High Yield (crush creogs) Flashcards
bladder injury incidence
0.05-0.66%
how large of bladder injury requires 2 layer closure
> 2cm defect
polyglactin suture brand name
Vicryl
polyglactin suture characteristics
absorbable
braided
multifilament
dyed vs undyed
polyglactin suture uses
skin, soft tissue, ligation vessels, repair bladder/bowel
polyglactin suture loses tensile strength …
lose 50% tensile strength in 3wk
- complete absorption in 60 days
silk suture characteristics
non-absorbable
braided - multifilament
very secure knots
significant inflammatory reaction
silk suture loses tensile strength …
1yr
poliglecaprone suture brand name
monocryl
poliglecaprone suture completely absorbs in
~100 days
polydioxanone suture name
PDS
PDS suture completely absorbs in
~200 days
PDS suture characteristics
absorbable
monofilament
poliglecaprone suture characteristics
absorbable
monofilament
polypropylene suture characteristics
non-absorbable
monofilament
dyed vs undyed
polypropylene suture name
prolene
when does organogenesis occur
weeks 6-8
what is gastrulation
establishes 3 germ cell layers (ectoderm, endoderm, mesoderm)
when does gastrulation occur
week 3
what does endoderm form
bladder & urethra
GI tract
resp system
thymus
parathyroid
what does mesoderm form
circulatory system
lymphatic system
connective tissue (bone, cartilage, vessels)
muscles
many internal organs (kidney, ureters, adrenal cortex, spleen)
what does ectoderm form
skin
mucosal linings
nervous system (brain, spinal cord)
portions of sensory organs
What is Class I surgical ound
Clean
uninfected operative wound
No entry into respiratory, alimentary, genital, or urinary tracts
What is class II wound
clean-contaminated
controlled entry into respiratory, alimentary, genital, or urinary tracts
No major contamination or infection
What is class III wound
contaminated
open, fresh accidental wounds.
Gross spillage from GI tract or nonpurulent inflammation
What is class IV wound
dirty or infected
Old traumatic wounds with devitalized tissue or clinical infection.
Involvement of perforated viscera
Only GYN procedures where abx are recommended
- hyst
- D&C, D&E
- colporrhaphy
+/- laparotomy without hyst
When do you increase abx dose
Obese patients (increase if >120kg)
Procedure >4hrs (redose)
EBL >1500mL
bowel injury incidence in GYN
0.10-0.50%
most common time for bowel injury
30-55% during entry
40% during adhesiolysis
when do most postop bowel injuries present
5-10 days postop
suture/stitch type for bowel injury
interrupted 3-0 delayed absorbable suture
when does bowel injury need 2 layer closure
if full thickness
which way do you throw stitch on bowel
“sutures throw the way the poop goes”
- perpendicular to the longitudinal plane of the bowel (so don’t decrease diameter of lumen)
for what population do you use T-score to interpret DEXA
postmenopausal
what does T-score compare
individual’s BMD measurements with peak mean BMD in healthy, young-adult reference population
what population do you use Z-score to interpret DEXA
usually premenopausal
What does Z-score compare
number of standard deviations beteen an individual’s BMD and the mean BMD of a reference population of the same sex, age
what T-score is diagnostic of osteoporosis
-2.5 or lower in femoral neck, total hip, L spine, or distal 1/3 radius
what T-score is osteopenia
-1.0 to -2.5
recommended daily intake calcium
1000mg/day 19-50y
1200 mg/day >50y
recommended daily Vit D intake
600 IU/day up to age 70y
800 IU/day >70y
hemorrhagic cyst US description
lace-like reticular echoes
or an intracystic solid structure (clot)
acoustic enhancement
no internal blood flow
endometrioma US description
round, homogenous appearing
low-level echoes
acoustic enhancement with diffuse ground glass echoes
mature teratoma US description
hypoechoic attenuating component with multiple small homogenous interfaces.
Echogenic sebaceous material and calcification
epithelial ovarian tumor markers
CA125
CEA
CA 19-9
types of epithelial ovarian tumors
high grade serous (most common)
low grade serous
endometrioid
clear cell
mucinous
carcinosarcoma
germ cell tumors come from
primordial cells (become sperm and eggs)
types of germ cell tumors
teratoma
dysgerminoma
yolk sac
embryonal
mixed
choriocarinoma
polyembryoma
germ cell tumor markers (general)
AFP, LDH, HCG
chance of malignant transformation of teratoma
0.2-2% into squamous cell carcinoma (b/c ectoderm)
LDH tumor marker for (most commonly)
dysgerminoma
notable characteristic of sex cord stromal tumors
produce hormones - androgen or estrogen excess
often solid masses
Don’t need to do LND
types of sex cord stromal tumors
granulosa tumor
sertoli-leydig
most common tumor marker for granulosa cell tumor
inhibin
identifying characteristic of granulosa cell tumor
produces estrogen
- must do EMB when diagnosed
identifying characteristic of sertoli leydig tumor
can secrete testosterone
- see androgenic effects
buzzword for sertoli leydig tumor
cells of reinke
four assumptions of trauma informed care
Realize
Recognize
Respond
Re-traumatization
four assumptions of trauma informed care: realize
realize the widespread effect of trauma and understand potential paths for recovery
four assumptions of trauma informed care: recognize
s/sx of trauma in clients, families, staff, and others involved with the system
four assumptions of trauma informed care: respond
Respond by fully integrating knowledge about trauma into policies, procedures, and practices
four assumptions of trauma informed care: re-traumatization
seek to actively resist re-traumatization
when does HPV vax switch from recommended to shared decision making
27
HPV vax timing <15yo
2 doses
@ 0 and 6-12mo
(if too soon recc 3rd dose)
HPV vax timing 15-26yo
3 doses
@ 0, 1-2mo, 6mo
HPV vax recc for CIN
adjuvant (postop) HPV vax in surgically-managed CIN 2-3 in previously unvaccinated individuals reduces recurrence of cervical dysplasia
(65% overall risk reduction)
lichen simplex chronicus presentation
skin thickening (leathery, bark-like)
itch-scratch cycle
lichen sclerosus presentation
porcelain-white papules and plaques
“cigarette paper”
classic “figure of 8” shape vulva
fusion of labia minora and fissures
vulvar pruritus, irritation, burning
lichen planus presentation
Classical: white, lacy, Wickham striae
hypertrophic: white, thick, warty plaques
erosive: erythematous erosions extend to labia
identifying characteristic of lichen planus
oral involvement is common if erosive lichen planus
recommended positioning for suspected air embolus
L lateral decubitus with trendelenberg (aka Durant’s maneuver)
encourages air to move out of RVOF and into R atrium
s/sx of air embolus
“mill wheel” murmur
earliest indicator of air embolus
reduced end tidal CO2
(also see reduced O2 sat, hypotension, tachycardia, R heart strain on echo)
most common locations of ureteral injury
- near IP (ureter crosses over bifurcation of iliacs)
- cardinal ligament (ureter under uterine artery)
- where ureter enters bladder
- lateral border of USLS
recommended repair for upper 1/3 ureteral injury
uretero-ureterostomy
recommended repair for middle 1/3 ureteral injury
uretero-ureterostomy
- can consider Boari flap
recommended repair for lower 1/3 ureteral injury
direct reimplantation
+/- psoas hitch
(within 6cm of bladder)
AIDET
5 fundamentals of patient communication
Acknowledge
Introduce
Duration
Explanation
Thank you
RESPECT model
Rapport
Empathy
Support
Partnership
Explanations
Culture competence
Trust
Cisplatin/carboplatin toxicity
ototoxicity (cisplatin)
nephrotoxicity (both)
Bleomycin toxicity
pulmonary fibrosis
doxorubicin toxicity
cardiotoxicity
trastuzumab toxicity
cardiotoxicity
cyclophosphamide toxicity
hemorrhagic cystitis
vincristine toxicity
peripheral neuropathy
paclitaxel toxicity
peripheral neuropathy
clues to hereditary cancer syndrome
age <50
multiple cancers in one individual
close relatives with same cancer type
unusual cancer presentation
skin growths, skeletal abnormalities, or other specific benign conditions linked to inherited syndromes
high-risk cancers for a hereditary syndrome (need genetics workup)
triple neg breast CA
epithelial ovarian CA
colorectal CA with DNA MMR deficiency
endometrial CA with DNA MMR deficiency
BRCA1 risk of ovarian cancer
40%
BRCA2 risk of ovarian cancer
15%
BRCA risk of breast cancer
70%
BRCA-like genes
ATM
BRIP1
CHEK2
NF1
PALB2
RAD51C
RAD51D
Lynch syndrome characteristics
autosomal dominant
colon, uterine, ovarian CA
3-5% of uterine cancer
DNA Mismatch repair genes!!
MLH1
MSH2
MSH6
PMS2
EPCAM
Li-fraumeni syndrome associated with mutation in
TP53
(tumor suppressor gene)
Li-fraumeni syndrome characteristics
autosomal dominant
osteosarcoma, breast, colon, leukemia, lymphoma, brain CA
Cowden syndrome characteristics
autosomal dominant
thyroid, breast, and endometrial cancers
Cowden syndrome gene abnormality
PTEN
- pathogenic variant in phospatase and tensin (PTEN) gene
mnemonic for Cowden syndrome
Pettin (PTEN) my COW BETty (breast, endometrial, thyroid)
peutz-jeghers syndrome characteristics
autosomal dominant
breast (50% lifetime risk), sex cord stromal, cervical, uterine, GI, pancreatic, lung
peutz-jeghers syndrome gene
serine/threonine kinase 11 (STK11) gene
how to dx peutz-jeghers syndrome
2 criteria of:
- hamartomatous polyps throughout GI tract
- mucocutaneous hyperpigmentation
- FHX same
para/mesonephric ducts give rise to which sex
Mesonephric = Male genital ducts
Paramesonephric = Female
when does sex differentiation occur
7 weeks development
what gene determines sex & how
SRY (on Y chromosome)
SRY+ = Males
(Males are SORRY)
ureteric bud becomes
ureter
mesonephric ducts become
all parts of testes/sperm tract (male)
trigone of bladder
urogenital sinus becomes
bladder (except trigone)
prostate gland vs lower 2/3 of vagina
bulbourethral gland
urethra
paramesonephric duct becomes
oviduct
uterus
upper 1/3 of vagina
what does absence of MIF do
no testosterone
mesonephric ducts regress (no male parts)
genital tubercle becomes
Male body/glans of penis, corpus cavernosum & spongiosum
Female body/glans of clitoris
genital folds become
male ventral aspect of penile and penile raphe
female labia minora
genital swellings become
male scrotum and scrotal raphe
female labia majorum, mons pubis
parvovirus in pregnancy
most lethal virus to fetus
slapped cheek
CMV in pregnancy
most common
hearing loss
blueberry muffin baby
toxoplasmosis in pregnancy comes from
undercooked meats
(cats litter more rare)
order of secondary sex characteristics
- growth spurt prior to breast buds
- thelarche - breast buds
- pubarche - pubic hairs
- adrenarche - axillary hair
- MAX growth spurt
- Menarche
- bone closure of epiphyseal plates
longest diameter of fetal head
supra-occipital mentum (12.5cm)
occiput posterior associated with shich type of pelvis
anthrOPoid
lemon sign on US indicative of
spina bifida
banana sign on US indicative of
arnold chiari malformation
most common causes of primary amenorrhea
- gonadal failure
- congenital absence of uterus (uterine agenesis, MRKH)
most common GYN cancer dx in pregnancy
cervical
low-risk score for GTN
WHO score <7
(>= 7 is high risk)
tx low-risk GTN
single agent chemo
- MTX vs Dactinomycin
tx high-risk GTN
combo chemo
- EMACO
EMACO
Etoposide
MTX
Actinomycin-D
cyclophosphamide
Vincristine
mnemonic for categories of points for GTN
PIMPBAT
of mets
Prior pregnancy
Interval
Mets site
Prior chemo
BHCG pretreatment
Age
Tumor size
sensitivity
TP / (TP+FN)
specificity
TN / (TN+FP)
PPV
TP / (TP+FP)
NPV
TN / (FN+TN)
cardinal movements of labor
ED FIrE REx
engagement,
descent,
flexion,
internal rotation,
extension,
Restitution (external rotation),
expulsion.
