Nerve Injuries

Question 1

Pfannensteil incision:
pain above the incision
How long will this take to get better?

Answer 1

6 months

Question 2

Femoral nerve
presentation
Treatment

Answer 2

Sensory deficit of anterior/medial thigh
Motor deficits of weakness of hip flexion/knee extension
Vaginal surgery: hip ABduction

90% resolve spontaneously

Question 3

Sciatic Nerve
When would it be injured?
Presentation

Answer 3

VH candy cane stirrups
weakness of knee flexion and dorsiflexions of foot, sensory symptoms of plantar foot

Question 4

Pudendal Nerve
What procedure would it be injured?
Symptoms?

Answer 4

risk during sacrospinous ligament fixation

Sx: perineal/mons and vulvar pain, worse when seated

Tx: nerve blocks or surgical decompression

Question 5

Obturator (L2-L4)
Injury how?
Symptom
Treatment

Answer 5

TOT or Radical hyst
Inability to ADDuct thigh, inner thigh numbness
Tx: PT

Question 6

Fistula repair

Question 7

Fourth Degree

Question 8

Post op fever
Day 1-3
Day 3-7
Day 4-7
Day 7+

Answer 8

Causes
1-3: Pneumonia/GI
3-7: DVT/ phlebitis
4-7: Wound, UTI, Pneumonia
7+ bladder, ureteric injury

Question 9

Young nulliparous patient is found to have a dysgerminoma, how would you treat?

Answer 9

Unilateral salpingo-oophorectomy
Serial tumor markers (LDH and HCG)

Question 10

Breast Cancer Surveillance in BRCA

Answer 10

25: Annual MRI and CBE every 6 mo

30: Annual MRI and Mammogram + CBE q 12

Question 11

RRBSO for BRCA 1/2

How to perform?

Answer 11

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

Question 12

LYNCH syndrome
Cancer screening
1) Colon
2) Endometrial
3) Breast
4) Ovarian

Answer 12

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)

Question 13

RRBSO for BRCA and HRT? Can you do it?

Answer 13

Yes, if there is no breast cancer, the you can place on HRT for a few years to mitigate menopausal symptoms

Question 14

Which anticoagulant requires renal dosing?

Answer 14

Lovenox (low molecular weight heparin)

Question 15

Heparin MOA

Answer 15

Cofactor for Anti thrombin 3
Inhibits thrombin and Factor Xa

Question 16

Which anti-coagulant effects PTT?

Answer 16

UFH and Warfarin

Question 17

What are the pros/cons of using Lovenox over UFH?

Answer 17

Pro: less bleeding and HIT
Con: cannot be fully reversed, renally dosing required

Question 18

Sexual assault work up
1) timing
2) treatment
3) follow up

Answer 18

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

Question 19

How do you treat PP Depression? Zuranolone
Onset
Dose
Alternative

Answer 19

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

Question 20

Cardiac Conditions in Pregnancy Contraindicated

Answer 20

1) Severe AS
2) Pulmonary HTN
3) Aortic Dilation 4.5 cm (Marfans)
4) NHYA class IV
5) EF < 30%
6) Severe cardiomyopathy

Question 21

Molar quant follow up

Answer 21

Partial: weekly until negative, then 1 month after
Complete: weekly until negative, then monthly x 3

Question 22

Recurrence risk molar?

Answer 22

2%

Question 22

HCG following- when to do be concerned for a post molar GTD

Answer 22

HCG increasing > 10% over 3 values, plateau HCG: measurements within 10% over 3 week

Question 23

Molar and when to consider hysterectomy

Answer 23

> 40
S>D
HCG > 100K
Bilateral theca lutein cysts

Question 24

Heterotopic pregnancy incidence

Answer 24

1/30K