Nerve Injuries Flashcards
Pfannensteil incision:
pain above the incision
How long will this take to get better?
6 months
Femoral nerve
presentation
Treatment
Sensory deficit of anterior/medial thigh
Motor deficits of weakness of hip flexion/knee extension
Vaginal surgery: hip ABduction
90% resolve spontaneously
Sciatic Nerve
When would it be injured?
Presentation
VH candy cane stirrups
weakness of knee flexion and dorsiflexions of foot, sensory symptoms of plantar foot
Pudendal Nerve
What procedure would it be injured?
Symptoms?
risk during sacrospinous ligament fixation
Sx: perineal/mons and vulvar pain, worse when seated
Tx: nerve blocks or surgical decompression
Obturator (L2-L4)
Injury how?
Symptom
Treatment
TOT or Radical hyst
Inability to ADDuct thigh, inner thigh numbness
Tx: PT
Fistula repair
Fourth Degree
Post op fever
Day 1-3
Day 3-7
Day 4-7
Day 7+
Causes
1-3: Pneumonia/GI
3-7: DVT/ phlebitis
4-7: Wound, UTI, Pneumonia
7+ bladder, ureteric injury
Young nulliparous patient is found to have a dysgerminoma, how would you treat?
Unilateral salpingo-oophorectomy
Serial tumor markers (LDH and HCG)
Breast Cancer Surveillance in BRCA
25: Annual MRI and CBE every 6 mo
30: Annual MRI and Mammogram + CBE q 12
RRBSO for BRCA 1/2
How to perform?
1: 35-40
2: 40-45
1) insect peritoneal cavity
2) perform washings
3) oophorectomy - 2 cm proximal of ovarian vessels proximal to insertion, FT at cornea, ovary removed at utero-ovarian ligament as close to uterus as possible
4)path to perform serial sectioning
LYNCH syndrome
Cancer screening
1) Colon
2) Endometrial
3) Breast
4) Ovarian
1) Colon: 20: colonoscopy q 1-2 yrs
2) Endometrial: 30: bx q 2 yrs
3) Breast: 40 mammogram
4) Ovairan: no screening
RR TRH BSO every to mid 40’s (or when done with child bearing)
RRBSO for BRCA and HRT? Can you do it?
Yes, if there is no breast cancer, the you can place on HRT for a few years to mitigate menopausal symptoms
Which anticoagulant requires renal dosing?
Lovenox (low molecular weight heparin)
Heparin MOA
Cofactor for Anti thrombin 3
Inhibits thrombin and Factor Xa
Which anti-coagulant effects PTT?
UFH and Warfarin
What are the pros/cons of using Lovenox over UFH?
Pro: less bleeding and HIT
Con: cannot be fully reversed, renally dosing required
Sexual assault work up
1) timing
2) treatment
3) follow up
1) within 72 hours
2) Emergency contraception
STI ppx: G/C/T: G: 500 IM, C Doxy x 7 days and Flagyl 7 days
HIV known: start HAART within 3 days
HIV unknown: call HIV hotline to discuss risk/benefits 28 day HAART
How do you treat PP Depression? Zuranolone
Onset
Dose
Alternative
Indication: depression that occurs in third trimester and within 4 weeks PP
Dose: Zuranolone 50 mg qD x 2 weeks
A/E: balance as it can cause suicidal thoughts/behavior
Alternative: Brexanolone IV over 60 hours
Cardiac Conditions in Pregnancy Contraindicated
1) Severe AS
2) Pulmonary HTN
3) Aortic Dilation 4.5 cm (Marfans)
4) NHYA class IV
5) EF < 30%
6) Severe cardiomyopathy
Molar quant follow up
Partial: weekly until negative, then 1 month after
Complete: weekly until negative, then monthly x 3
Recurrence risk molar?
2%
HCG following- when to do be concerned for a post molar GTD
HCG increasing > 10% over 3 values, plateau HCG: measurements within 10% over 3 week
Molar and when to consider hysterectomy
> 40
S>D
HCG > 100K
Bilateral theca lutein cysts
Heterotopic pregnancy incidence
1/30K
