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Oral Boards > GYN > Flashcards

GYN Flashcards

1
Q

What are some clinical risk factors for DVT?

A

Age > 40
Surgery for malignancy
Prolonged surgery (> 30-45 mins)
Obesity
Delayed POP ambulation
Medical disease (DM, heart failure, COPD, prior DVT)

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2
Q

What are the steps to assess a bladder injury repair?

A
  1. Location of injury in relation to the trigone
  2. Proceed gently - friable bladder mucosa
  3. Close in 2-3 layers
    - Submucosa + mucosa
    - Muscularis +/- paravesical fascia
  4. Consider sterile milk to test integrity
  5. Cystoscopy to assess trigone and closure
  6. Foley for 7d
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3
Q

How would you repair a ureteral injury > 5cm from the UVJ?

A

Uretero-ureteterostomy (End to end anastomosis)
- Spatulate ends
- 4-6 interrupted sutures of 4-0 chromic through full thickness of cut edge
- Make sure no tension
- Consider placing a drain (not in contact w suture)
- Stent the ureters and cath the bladder x 10d

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4
Q

How would you repair a ureteral injury < 5cm from the UVJ?

A

Ureteroneocystotomy (re-implant into the bladder)
- Must be off tension
- Consider Psoas Hitch, Baori flap, or mobilizing bladder

Transureteroureterostomy (implant to contralateral ureter)

Always place a drain to avoid urinoma

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5
Q

What can you do if a primary ureteral repair of an injury cannot be performed?

A

Percutaneous nephrostomy

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6
Q

What are the steps of repairing a bowel injury?

A
  1. Run the bowel first to identify other areas of injury
  2. Close to to avoid narrowing of the lumen of the bowel
    - Side to side if lac is perpendicular to long axis
    - End to end if lack is parallel to long axis
  3. Use 3-0 vicryl to close mucosa/muscularis in single layer interrupted
  4. Use 3-0 non absorbable for muscualris/serosa
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7
Q

What are some different abdominal incisions?

A

Pfannenstiel
Joel-Cohen
Cherney
Maylard

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8
Q

What characterizes a Pfannenstiel incision?

A

2cm above the pubic symphysis
Separate rectus from sheath

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9
Q

What characterizes a Joel-Cohen incision?

A

5cm above the pubic symphysis
Blunt dissection
Associated with less fever, pain, blood loss, op time

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10
Q

What characterizes a Cherney incision?

A

Separate the rectus tendon from the pubic symphysis to visualize the space of Retzius

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11
Q

What characterizes a Maylard incision?

A

Transect the rectus muscle with ligation of the inferior epigastrics. No separation of rectus from sheath.

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12
Q

What characterizes a mass closure?

A

Incorporating the subcutaneous tissue, rectus, rectus sheath, fascia, and peritoneum in one bite

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13
Q

What characterizes a Smead-Jones mass closure?

A

Vertical mattress mass closure with double loop, then,
incorporate medical edge of sheath in a single loop

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14
Q

What are some factors necessitating mass closure?

A

Age, obesity, poor nutrition, steroids, radiotherapy, chemotherapy, any chronic condition leading to weak tissue

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15
Q

Suture material: Plain gut
- natural vs synthetic
- absorption time
- breakdown mechanism

A

Plain gut
- Natural
- 7d
- Inflammation

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16
Q

Suture material: Chromic gut
- natural vs synthetic
- absorption time
- breakdown mechanism

A

Chromic
- Natural
- 14d
- Inflammation

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17
Q

Suture material: Vicryl
- natural vs synthetic
- absorption time
- breakdown mechanism

A

Vicryl
- Synthetic
- Loses 50% tensile strength at 21d
- Hydrolysis

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18
Q

Suture material: Dexon
- natural vs synthetic
- absorption time
- breakdown mechanism

A

Dexon
- Synthetic
- Loses 50% of tensile strength at 30d
- Hydrolysis

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19
Q

Suture material: PDS/Maxon
- natural vs synthetic
- absorption time
- breakdown mechanism

A

PDS/Maxon
- Synthetic monofilament
- Loses 50% of tensile strength at 60d
- Hydrolysis

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20
Q

Suture material: Silk
- natural vs synthetic
- absorption time
- breakdown mechanism

A

Silk
- Natural braided
- Permanent

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21
Q

Suture material: Nylon
- natural vs synthetic
- absorption time
- breakdown mechanism

A

Nylon
- Synthetic monofilament
- Permanent

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22
Q

What are the 5Ws of post op fever?

A

Wind: bowel obstruction, ileus, PNA
Water: UTI
Wound: Infection
Walking : DVT
Wonder drugs: Drug allergies
(Wonder breasts: mastitis)

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23
Q

What is the time frame this cause of POP fever: PNA/GI?

A

1-3d POP

24
Q

What is the time frame this cause of POP fever: DVT?

A

3-7d

25
Q

What is the time frame this cause of POP fever: UTI?

A

4-7d

26
Q

What is stage 0 POP?

A

No prolapse

27
Q

What is stage 1 POP?

A

Greater than 1cm above the hymen

28
Q

What is stage 2 POP?

A

Between 1cm above the hymen and 1cm below the hymen

29
Q

What is stage 3 POP?

A

More than 1cm below the hymen but no further than 2cm less than total vaginal length

30
Q

What is stage 4 POP?

A

Complete procidentia

31
Q

What is a Halban’s culdoplasty for enterocele prevention?

A

Vertical sutures incorporating uterosacrals, performed abdominally

32
Q

What is a Moskowitz culdoplasty for enterocele prevention?

A

Pursestring sutures incorporating uterosacrals, performed abdominally

33
Q

What is a McCall’s culdoplasty for enterocele prevention (and prophylaxis for vault prolapse)?

A

Plicate the uterosacral ligaments in the midline, performed vaginally

34
Q

What are three surgical treatments of vaginal vault prolapse?

A
  1. Abdominal sacrocolpopexy
  2. Sacrospinous ligament fixation
  3. Uterosacral ligament fixation
35
Q

What are the 5 compartments to check for prolapse?

A
  1. Anterior (cystocele)
  2. Posterior (rectocele)
  3. Uterus/apex (apical)
  4. Posterior cul de sac (enterocele)
  5. Vaginal outlet (perineal body)
36
Q

What are 3 risk factors for recurrent prolapse?

A
  1. Age < 60
  2. BMI > 26
  3. Stage 3 or 4 prolapse
37
Q

What is the minimum evaluation of urinary incontinence?

A
  1. History
  2. Physical
  3. UA
  4. Assessment of stress incontinence
  5. Assessment of urethral mobility
  6. Measure PVR
38
Q

What are 3 classes of medications for UUI?

A
  1. Antimuscarinics: Oxybutinin
  2. Beta adrenergics: Mirabegron
  3. Botox
39
Q

How do antimuscarinics work for UUI?

A

Block parasympathetic M2/M3 receptors to inhibit involuntary detrusor contractions

Side effects: dry mouth and eyes, constipation

40
Q

How do beta adrenergics work for UUI?

A

Relax detrusor muscle to increase bladder capacity

Side effects: no worse than placebo

Contraindicated with severe HTN, renal disease, liver disease

41
Q

How does botox work for UUI?

A

Paralyses/relaxes bladder to increase capacity

Side effects: UTI, urinary retention

42
Q

What is a treatment for refractory UUI?

A

Sacral neuromodulation

43
Q

What are surgical treatment options for SUI?

A

Urethral bulking
Slings
Suspensions

44
Q

What are some complications of sling procedures?

A

UTI
Surgical site bleeding, Retzius hematoma
Placement of sling or suture in bladder
Mesh erosion
Urinary retention
Unmasking of urge incontinence
Fistula if using mesh

45
Q

What are the treatment options for mesh erosion?

A
  1. Pelvic rest for 6-8w, vaginal estrogen
  2. Excision of mesh in office
  3. Excision of mesh in OR with repair+cysto
46
Q

What are the three levels of wound failure?

A
  1. Superficial separation
  2. Fascial dehiscence
  3. Evisceration
47
Q

What factors are associated with regret for tubal sterilzation?

A

Age < 30yo
Recent decision < 6mo ago
Unstable marriage or single
Unhealthy children
Unhealthy neonate (low Apgars, premature, FGR, etc)

48
Q

What are some disadvantages of robotic surgery?

A

Longer operative time
More surgical incisions
Extensive learning curve
Medical cost

49
Q

What are some advantages of robotic surgery?

A

3D vision
Improved fine motor control and articulation
Potentially decreased blood loss
Minimally invasive approach to otherwise open cases

50
Q

What are some risk factors for surgical site infection?

A

Obesity BMI > 30
Nutritional status
SubQ > 3cm
Smoking
Immunosuppression
Perioperative hyperglycemia
Co-existant infection at remote body site
Vaginal colonziation
MRSA status

51
Q

What are the steps of an appendectomy?

A
  1. Dissect mesosalpinx
  2. Ligate appendix vessels
  3. Clamp and cut base of appendix
  4. Purse string suture around base
  5. Embed the stump prior to closing purse string
52
Q

What are some complications of UAE?

A

Pain and degeneration of fibroids
Myometritis
Bacteriemia
Uterine artery perforation/hemorrhage
Loss of ovarian function

53
Q

What qualities on US increase risk of adnexal mass malignancy?

A

Size > 10cm
Hetergeneous components
Intramural nodule
Papillary excrescences
Septatations
Increased doppler flow
Free fluid

54
Q

What non-malignancy conditions can cause elevated Ca 125?

A

Endometriomas
PID
Inflammatory states (SLE/IBD)
Non gyn malignancy
Pregnancy

55
Q

What is partner treatment for gonorrhea?

A

800mg cefixime (+100mg doxy bid if chlamydia status unk)

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