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Oral board studying Prep book > GYN must know complications > Flashcards

GYN must know complications Flashcards

1
Q

What is Virchow triad?

A

Postulates 3 factors that predispose a patient to developing vascular thrombosis

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2
Q

What are the 3 factors in Virchow triad?

A
  1. Venous stasis
  2. Hypercoauglable state
  3. Irregular vessel wall (endothelial damage)
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3
Q

Is factor V leiden mutation inherited or acquired?

A

Inherited

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4
Q

Is protein C deficiency inherited or acquired?

A

Both

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5
Q

Is Antithrombin 3 deficiency inherited or acquired?

A

Inherited

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6
Q

Is Antiphospholipid syndrome inherited or acquired?

A

Acquired

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6
Q

Is Protein S deficiency inherited or acquired?

A

Both

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6
Q

Is Antiphospholipid syndrome inherited or acquired?

A

acquired

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7
Q

What is the thrombosis risk for MTHFR mutation?

A

Very low

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8
Q

What is the thrombosis risk for MTHFR mutation

A

Very low

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9
Q

What is the thrombosis risk for factor V Leiden mutation?

A

5%

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10
Q

What is the thrombosis risk for prothrombin mutation?

A

2-5%

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11
Q

What is the thrombosis risk for Protein C deficiency?

A

5-10%

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12
Q

What is the thrombosis risk for Protein S deficiency?

A

5%

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13
Q

What is the thrombosis risk for Antithrombin 3 deficiency?

A

30-50%

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14
Q

What is the thrombosis risk for Antiphospholipid syndrome?

A

> 5%

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15
Q

If you want to test for Factor V Leiden mutation how do you test for it?

A

Test for Factor V leiden mutation

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16
Q

If you want to test for Antithrombin 3 deficiency how do you test for it?

A

Test for antithrombin 3 activity level

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17
Q

If you want to test for Protein C deficiency how do you test for it?

A

Test for Protein C activity level

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18
Q

If you want to test for Protein S deficiency how do you test for it?

A

Test for Protein S activity level

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19
Q

If you want to test for Antiphospholipid syndrome how do you test for it?

A

Anticardiolipin Ab
Anti B2 glycoprotein
Lupus anticoagulant

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20
Q

What is the caprini score?

A

Used to assess risk of VTE

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21
Q

What does a caprini score of 1-2 tell you?

A

Low risk of thrombosis

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22
Q

What kind of prophylaxis is needed with caprini score of 1-2?

A

Mechanical prophylaxis

23
Q

What does a caprini score of 3-4 tell you?

A

Moderate thrombosis risk

24
Q

What kind of prophylaxis is needed with caprini score of 3-4?

A

Mechanical prophylaxis or pharmacologic prophylaxis depending on risk of major bleeding complication

25
Q

What does a caprini score of >5 tell you?

A

High thrombosis risk

25
Q

What kind of prophylaxis is needed with a caprini score of >5?

A

Pharmacologic plus mechanical prophylaxis

26
Q

What kind of prophylaxis is needed with a caprini score >5 in a high risk cancer patient?

A

Pharmacologic plus mechanical prophylaxis and extended prophylaxis post discharge . If there is a high risk for bleeding complication the use mechanical until risk of bleeding has diminished.

27
Q

What if there is a high risk thrombotic patient with a heparin contraindication?

A

Then you use fondaparinux

28
Q

What are some risk factors for major bleeding complications during surgery?

A
  1. Known untreated bleeding disorder
  2. Active bleeding
  3. Acute stroke
  4. Uncontrolled hypertension
  5. Severe hepatic or renal failure
  6. Performing surgery on 2 or more compartments or difficult dissections
  7. Malignancy
  8. Thrombocytopenia
29
Q

How effective is mechanical prophylaxis with intermittent pneumatic compression devices for major GYN surgery?

A

It is as effective when used during and after surgery as LDUH/LMWH in reducing incidence of DVT

30
Q

What is fondaparinux?

A

Indirect factor Xa inhibitor that is used when there is a contraindication to use of LDUH/LMWH

31
Q

What is rivaroxaban and apixaban?

A

Direct factor Xa inhibitors
oral anticoagulant

32
Q

What is dabigatran?

A

Direct thrombin inhibitor
Oral anticoagulant

33
Q

How do the oral anticoagulants hold up to LMWH/LDUH?

A

As efficacious or maybe superior.
Rapid onset and rapid clearance

34
Q

When should you discontinue estrogen contraceptives for surgery?

A

If you are undergoing a major surgery and expected to have prolonged immobilization

35
Q

If estrogen containing contraceptives are to be stopped how long prior to surgery should you stop them?

A

4-6 weeks

36
Q

What is the difference between neuraxial catheter removal and replacement in regards to LMWH & LDUH?

A

LDUH has a low risk of hematoma with neuraxial anesthesia. Catheter can be removed or replaced 4-6hrs after administration

LMWH has higher risk of hematoma with neuraxial anesthesia. Catheter can be removed or replaced 12hrs after administration. After removal of epidural LMWH should be held for at least 4hrs

37
Q

What are some risk factors for DVT?

A
  1. Obesity
  2. Prolonged surgery (>30min)
  3. History of DVT
  4. Surgery for malignancy
  5. Delayed ambulation post op
  6. Varicose veins
  7. Age>40 y/o
  8. Medical disease (DM, COPD, heart failure)
38
Q

What is the clinical presentation for DVT?

A

Warm
Swollen
Tender
Inflamed

39
Q

What is Homan sign?

A

Marker for suspected DVT
When foot is doors-flexed pain is noted in the popliteal area

40
Q

How do you work up a DVT?

A

Doppler ultrasound of lower extremity

Venography

41
Q

What are the clinical signs of PE?

A
  1. Shortness of breath
  2. Chest pain
  3. Tachycardia
  4. Tachypnea
  5. Hemoptysis
42
Q

What is the test of choice for PE?

A

CT pulmonary angiography (Spiral CT)

43
Q

What is the management for PE?

A

Heparin with a bridge to warfarin for 3 months

44
Q

How does heparin work?

A

Increases inhibition of factor Xa and thrombin

45
Q

What are the complications of heparin therapy?

A

Osteoporosis, alopecia, thrombocytopenia

46
Q

What are the steps if you have a bladder injury?

A
  1. Assess location of injury with respect to trigone
  2. Close in 3 layers
    - nonlocking continuous through mucosa and submucosa with 3-0 vicryl
    - Interrupted 3-0 vicryl to muscular layer
    - Interrupted 2-0 vicryl to para vesical fascia layer
  3. Instill sterile milk to assess integrity of closure
  4. Consider cystoscopy to assess proximity to trigone and closure
  5. Foley catheter for 7 days
47
Q

What is the overall basis of ureteral injury repair?

A

Correction depends on distance of injury from bladder insertion

48
Q

How do you repair the ureter if the injury is >5cm above the UVJ?

A

Ureteroureterostomy (end to end anastomosis)

4-0 chromic interrupted sutures

Ureteric stents and catheter for 10 days

49
Q

How do you repair the ureter if the injury is <5cm above the UVJ?

A

Ureteroneocystotomy (implanting ureter directly into bladder)

50
Q

What is transureteroureterostomy?

A

Rare procedure when the injuries ureter is implanted into the contralateral ureter

51
Q

What is the psoas hitch in ureter injury?

A

When the ureter injury is <5cm above UVJ and implanting directly into the bladder provides to much tension because it cannot reach the bladder then you consider psoas hitch

With psoas hitch the bladder is pulled up and secured to the psoas muscle to the injured ureter can reach the bladder and be reimplanted without tension

52
Q

What is the boari flap in ureter injury?

A

Extending a flap of bladder to the injuries ureteral orifice

53
Q

What is the repair technique for a small bowel injury parallel to long axis of bowel?

A

End to end repair to avoid narrowing the lumen of the bowel
3-0 vicryl with interrupted fashion

54
Q

What is the first thing you should do when you note a bowel injury?

A

Run the entire bowel to ensure there are no other bowel injuries

54
Q

What is the repair technique for a small bowel injury at right angle to long axis of bowel?

A

Side to side repair to avoid narrowing the lumen of the bowel
3-0 vicryl with interrupted fashion

Oral board studying Prep book (50 decks)

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