GYN / URO Flashcards
When mucopurulent cervicitis is clinically diagnosed, empiric therapy for what is started
chlamydia
recommended in women at increased risk of this common STD (young age < 25 years, new or multiple sexual partners, unprotected sex).
If the prevalence of N. gonorrhoeae is greater than 5%, concurrent therapy for N. gonorrhoeae is indicated.
If presumptive treatment is deferred, the use of sensitive nucleic acid test for C. trachomatis and N. gonorrhoeae is needed.
For all women with either chlamydial or gonorrheal infections, partners should be treated
Patients should be instructed to refer all sexual partners of the last 60 days for evaluation and treatment
most sensitive and specific diagnostic tool for identifying gonorrheal and chlamydial infections.
Nucleic acid amplification testing (NAAT) of the urine or cervix
Concomitant trichomoniasis (choice E) should also be treated if detected, as should bacterial vaginosis.
Treament of volvar squamous cell cancer
is primarily surgical.
A vulvar lesion with a depth < 1 mm can be treated with wide local excision (choice B).
Lesions greater than 1 mm in depth require a radical vulvectomy which extends down to the endopelvic fascia, with a 2 cm margin, and bilateral inguinal node dissection (choice D).
If the lesion is unilateral, then only the ipsilateral inguinal nodes are necessary. Positive nodes or extension into the vagina or anus will require adjuvant
chemoradiation therapy (choice E). Bottom Line: Vulvar cancers > 1 mm in depth require a radical vulvectomy and
lymph node dissection.
mainstay of treatment for localized RCC
Surgical extirpation (open or laparoscopic) remains the as standard
even with metastatic RCC, there is poor response to standard chemotherapy and radiation therapy!
Nephron-sparing surgery (NSS or partial nephrectomy)
has been shown to provide excellent oncologic and functional outcomes at 10 years or longer.
Several reports have shown that NSS provides equivalent oncologic and, in some cases, superior renal functional outcomes when compared with radical nephrectomy.
As experience with NSS grows, many have suggested this as the standard of care for the management of small renal masses…
ACS
Septic pelvic thrombophlebitis
rare disorder that may be caused by venous seeding of microorganisms that may trigger thrombosis.
first 2–4 days postpartum and present with signs and symptoms of fever, tachycardia, abdominal pain that radiates to the groin or upper abdomen, nausea, and vomiting.
Physical exam may reveal a rope-like mass on the effected side.
CT and MRI may show thrombus in large pelvic vessels.
Response to a trial of systemic heparin therapy is the best diagnosis.
Patients should be treated for a 7–10 day course with systemic heparin to double the PTT as well as administration of broad spectrum antibiotics for the duration of heparin therapy.
Long term anticoagulation should be considered if the patient develops extensive pelvic clot formation or pulmonary emboli.
Failure to respond to this treatment may require surgical intervention.
Ligation of the affected vessel may be curative.
Extensive clot formation may require embolectomy.
Abscess formation may require removal of the effected vessel and ipsilateral adnexa.
Urethral injuries Long term consequences
can include stricture, incontinence, sexual dysfunction and chronic pain.
Urethral injuries should be suspected if
patient complains of inability to void, or physical exam reveals a high riding prostate, blood at the urethral meatus, a palpable bladder or butterfly perineal hematoma.
symphysis fractures,
associated bladder injury
and
pelvic hematomas.
Pubic diastasis
inferior pubic rami fractures “straddle fracture”
should foley cath attempt be made if blood at urethral meatus
“There is no strong evidence that a single attempt will convert a partial tear to a complete disruption.” test weapon, ACS 2010..
Urethral injuries are Graded and associated management
Grade I injuries are contusions. Grade II are urethral stretch injuries. Grade III are partial disruptions. Grades IV and V are complete disruptions with or without extensive separation.
Low grade injuries need only catheter drainage.
Grade III injuries may need surgical alignment.
Grade IV and V may need suprapubic cystostomy and endoscopic realignment.
The optimal management of these injuries is largely dependent on concomitant injuries, and diversion with delayed repair is an option.
Bladder neck injuries or severe bladder displacement may require additional surgical repair. After realignment, repeat retrograde urethrogram is performed 6 weeks after repair to document healing.
Inhibin
Bottom Line: Inhibin is used to detect granulosa cell tumors which are sex cord-stromal tumors of the ovary.
tumor marker
non-steroidal polypeptide hormone that is secreted by granulosa cells of the ovary.
produced during menstrual cycle or pregnancy but not in a postmenopausal woman.
Immunohistochemical staining (IHC) using antibodies against markers of granulosa cell tumors (like inhibin) appears to be the most sensitive and specific for granulosa cell tumors.
The preoperative evaluation of a woman with suspected ovarian cancer includes measurement of the
serum glycoprotein CA 125
CA 125
used to detect epithelial ovarian cancer.
BUT
CA 125 is not specific for ovarian cancer. It is also increased in patients with other malignancies, including endometrial cancer and certain pancreatic cancers; in a variety of benign conditions, such as endometriosis, uterine leiomyoma, and pelvic inflammatory disease; and in approximately 1 percent of healthy women.
CA 125 (normal 65 units/mL) in over 80 percent of women with advanced epithelial ovarian cancer.
human chorionic gonadotropin (HCG)
Choriocarcinomas
The presence of alphafetoprotein with an ovarian neoplasm strongly suggests a diagnosis of
endodermal sinus tumor
