High Yield (crush creogs) Flashcards
1
Q
bladder injury incidence
A
0.05-0.66%
2
Q
how large of bladder injury requires 2 layer closure
A
> 2cm defect
3
Q
polyglactin suture brand name
A
Vicryl
4
Q
polyglactin suture characteristics
A
absorbable
braided
multifilament
dyed vs undyed
5
Q
polyglactin suture uses
A
skin, soft tissue, ligation vessels, repair bladder/bowel
6
Q
polyglactin suture loses tensile strength …
A
lose 50% tensile strength in 3wk
- complete absorption in 60 days
7
Q
silk suture characteristics
A
non-absorbable
braided - multifilament
very secure knots
significant inflammatory reaction
8
Q
silk suture loses tensile strength …
A
1yr
9
Q
poliglecaprone suture brand name
A
monocryl
10
Q
poliglecaprone suture completely absorbs in
A
~100 days
11
Q
polydioxanone suture name
A
PDS
12
Q
PDS suture completely absorbs in
A
~200 days
13
Q
PDS suture characteristics
A
absorbable
monofilament
14
Q
poliglecaprone suture characteristics
A
absorbable
monofilament
15
Q
polypropylene suture characteristics
A
non-absorbable
monofilament
dyed vs undyed
16
Q
polypropylene suture name
A
prolene
17
Q
when does organogenesis occur
A
weeks 6-8
18
Q
what is gastrulation
A
establishes 3 germ cell layers (ectoderm, endoderm, mesoderm)
19
Q
when does gastrulation occur
A
week 3
20
Q
what does endoderm form
A
bladder & urethra
GI tract
resp system
thymus
parathyroid
21
Q
what does mesoderm form
A
circulatory system
lymphatic system
connective tissue (bone, cartilage, vessels)
muscles
many internal organs (kidney, ureters, adrenal cortex, spleen)
22
Q
what does ectoderm form
A
skin
mucosal linings
nervous system (brain, spinal cord)
portions of sensory organs
23
Q
What is Class I surgical ound
A
Clean
uninfected operative wound
No entry into respiratory, alimentary, genital, or urinary tracts
24
Q
What is class II wound
A
clean-contaminated
controlled entry into respiratory, alimentary, genital, or urinary tracts
No major contamination or infection
25
What is class III wound
contaminated
open, fresh accidental wounds.
Gross spillage from GI tract or nonpurulent inflammation
26
What is class IV wound
dirty or infected
Old traumatic wounds with devitalized tissue or clinical infection.
Involvement of perforated viscera
27
Only GYN procedures where abx are recommended
- hyst
- D&C, D&E
- colporrhaphy
+/- laparotomy without hyst
28
When do you increase abx dose
Obese patients (increase if >120kg)
Procedure >4hrs (redose)
EBL >1500mL
29
bowel injury incidence in GYN
0.10-0.50%
30
most common time for bowel injury
30-55% during entry
40% during adhesiolysis
31
when do most postop bowel injuries present
5-10 days postop
32
suture/stitch type for bowel injury
interrupted 3-0 delayed absorbable suture
33
when does bowel injury need 2 layer closure
if full thickness
34
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)
35
for what population do you use T-score to interpret DEXA
postmenopausal
36
what does T-score compare
individual's BMD measurements with peak mean BMD in healthy, young-adult reference population
37
what population do you use Z-score to interpret DEXA
usually premenopausal
38
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
39
what T-score is diagnostic of osteoporosis
-2.5 or lower in femoral neck, total hip, L spine, or distal 1/3 radius
40
what T-score is osteopenia
-1.0 to -2.5
41
recommended daily intake calcium
1000mg/day 19-50y
1200 mg/day >50y
42
recommended daily Vit D intake
600 IU/day up to age 70y
800 IU/day >70y
43
hemorrhagic cyst US description
lace-like reticular echoes
or an intracystic solid structure (clot)
acoustic enhancement
no internal blood flow
44
endometrioma US description
round, homogenous appearing
low-level echoes
acoustic enhancement with diffuse ground glass echoes
45
mature teratoma US description
hypoechoic attenuating component with multiple small homogenous interfaces.
Echogenic sebaceous material and calcification
46
epithelial ovarian tumor markers
CA125
CEA
CA 19-9
47
types of epithelial ovarian tumors
high grade serous (most common)
low grade serous
endometrioid
clear cell
mucinous
carcinosarcoma
48
germ cell tumors come from
primordial cells (become sperm and eggs)
49
types of germ cell tumors
teratoma
dysgerminoma
yolk sac
embryonal
mixed
choriocarinoma
polyembryoma
50
germ cell tumor markers (general)
AFP, LDH, HCG
51
chance of malignant transformation of teratoma
0.2-2% into squamous cell carcinoma (b/c ectoderm)
52
LDH tumor marker for (most commonly)
dysgerminoma
53
notable characteristic of sex cord stromal tumors
produce hormones - androgen or estrogen excess
often solid masses
Don't need to do LND
54
types of sex cord stromal tumors
granulosa tumor
sertoli-leydig
55
most common tumor marker for granulosa cell tumor
inhibin
56
identifying characteristic of granulosa cell tumor
produces estrogen
- must do EMB when diagnosed
57
identifying characteristic of sertoli leydig tumor
can secrete testosterone
- see androgenic effects
58
buzzword for sertoli leydig tumor
cells of reinke
59
four assumptions of trauma informed care
Realize
Recognize
Respond
Re-traumatization
60
four assumptions of trauma informed care: realize
realize the widespread effect of trauma and understand potential paths for recovery
61
four assumptions of trauma informed care: recognize
s/sx of trauma in clients, families, staff, and others involved with the system
62
four assumptions of trauma informed care: respond
Respond by fully integrating knowledge about trauma into policies, procedures, and practices
63
four assumptions of trauma informed care: re-traumatization
seek to actively resist re-traumatization
64
when does HPV vax switch from recommended to shared decision making
27
65
HPV vax timing <15yo
2 doses
@ 0 and 6-12mo
(if too soon recc 3rd dose)
66
HPV vax timing 15-26yo
3 doses
@ 0, 1-2mo, 6mo
67
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)
68
lichen simplex chronicus presentation
skin thickening (leathery, bark-like)
itch-scratch cycle
69
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
70
lichen planus presentation
Classical: white, lacy, Wickham striae
hypertrophic: white, thick, warty plaques
erosive: erythematous erosions extend to labia
71
identifying characteristic of lichen planus
oral involvement is common if erosive lichen planus
72
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
73
s/sx of air embolus
"mill wheel" murmur
74
earliest indicator of air embolus
reduced end tidal CO2
(also see reduced O2 sat, hypotension, tachycardia, R heart strain on echo)
75
most common locations of ureteral injury
1. near IP (ureter crosses over bifurcation of iliacs)
2. cardinal ligament (ureter under uterine artery)
3. where ureter enters bladder
4. lateral border of USLS
76
recommended repair for upper 1/3 ureteral injury
uretero-ureterostomy
77
recommended repair for middle 1/3 ureteral injury
uretero-ureterostomy
- can consider Boari flap
78
recommended repair for lower 1/3 ureteral injury
direct reimplantation
+/- psoas hitch
(within 6cm of bladder)
79
AIDET
5 fundamentals of patient communication
Acknowledge
Introduce
Duration
Explanation
Thank you
80
RESPECT model
Rapport
Empathy
Support
Partnership
Explanations
Culture competence
Trust
81
Cisplatin/carboplatin toxicity
ototoxicity (cisplatin)
nephrotoxicity (both)
82
Bleomycin toxicity
pulmonary fibrosis
83
doxorubicin toxicity
cardiotoxicity
84
trastuzumab toxicity
cardiotoxicity
85
cyclophosphamide toxicity
hemorrhagic cystitis
86
vincristine toxicity
peripheral neuropathy
87
paclitaxel toxicity
peripheral neuropathy
88
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
89
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
90
BRCA1 risk of ovarian cancer
40%
91
BRCA2 risk of ovarian cancer
15%
92
BRCA risk of breast cancer
70%
93
BRCA-like genes
ATM
BRIP1
CHEK2
NF1
PALB2
RAD51C
RAD51D
94
Lynch syndrome characteristics
autosomal dominant
colon, uterine, ovarian CA
3-5% of uterine cancer
95
DNA Mismatch repair genes!!
MLH1
MSH2
MSH6
PMS2
EPCAM
96
Li-fraumeni syndrome associated with mutation in
TP53
(tumor suppressor gene)
97
Li-fraumeni syndrome characteristics
autosomal dominant
osteosarcoma, breast, colon, leukemia, lymphoma, brain CA
98
Cowden syndrome characteristics
autosomal dominant
thyroid, breast, and endometrial cancers
99
Cowden syndrome gene abnormality
PTEN
- pathogenic variant in phospatase and tensin (PTEN) gene
100
mnemonic for Cowden syndrome
Pettin (PTEN) my COW BETty (breast, endometrial, thyroid)
101
peutz-jeghers syndrome characteristics
autosomal dominant
breast (50% lifetime risk), sex cord stromal, cervical, uterine, GI, pancreatic, lung
102
peutz-jeghers syndrome gene
serine/threonine kinase 11 (STK11) gene
103
how to dx peutz-jeghers syndrome
2 criteria of:
1. hamartomatous polyps throughout GI tract
2. mucocutaneous hyperpigmentation
3. FHX same
104
para/mesonephric ducts give rise to which sex
Mesonephric = Male genital ducts
Paramesonephric = Female
105
when does sex differentiation occur
7 weeks development
106
what gene determines sex & how
SRY (on Y chromosome)
SRY+ = Males
(Males are SORRY)
107
ureteric bud becomes
ureter
108
mesonephric ducts become
all parts of testes/sperm tract (male)
trigone of bladder
109
urogenital sinus becomes
bladder (except trigone)
prostate gland vs lower 2/3 of vagina
bulbourethral gland
urethra
110
paramesonephric duct becomes
oviduct
uterus
upper 1/3 of vagina
111
what does absence of MIF do
no testosterone
mesonephric ducts regress (no male parts)
112
genital tubercle becomes
Male body/glans of penis, corpus cavernosum & spongiosum
Female body/glans of clitoris
113
genital folds become
male ventral aspect of penile and penile raphe
female labia minora
114
genital swellings become
male scrotum and scrotal raphe
female labia majorum, mons pubis
115
parvovirus in pregnancy
most lethal virus to fetus
slapped cheek
116
CMV in pregnancy
most common
hearing loss
blueberry muffin baby
117
toxoplasmosis in pregnancy comes from
undercooked meats
(cats litter more rare)
118
order of secondary sex characteristics
1. growth spurt prior to breast buds
2. thelarche - breast buds
3. pubarche - pubic hairs
4. adrenarche - axillary hair
5. MAX growth spurt
6. Menarche
7. bone closure of epiphyseal plates
119
longest diameter of fetal head
supra-occipital mentum (12.5cm)
120
occiput posterior associated with shich type of pelvis
anthrOPoid
121
lemon sign on US indicative of
spina bifida
122
banana sign on US indicative of
arnold chiari malformation
123
most common causes of primary amenorrhea
1. gonadal failure
2. congenital absence of uterus (uterine agenesis, MRKH)
124
most common GYN cancer dx in pregnancy
cervical
125
low-risk score for GTN
WHO score <7
(>= 7 is high risk)
126
tx low-risk GTN
single agent chemo
- MTX vs Dactinomycin
127
tx high-risk GTN
combo chemo
- EMACO
128
EMACO
Etoposide
MTX
Actinomycin-D
cyclophosphamide
Vincristine
129
mnemonic for categories of points for GTN
#PIMPBAT
of mets
Prior pregnancy
Interval
Mets site
Prior chemo
BHCG pretreatment
Age
Tumor size
130
sensitivity
TP / (TP+FN)
131
specificity
TN / (TN+FP)
132
PPV
TP / (TP+FP)
133
NPV
TN / (FN+TN)
134
cardinal movements of labor
ED FIrE REx
engagement,
descent,
flexion,
internal rotation,
extension,
Restitution (external rotation),
expulsion.
