the kidney)
Crossing of common iliac vessels
Ureterovesical junction (at the bladder)
Blood supply for upper and lower ureter?
Upper: aorta, renal, gonadal
Lower: common iliac, hypogastric
What is the blood supply to the bladder?
Superior vesical
Inferior vesical
Both come from hypogastric
Someone presents with penile fracture. What do you do?
Cystoscopy followed by fracture repair
Renal trauma grading system
Grade I: bruise
Grade II: < 1cm
Grade III: > 1cm
Grade IV: involves collecting system, vessel injury, clot in renal artery
Grade V: shattered kidney. Hilar avulsion
When your doing a psoas hitch what nerve can you injure?
Genitofemoral nerve
Does orchidopexy decrease the risk of testicular cancer?
Yes. From 2.5-8x to 2-3x but doesn’t get rid of it
What is the most common symptom of testicular cancer at the time of diagnosis?
Painless swelling or enlargment
Where does majority of testicular cancer spread?
Retroperitoneum
Seminoma vs non-seminoma
- radiation?
- prognosis?
- AFP level?
- age at diagnosis?
Which one gets radiation? What the the other one get?
- Seminomas get radiation
- seminomas have favorable prognosis
- seminomas: no AFP. non-seminomas: high AFP
- non-seminomas in younger patients
Teratomas are not sensitive to radiation. You need retroperitoneal lymph node dissection
What is the most complaint upon diagnosis of renal cell cancer?
Asymptomaticm most of them are diagnosed incidentally
For metastatic renal cell cancer, why take out the kidney?
what tumor is most likely to metastasize to the kidney?
They actually have improved survival with removal of the kidney even if metastatic
lung most likely
What is the most common presentation prior to a prostate cancer diagnosis?
Asymptomatic. Elevated PSA. Not retention or nocturia, etc
Which type is the most common in primary testicular tumor?
Seminomas
Most common cause of bilateral testicular mass in men over 50?
Lymphoma
What % of pts with primary germ cell tumor of the testes have history of cryptorchidism?
Up to 10%
What’s the difference between stage II vs stage III testicular cancer?
Between T3 and T4?
Stage II: retroperitoneal lymph nodes
Stage III: supradiaphragmatic nodes or visceral nodes
T3: invade the spermatic cord
T4: invade the scrotum
What are the three testicular tumor markers?
Do they impact staging.
LDH
AFP
hCG
Yes they do. They have their own grading system in addition to TNM based on the lvl of the markers
If AFP bCG or LDH is elevated, which tumor type is it seminoma or non-seminoma?
Non-seminoma
What is the single most commonly performed GYN operation in the US? #2?
2: hysterectomy
C-section
When debulking peritoneal seedings of ovarian tumor, leaving seedings size < what size is acceptable?
Less than 1cm can be left. Considered “optimal debulking”
some say 2mm. i think 2mm is a better answer
Ureters are medial/lateral to the broad ligament?
Medial
What complication can occur if endometriosis is untreated?
Infertility
After hysterectomy for uterine cancer, when are adj radiation and chemo indicated?
Radiation: moderate to poorly differentiated cancer therefore higher rate of recurrence
Chemo: for disease that spread outside the uterus
What is the most common general surgical problem in pregnancy?
Appendicitis
What is the first symptom of appendicitis in pregnancy?
Abdominal pain
T/F: for pregnant appendicitis, antibiotics alone is not acceptable.
T/F: delay in surgery for >24hrs increases the risk of appendiceal perforation
True
True
What is the most common location of ectopic pregnancy?
Fallopian tube
For ectopic pregnancy to meet requirement for methotrexate, the pt has to be stable and hCG has to be less than what?
what is an absolute contraindication? let’s say the pt recently gave birth
what ectopic pregnancy size is a contraindication to methotrexate?
5,000 this is a relative contraindication
breastfeeding
ectopic size > 3.5cm
Two most common organisms in PID?
Treatment?
Gonorrhea and chlamydia
Crftriaxone + doxycycline for minimum 14 days
T/F: OCP’s reduce the risk of PID
True
What % of ovarian masses in reproductive women are malignant?
15%
Pts with ovarian cancer present most commonly at what stage? What and is the 5 yr survival?
Stage III (55%)
5yr survival: 33%
23F 72hr s/p vaginal delivery. Now febrile, LLQ pain. Bimanual exam: rope like mass. CT shows left ovarian vein thrombosis. Treatment?
First 7-10d of systemic heparin therapy + abx
This is septic pelvic thrombophlebitis. Venous seeding of microorganisms causing thtombosis
Tumor markers for epithelial vs non-epithelial ovarian tumors
Epithelial: CA125
non-epithelial: inhibin
Most common presentation of uterine cancer?
Vaginal bleeding. Not asymptomatic
Tubo-ovarian abscess size cutoff for abx only vs drainage?
<4-5cm: abx only. If doesn’t work then surgical drainage needed
> 7-8cm: needs some sort of drainage
Asymptomatic microhematuria is how many rbcs per hpf?
Next step? does age matter?
> 3 RBC per hpf
Cystoscopy for anyone > 35yo
Urine cytology is not sensitive enough
Rate of ureteral injury during GYN procedure vs colorectal?
GYN: 0.2 - 0.3%
Crs: 0.2 - 8%
T/F boari flap can be used to repair middle 1/3 ureteral injury
True
23F, 3d postpartum. Fever, abd pain. Rope like mass in the left adnexa. Thrombus in the left ovarian vein.
Diagnosis and treatment?
Septic pelvic thrombiphlebitis
Anticoagulate with heparin + broad spectrum abx
T/F: gerota fascia has two leaves that fuse superiorly, inferiorly, medially, and laterally
False. Anterior and posterior leaves so 2 is true. But they don’t fuse inferiorly, allowing the ureter and gondal vessels to exit
From what vertebral lvl do the renal arteries originate?
L2
Renal cell carcinoma: when can you do nephron sparing nephrectomy?
Size < 3cm
testicular cancer. already did ultrasound. what will you do next? CT chest abd pelvis or b-hcg, afp, LDH?
CT is delayed until after surgery because of high false negative rate (44%). get the labs first
lymphatic drainage of left vs. right testicle cancer?
left: para-aortic lymph nodes
right: paracaval/interaortocaval nodes
prostate cancer screening. who has higher risk?
when to start screening for standard vs. high risk?
higher risk:
- african american
- age > 40
- 1st degree relative diagnosed at age <65
- BRCA mutation
standard: start at age 50
higher risk: start at age 40, PSA every 1-2 years
DRE is not part of the prostate cancer screening
in pregnancy, what happens to
- heart rate?
- stroke volume?
- mean arterial pressure?
- vascular resistance?
- heart rate: increased
- stroke volume: increased
- mean arterial pressure: decreased
- vascular resistance: decreased
for women with BRCA1 who still want children, what are the surveillance options until they are done bearing children?
transvaginal ultrasound and CA-125 every 6 months
pregnant lap appy. depending on gestational age, what fetal monitoring is needed?
<24 wks: confirmation of fetal heart tone pre- and post-op is sufficient
> 24 wks: continuous fetal heart monitoring
what are the 5 elements of frailty?
unintentional weight loss weak grip strength self-reported exhaustion slow walking speed low physical activity.
