GYN

Question 1

Hypotonic media fluid deficit for hysteroscopy

Answer 1

1000 mL

Question 2

Redating GA via US <9w

Answer 2

> 5d

Question 3

Redating GA via US 9w to <16w

Answer 3

> 7d

Question 4

Redating GA via US 16w to <22w

Answer 4

> 10d

Question 5

Redating GA via US 22w to <28w

Answer 5

> 14d

Question 6

Redating GA via US 28w +

Answer 6

> 21d

Question 7

Septic abortion treatment

Answer 7

Amp/gent/clinda
Covers gram positives, resistant gram neg aerobes, gram neg anaerobes

Question 8

Ovarian torsion risk factors

Answer 8

Ovarian mass >5 cm
Reproductive age
Pregnancy, ovulation induction
- progesterone supplementation needed until 10w if corpus luteum removed
Adolescents with normal ovaries (46% of cases)
2-12% risk of recurrence

Question 9

Ovarian torsion ultrasound findings

Answer 9

Edematous ovary (sn 86%, sp 18%)
Heterogeneous appearing (sn 85%, sp 18%)
Peripheral follicles, abnormal location
Decreased doppler flow (sn 85%, sp 37%)
Whirlpool sign of ovarian vessels

Question 10

Perioperative medication management

Answer 10

Continue: beta blockers, statins, SSRIs, corticosteroids, thyroid hormone
Discontinue: diuretics, ARBs, ACE-I, oral anticoagulation, NSAIDs, herbal supplements
Adjust dosing: insulin
Individualize: aspirin, clopidogrel

Question 11

Femoral triangle borders

Answer 11

Inguinal ligament
Adductor longus (medial)
Sartorius (lateral)
Contains femoral n/a/v (lateral to medial)

Question 12

Endometrial ablation relative contraindications

Answer 12

Increased risk of endometrial CA (anovulation, obesity, tamoxifen, Lynch)
Postmenopausal
Patient desires amenorrhea
Myometrial thinning after uterine surgery
Uterine anomalies

Question 13

Chronic pelvic pain definition, prevalence

Answer 13

Pain lasting 6+ months
6-25% of reproductive aged women

Question 14

Features of partial mole

Answer 14

69 XXX/XXY
small for dates
hCG <100k
GTN rate 1-5%
Fetal parts present, focal villous edema
+p57 (trophoblast atypia)

Question 15

Features of complete mole

Answer 15

46 XX
large for dates
Theca-lutein cysts up to 30%
hCG >100k
GTN rate 15-20%
absent fetal parts, widespread villous edema
negative p57 stain

Question 16

Adnexal mass findings suspicious for malignancy

Answer 16

Multilocular
Papillary excrescences
Solid components
Ascites
Doppler flow

Question 17

MTX relative contraindications

Answer 17

Cardiac activity
High initial hCG (>5k)
Ectopic >4 cm
Declines blood products

Question 18

Pre-op labs for htn, diabetes

Answer 18

HTN: BUN/creatinine, + electrolytes if on ACE/ARB/diuretics
DM: serum glucose

Question 19

Common peroneal nerve injury finding

Answer 19

Footdrop
Caused by incorrect positioning/stirrups
L4-S2
Lateral calf, dorsum foot

Question 20

Femoral nerve injury finding

Answer 20

Can’t climb stairs, anteromedial thigh numbness
L2-4, quadriceps muscle

Question 21

Obturator nerve injury finding

Answer 21

Inability to adduct
L2-4, adductor longus
Superomedial thigh

Question 22

Genitofemoral nerve injury finding

Answer 22

Loss of sensation at vulva/labia majora, anterior superior thigh (or burning)
L1-2, retractor compression

Question 23

Cell salvage contraindications

Answer 23

Absolute:
- hypotonic fluids (rbc hemolysis), toxic solutions (antibiotics, iodine, alcohol)
- contamination with hemostatic agents or bone cement

Relative:
- Bacterial infection of wound, active malignancy in surgical field

Question 24

Ilioinguinal nerve injury

Answer 24

Inferior abdominal wall, labia majora, mons

Question 25

Iliohypogastric nerve injury

Answer 25

Inferior abdominal wall, superolateral gluteal

Question 26

Tibial nerve injury

Answer 26

Plantar surface of foot

Question 27

Dermoid cyst characteristics

Answer 27

- Hyperechoic lines (dermoid mesh) - Rokitansky protuberance - Solid components with shadowing in background, ie. hair, aka "tip of the iceberg" - Points - solid components causing hyperechoic points

Question 28

Indirect inguinal hernia

Answer 28

Most common Internal inguinal ring (where round ligament/vas deferens exits abdomen); borders include transversalis fascia and inferior epigastric vessels

Question 29

Direct inguinal hernia

Answer 29

More common in men Hesselbach triangle; borders include inferior epigastric vessels (laterally), inguinal ligament, rectus fascia

Question 30

Perineal body components

Answer 30

Superficial transverse perineal Bulbospongiosus External anal sphincter

Question 31

Bladder injury management

Answer 31

- <2mm: expectant management - 2mm-1cm: expectant or 1-2 layer closure with absorbable suture, foley in place 5=7d - >1 cm: 1-2 layer repair - >3 cm: 2 layers of delayed absorbable suture, foley in 5-14d

Question 32

Lidocaine max doses

Answer 32

Without epi: 4mg/kg With epi: 7mg/kg

Question 33

Lidocaine toxicity

Answer 33

Oral: metallic taste, circumoral numbness, tongue paresthesias CNS: change in alertness/restlessness, seizures, tinnitus

Question 34

Bowel injury management

Answer 34

Superficial sharp/thermal injury: primary oversewing Partial thickness seromuscular: single layer closure Full thickness <1 cm: double layer closure Full thickness >1 cm: primary repair or resection Large delayed thermal injury: resection, drain, consider diverting ostomy

Question 35

Surgicel

Answer 35

Oxidized regenerated cellulose Plant derived Activates extrinsic coagulation pathway/platelet aggregation

Question 36

Arista

Answer 36

aka Microporous polysaccharide hemospheres Absorbs water, concentrates platelets and blood proteins Plant derived Only agent approved for arterial bleeding

Question 37

Gelfoam/surgifoam

Answer 37

aka Gelatin matrix Absorbs blood and fluid> mechanical hemostasis and matrix for clot formation Porcine derived

Question 38

Floseal/surgiflo

Answer 38

aka Thrombin Bovine/human/recombinant derived Converts fibrinogen to fibrin

Question 39

Postoperative fever days 1-2

Answer 39

Wind Pneumonia, aspiration, atelectasis if <24h

Question 40

Postoperative fever days 3-5

Answer 40

Water UTI

Question 41

Postoperative fever days 4-6

Answer 41

Walking DVT or PE

Question 42

Postoperative days 5-7

Answer 42

Wound Surgical site infection

Question 43

Postoperative day 7+

Answer 43

Wonder drugs Drug fever

Question 44

Pelvic ureter injury management

Answer 44

Within 6 cm of bladder - ureteroneocystostomy preferred - with or without psoas hitch, consider boari flap