GYN - Exampro

Question 1

What is the most common sexual disorder/dysfunction in women?

Answer 1

MC = Low intreest /Sexual Desire Disorder

Onset in Adulthood
Characterized by:
-Loss of interest / seeking sexual experiences
-Sexual response is preserved
-Anorgasmia is not a feature
Phyisologic and Psychological causes

tx: psychotherapy / BCT. Couples counseling if needed

Question 2

Loss of interest, last seeking sexual situations but also avoid sexual approach. Has anti-fantasies.

Answer 2

Sexual Aversion Disorders
-Again, anorgasmia is not a feature
-Primarily psychological root to etiology

Question 3

What is the most common cause of of primary anorgasmia?

Answer 3

Psychological etiology

Occurs in 5- 8% of women
Characterized by absent or delayed orgasm
Normal sexual excitement and arousal phase
Commonly have hx sexual abuse, poor body image, control issues
spectating
Treatment: directed masturbation

Secondary: 2- 4% of women, also psychological. treatment is more therapy, review meds

Question 4

Involuntary muscle retraction with penetration?

Answer 4

Vaginismus
-Affects 1% of women at any time
-Contraction if involuntary
-Involves outer 1/3 vacinal musculature
-Penetration is real or imagined
-Situational component
-Causes: also psychological, other secondary onset etiologies = endometriotic pain, PID, partial imperforate hymen, vaginal stenosis
-Treatment successful in 90% of patients –> vaginal dilators w/ PFPT

Question 5

What is the definition of dyspareunia?

Answer 5

Genital pain with coitus, but is NOT related to vaginismus
-MC in postmenopausal but affects all women

Occurs at introital (most common), midvagina (least common) and deep dyspareunia.

Question 6

Can women with a history of estrogen - dependent breast cancer be given vaginal estrogen?

Answer 6

YES! FDA and ACOG have endorses this.

Always work with medonc and shared decision making.

Question 7

Most common malpractice claim in GYN?

Answer 7

1 = missing cancer

#2 = GU injury

Question 8

What is the typical distance of the ureter from the cervix ?

Answer 8

1- 2 cm lateral to uterosacral ligament and cervix

Enters tunnel under uterine artery
Courses medial through vesico-uterine ligament into trigone.

Question 9

What is the most common site of ureteral injury?

Answer 9

-Pelvic bring at level of IP (during ooph)
-Along the pelvic side wall
-At level of uterine artery, next to uterosacral ligament

Injury to GU tract is estimated to occur in 1- 2 % of all major GYN surgeries
-75% occur during hysterectomy

Question 10

What is most common route of hysterectomy for bladder versus ureteral injury?

Answer 10

Bladder / Ureter =
both Robotic > TLH (vaginal is lease likely)

Question 11

What is more common: bladder versus ureter injury?

Answer 11

Bladder injury is 3x more common than ureter

Question 12

What is the most common cause of bowel injury during GYN surgery?

Answer 12

Blind entry / entrance into peritoneal cavity (37%)

2nd MC = LOA of pelvic adhesions (35%)

Small bowel is MC than large bowel for injury

Question 13

Define palmars point?

Answer 13

3cm below the costal margin in the midclavicular line on the left

Question 14

What direction do you close a bowel injury?

Answer 14

Close perpendicular to the longitudinal axis, to prevent narrowing of the lumen

Question 15

What vessel lites in the lateral third on undersurface of rectus abdominus?

Answer 15

Inferior epigastric artry and vein
Branches of external iliac artery

Question 16

What vessel travels within the subcutaneous tissue and abdominal wall?

Answer 16

Superficial epigastric artery and vein.

Originates from femoral artery

Question 17

Median umbilical fold –>
Medial umbilical fold –>
lateral umbilical fold –>

Answer 17

Median = obliterated urachus
Medial = obliterated umbilical arteries
Lateral = inferior epigastric vessels

Question 18

At what ratio should blood products be replaced?

Answer 18

1:1:1
PRBCs, FFP, PLT

Question 19

What nerves course 2 cm lateral and superior to the pubic tubercle?

Answer 19

Iliohypogastric (T12-L1) - Mons, lateral labia, upper inner thigh
Ilioinguinal (T12-L1) - Groins, symphysis

Question 20

Genitofemoral: what is the nerve root and motor/sensory loss?

Answer 20

L1- L2
No motor
Upper labia, upper unner thigh sensory loss

Question 21

Lateral femoral: what is the nerve root and motor/sensory loss?

Answer 21

L2-L3
No motor
Anterior and posterior lateral thigh

Question 22

Cutaneous femoral: what is the nerve root and motor/sensory loss?

Answer 22

L2-L4
Motor: hip flexion, adduction, knee extension
Sensory: anterior and medial thigh, medial calf

Question 23

Obturator: what is the nerve root and motor/sensory loss?

Answer 23

L2-4
Motor: thigh adduction
No sensory

Question 24

Pudendal: what is the nerve root and motor/sensory loss?

Answer 24

S2-4
No motor
Perineum sensory loss

Question 25

Sciatic / common peroneal: what is the nerve root and motor/sensory loss?

Answer 25

L4- S3
Sciatic hip extension, knee flexion, sensory = none
Peroneal Foot dorsiflexion, sensory = lateral calf

Question 26

Tibial: what is the nerve root and motor/sensory loss?

Answer 26

tibial = foot plantar flexion, foot inversion, loss of sensation of plantar surface of foot

Question 27

MC injury during self retaining retractors?

Answer 27

femoral nerve.

-can also be damaged in lithotomy with stirrups (More common in very obese, very thin or smokers). avoid hyperflexion of hips and knees.

Question 28

What are the receptors in the bladder and the result?

Answer 28

Muscarinic (M2 and M3) = promotes bladder contractions
B3 receptors = promotes bladder relaxation
A1 adrenergic = bladder neck and trigone, promote urethral contraction

Question 29

What is the most common side effect of anticholinergics?

Answer 29

1 = dry mouth

Question 30

How does botox work for OAB?

Answer 30

Prevents ACh release at receptors.
Cleaves SNAP-25
Results in reversible denervation of the nerves x 9 months
prevent OAB

Best dose = 100