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Forget Nots > GU/GYN > Flashcards

GU/GYN Flashcards

1
Q

Right sided varicocele vs left sided varicocele.

Next best step when diagnosed a right sided varicocele?

A

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

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2
Q

What are the three natural narrowing in ureter?

A

Ureteropelvic junction (at the kidney)

Crossing of common iliac vessels

Ureterovesical junction (at the bladder)

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3
Q

Blood supply for upper and lower ureter?

A

Upper: aorta, renal, gonadal

Lower: common iliac, hypogastric

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4
Q

What is the blood supply to the bladder?

A

Superior vesical
Inferior vesical

Both come from hypogastric

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5
Q

Someone presents with penile fracture. What do you do?

A

Cystoscopy followed by fracture repair

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6
Q

Renal trauma grading system

A

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

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7
Q

When your doing a psoas hitch what nerve can you injure?

A

Genitofemoral nerve

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8
Q

Does orchidopexy decrease the risk of testicular cancer?

A

Yes. From 2.5-8x to 2-3x but doesn’t get rid of it

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9
Q

What is the most common symptom of testicular cancer at the time of diagnosis?

A

Painless swelling or enlargment

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10
Q

Where does majority of testicular cancer spread?

A

Retroperitoneum

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11
Q

Seminoma vs non-seminoma

  • radiation?
  • prognosis?
  • AFP level?
  • age at diagnosis?

Which one gets radiation? What the the other one get?

A
  • 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

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12
Q

What is the most complaint upon diagnosis of renal cell cancer?

A

Asymptomaticm most of them are diagnosed incidentally

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13
Q

For metastatic renal cell cancer, why take out the kidney?

what tumor is most likely to metastasize to the kidney?

A

They actually have improved survival with removal of the kidney even if metastatic

lung most likely

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14
Q

What is the most common presentation prior to a prostate cancer diagnosis?

A

Asymptomatic. Elevated PSA. Not retention or nocturia, etc

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15
Q

Which type is the most common in primary testicular tumor?

A

Seminomas

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16
Q

Most common cause of bilateral testicular mass in men over 50?

A

Lymphoma

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17
Q

What % of pts with primary germ cell tumor of the testes have history of cryptorchidism?

A

Up to 10%

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18
Q

What’s the difference between stage II vs stage III testicular cancer?

Between T3 and T4?

A

Stage II: retroperitoneal lymph nodes
Stage III: supradiaphragmatic nodes or visceral nodes

T3: invade the spermatic cord
T4: invade the scrotum

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19
Q

What are the three testicular tumor markers?

Do they impact staging.

A

LDH

AFP

hCG

Yes they do. They have their own grading system in addition to TNM based on the lvl of the markers

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20
Q

If AFP bCG or LDH is elevated, which tumor type is it seminoma or non-seminoma?

A

Non-seminoma

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21
Q

What is the single most commonly performed GYN operation in the US? #2?

A

2: hysterectomy

C-section

22
Q

When debulking peritoneal seedings of ovarian tumor, leaving seedings size < what size is acceptable?

A

Less than 1cm can be left. Considered “optimal debulking”

some say 2mm. i think 2mm is a better answer

23
Q

Ureters are medial/lateral to the broad ligament?

A

Medial

24
Q

What complication can occur if endometriosis is untreated?

A

Infertility

25
Q

After hysterectomy for uterine cancer, when are adj radiation and chemo indicated?

A

Radiation: moderate to poorly differentiated cancer therefore higher rate of recurrence

Chemo: for disease that spread outside the uterus

26
Q

What is the most common general surgical problem in pregnancy?

A

Appendicitis

27
Q

What is the first symptom of appendicitis in pregnancy?

A

Abdominal pain

28
Q

T/F: for pregnant appendicitis, antibiotics alone is not acceptable.

T/F: delay in surgery for >24hrs increases the risk of appendiceal perforation

A

True

True

29
Q

What is the most common location of ectopic pregnancy?

A

Fallopian tube

30
Q

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?

A

5,000 this is a relative contraindication

breastfeeding

ectopic size > 3.5cm

31
Q

Two most common organisms in PID?

Treatment?

A

Gonorrhea and chlamydia

Crftriaxone + doxycycline for minimum 14 days

32
Q

T/F: OCP’s reduce the risk of PID

A

True

33
Q

What % of ovarian masses in reproductive women are malignant?

A

15%

34
Q

Pts with ovarian cancer present most commonly at what stage? What and is the 5 yr survival?

A

Stage III (55%)

5yr survival: 33%

35
Q

23F 72hr s/p vaginal delivery. Now febrile, LLQ pain. Bimanual exam: rope like mass. CT shows left ovarian vein thrombosis. Treatment?

A

First 7-10d of systemic heparin therapy + abx

This is septic pelvic thrombophlebitis. Venous seeding of microorganisms causing thtombosis

36
Q

Tumor markers for epithelial vs non-epithelial ovarian tumors

A

Epithelial: CA125

non-epithelial: inhibin

37
Q

Most common presentation of uterine cancer?

A

Vaginal bleeding. Not asymptomatic

38
Q

Tubo-ovarian abscess size cutoff for abx only vs drainage?

A

<4-5cm: abx only. If doesn’t work then surgical drainage needed

> 7-8cm: needs some sort of drainage

39
Q

Asymptomatic microhematuria is how many rbcs per hpf?

Next step? does age matter?

A

> 3 RBC per hpf

Cystoscopy for anyone > 35yo

Urine cytology is not sensitive enough

40
Q

Rate of ureteral injury during GYN procedure vs colorectal?

A

GYN: 0.2 - 0.3%
Crs: 0.2 - 8%

41
Q

T/F boari flap can be used to repair middle 1/3 ureteral injury

A

True

42
Q

23F, 3d postpartum. Fever, abd pain. Rope like mass in the left adnexa. Thrombus in the left ovarian vein.

Diagnosis and treatment?

A

Septic pelvic thrombiphlebitis

Anticoagulate with heparin + broad spectrum abx

43
Q

T/F: gerota fascia has two leaves that fuse superiorly, inferiorly, medially, and laterally

A

False. Anterior and posterior leaves so 2 is true. But they don’t fuse inferiorly, allowing the ureter and gondal vessels to exit

44
Q

From what vertebral lvl do the renal arteries originate?

A

L2

45
Q

Renal cell carcinoma: when can you do nephron sparing nephrectomy?

A

Size < 3cm

46
Q

testicular cancer. already did ultrasound. what will you do next? CT chest abd pelvis or b-hcg, afp, LDH?

A

CT is delayed until after surgery because of high false negative rate (44%). get the labs first

47
Q

lymphatic drainage of left vs. right testicle cancer?

A

left: para-aortic lymph nodes
right: paracaval/interaortocaval nodes

48
Q

prostate cancer screening. who has higher risk?

when to start screening for standard vs. high risk?

A

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

49
Q

in pregnancy, what happens to

  • heart rate?
  • stroke volume?
  • mean arterial pressure?
  • vascular resistance?
A
  • heart rate: increased
  • stroke volume: increased
  • mean arterial pressure: decreased
  • vascular resistance: decreased
50
Q

for women with BRCA1 who still want children, what are the surveillance options until they are done bearing children?

A

transvaginal ultrasound and CA-125 every 6 months

51
Q

pregnant lap appy. depending on gestational age, what fetal monitoring is needed?

A

<24 wks: confirmation of fetal heart tone pre- and post-op is sufficient

> 24 wks: continuous fetal heart monitoring

52
Q

what are the 5 elements of frailty?

A 
unintentional weight loss
weak grip strength
self-reported exhaustion
slow walking speed
low physical activity.

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