Gynecologic Surgery

Question 1

what are 4 common transvaginal procedures? (DC, CCB, H, H)

Answer 1

1. dilate and curettage
2. cervical cone biopsy
3. hysteroscopy
4. hysterectomy

Question 2

what are 4 common perineal procedures? (LFoC, BCM, APR, V)

Answer 2

1. laser fulguration of condyloma
2. bartholin cyst marsupialization
3. a/p repair
4. vulvectomy

Question 3

what are 6 common intra-abdominal procedures? (H,O,M,RE,S,C)

Answer 3

1. hysterectomy
2. oophorectomy
3. myomectomy
4. ruptured ectopic
5. salpingectomy
6. cystectomy

Question 4

what is the one common transabdominal procedure? (L)

Answer 4

laparoscopy

Question 5

what nerve can be injured with dissection in the retroperitoneum or paravaginal area? (O)

Answer 5

obturator nerve

Question 6

surgical injury to the pelvic nerve plexus can cause what type of pain? (NP)

Answer 6

neuropathic pain

Question 7

what 3 functions are diminished if the pelvic nerve plexus is injured? (S, V, E)

Answer 7

sexual, voiding, excretory

Question 8

what nerve is most common injured in the lithotomy position?

Answer 8

common peroneal nerve

Question 9

greater than how many hours in stirrups can cause ischemia?

Answer 9

4 hours

Question 10

in the trendelenburg position, the displacement of the abd viscera pushes the diaphragm against the heart and increases or decreases BP and SV?

Answer 10

decreases

Question 11

Category A, B, C, D or X:
Adequate and well-controlled
studies have failed to demonstrate a risk to the
fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).

Answer 11

Category A

Question 12

Category A, B, C, D or X:
Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnancy women despite potential risks.

Answer 12

Category B

Question 13

Category A, B, C, D or X:
Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Answer 13

Category C

Question 14

Category A, B, C, D or X:
There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Answer 14

Category D

Question 15

Category A, B, C, D or X:
Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.

Answer 15

Category X

Question 16

What category are fentanyl, vecuronium, and succs in?

Answer 16

C

Question 17

what category are ACE inhibitors and versed in?

Answer 17

D

Question 18

what 3 medications are used to increase uterine tone? (P, M, P)

Answer 18

pitocin, methergine, prostaglandins

Question 19

what to meds decreases hemorrhage postpartum and after abortion? (P, M)

Answer 19

pitocin, methergine

Question 20

what med decreases bleeding during a cervical cone biopsy? (V)

Answer 20

vasopressin

Question 21

where is vasopressin injected into?

Answer 21

the cervix

Question 22

how many mg and what 2 routes is methergine given?

Answer 22

0.2 mg IM/PO

Question 23

what are the 5 risks of pitocin? (UH, UR, H, RT, A)

Answer 23

uterine hyperactivity, uterine rupture, hypotension, reflex tachycardia, anaphylaxis

Question 24

what are the 3 risks of vasopressin? (CV, STC, GISMS)

Answer 24

coronary vasospasms, ST changes, GI smooth muscle stimulation

Question 25

what are the 4 risks of methergine? (PV, H, S, S)

Answer 25

peripheral vasoconstriction, HTN, seizures, stroke

Question 26

what are the 2 abbreviations for prostaglandins?

Answer 26

PGE2 and PGF2

Question 27

what is the prostaglandin med? (C)

Answer 27

carboprost

Question 28

Prostaglandins are used to induce what in early pregnancy?

Answer 28

abortions

Question 29

what route is prostaglandins given?

Answer 29

intra-amniotic

Question 30

what are the 4 risks of prostaglandins? (NV, B, UT, H)

Answer 30

N/V, bronchospasm, uterine tetany, hypotension

Question 31

what dermatome level range is adequate for most intra-abdominal procedures?

Answer 31

T4-T6

Question 32

what type of anesthesia block for cervical procedures like D&C, cone bx and cysto-procto?

Answer 32

spinal

Question 33

what LA, what mg range and in what solution as a spinal for cervical procedures (D&C, cone bx, cysto-procto)?

Answer 33

0.75% Bupivacaine 10-15 mg in 7.5% dextrose

Question 34

what block name can be used for vulva procedures? (SB)

Answer 34

saddle block

Question 35

Saddle block: 1. what part of the spinal cord? 2. spinal or epidural? 3. what type of solution?

Answer 35

1. sacral 2. spinal 3. hyperbaric

Question 36

what are 3 procedures to correct urinary incontinence? (MMK, TFVT, PS)

Answer 36

marshall marchetti krantz, tension-free vaginal tape, pubovaginal sling

Question 37

what level block is needed for a cervix procedure (cone biopsies, LEEP)?

Answer 37

T10

Question 38

Are spinal blocks or epidural blocks used for elective procedures?

Answer 38

spinal blocks

Question 39

what nerve supplies sensory to the vagina? (P)

Answer 39

pudendal nerve

Question 40

Dilation and Curettage (D&C): what block level range is needed to block vaginal sensory and what block level is needed to block cervical dilation?

Answer 40

S2-4; T10

Question 41

During hysteroscopy, frequent and accurate irrigant absorbed recordings are needed. If greater than 200-300 mL of fluid is absorbed, what lab should be checked?

Answer 41

Na+

Question 42

what are 2 possible complications of a hysterectomy? (WI, VAE)

Answer 42

water intoxication, venous air embolism

Question 43

what block level is needed to deal with uterine tractions of a vaginal hysterectomy?

Answer 43

T6

Question 44

Tubal pregnancy surgery can result in what emergency? (H)

Answer 44

hemoperitoneum

Question 45

what organ does each chemo effect? 1. adriamycin 2. bleomycin 3. cis-platinum

Answer 45

1. heart 2. lungs 3. kidneys

Question 46

manys pts undergoing a tumor debulking may have a small bowel obstruction require what two types of intubation?

Answer 46

awake or RSI

Question 47

radical hysterectomy can lose up to how many liters of blood?

Answer 47

2L

Question 48

what gynecologic malignancies is the most lethal? (OC)

Answer 48

ovarian carcinoma

Question 49

what procedure involves an en bloc resection of all pelvic tissues including the uterus, cervix, vagina, bladder and rectum, and can be up to a 10 hour case? (PE)

Answer 49

pelvic exenteration

Question 50

what procedure uses a wire loop electrode to transmit electric current to cut away tissue?

Answer 50

loop electrosurgical excision procedure (LEEP)

Question 51

what position is used for robotic procedures?

Answer 51

steep trendelenburg

Question 52

what vent setting should you consider for pts in steep trendelenburg?

Answer 52

pressure control

Question 53

what are the 3 category C drugs? (F, V, S)

Answer 53

fentanyl, vecuronium, succs

Question 54

what are the 2 category D drugs? (A, V)

Answer 54

ace inhibitors, versed

Question 55

what are the 2 category X drugs? (T, P)

Answer 55

thalidomide, pitocin

Question 56

never give methergine IV d/t what risk? (RD)

Answer 56

retinal detachment

Question 57

what is the other name for vasopressin? (P)

Answer 57

pitressin

Question 58

how many units of vasopressin are injected into the cervix?

Answer 58

20 units

Question 59

how many units of pitocin are in a 1 liter bag of IVF?

Answer 59

20 units