Case List- Gyn Flashcards

Question

what is the anal wink testing and how do you perform? what is the bulbocarvenosus reflex?

Answer 1

1) skin near perineum, intact pudendal nerve = contraction of external sphincter 2) tap clitoris and external sphinter reflex (checking S2-S4)

Answer 2

Around 90%

Answer 3

1) No, this patient had acute on chronic blood loss anemia. - Due to heavy menstural blood loss, she did not have enough iron to make enough hemoglobin (in the bone marrow) 2) submucosal and intramural are more likely to bleed. -Submucosal as they are abutting the endometrium and increasing endometrial surface Intramural: due to the neovarscularization around the fibroid to the pseudo capsule (with friable vessels) as well as the -larger size prevents the uterus from contracting down and controlling bleeding and/or more likely to ulcerate/degenerate and cause increase in bleeding

Answer 4

Risk factors: Diabetes, venous insufficiency, PAD, lymphadema, hx MRSA -Staph Aureus, Streptococcus, Enterococcus -hematoma, seroma, abscesss, retained suture Bactrim BID x 7-10 days or Clinda or Doxy

Answer 5

Want wound packing material to be moist and warm to facilitate healing Moisture bc wound fluids contain tissue growth factors that facilitate re-epithelizlization When you remove the dressing, you want it to be moist still and the necrotic tissue will be removed with is, so its a way of debriding the area

Answer 6

Granulation tissue is a key component of the wound healing process- proliferation phase. It consists of new connective tissue and tiny blood vessels that develop in the wound bed as part of the body's response to injury. This tissue appears pink or red in color and has a granular or bumpy texture, hence the name "granulation." Essentially, granulation tissue serves as a scaffold for the formation of new tissue and blood vessels, helping to fill in the wound and promote healing

Answer 7

- impede the healing process by delaying wound closure and increasing the risk of infection.

Answer 8

-Bacteriocidal - prevents new growth -Reduce inflammation -promote tissue regeneration. Minimize the risk of complications, such as wound infection or delayed healing.

Answer 9

1. could have done a CKC 2. CIN 2 positive margin.... conservative mgmt would be to Colpo with ECC at 4-6 months

Answer 10

8-12 weeks dissolves fully at 8-10 weeks (by hydrolysis) tensile strength held up for 3 weeks

Answer 11

-I identified the course of the ureter and peristalsis was noted bilaterally after cuff closure. -There was adequate exposure, manipulator placed cephalic to displace the ureters, and the greatest risk of injury for this patient would be while dividing the cardinal ligament, and a cystoscopy would not pick up a thermal injury.

Answer 12

o Upon entry in the abdomen, there was a small amount of free fluid in the pelvis, this was suctioned. The residual cyst was small, thus the decision was made to aspirate the cyst rather than perform a cystectomy due to risks of compromising the ovarian parenchyma/bleeding. patient also was considering future children, thus I did not want to compromise the fallopian tube potency

Answer 13

1) Simple ovarian cysts up to 10 cm are likely benign and can be observed via serial US (even in post menopausal women) 2) Complex, internal architecture solid mass BL massess suspicious findings on US elevated tumor markers ascites symptomatic mass OR torsion

Answer 14

Lower abdominal pelvic pain in sexually active female and other causes have been ruled out. + symptoms of adnexal or uterine tenderness and/or CMT + supporting evidence

Answer 15

1) H&P 2) US 3) Tumor markers IF suspicious.. work up further with 4) CT scan ( and consider lung CT to look for pleural effusions) Surgical approach: midline vertical is standard approach (less data for ovarian cancer with robot than for cervical/uterine) Washings Frozen sectoin Definitive therapy: Hysterectomy BSO, omentectomy, LAD, debunking

Answer 16

-oma's (except teratoma) Fibroma, thecoma, dysgerminoma fibroid- pedunculate brenner, granulose cells

Answer 17

functional, serous, mucinous, mature cystic teratoma, endometrioma

Answer 18

1) Serous CA 125 (50% of the time for Stage 1 epithelial have NORMAL VALUES) Non epithelial ovarian -all the others

Answer 19

yolk sac or embryonal tumors

Answer 20

choriocarcinoma, embryonal carcinoma, dysgerminoma

Answer 21

estrogen and inhibit

Answer 22

thecoma, fibroma, sertoli leydig

Answer 23

dysgerminoma

Answer 24

1) Unilateral SO (conserves CL ovary/uterus) 2) follow with serial tumor markers (LDH) 3) Chemosensitive with Bleomycin, Etoposide, Cysplatin 2/3 dx at early stage

Answer 25

benign mucinous cyst adenoma

Answer 26

Recommend surgical removal as being post menopausal and increased in size > 10 cm, I would recommend removal. Though the majority (80%) of ovarian neoplasms in post menopausal patients are benign epithelial (cyst adenoma)

Answer 27

Breast GI (colon, stomach, appendix) Endometrium Lung Lymphoma

Answer 28

epithelial stratifications papillations nuclear atypia NO STROMAL INVASION

Answer 29

interfere with normal healing process, prevent inflammation and fibroblast proliferation, and collagen synthesis and re-epithelialization

Answer 30

germ cell tumor: AFP, HCG, LDH

Answer 31

o My main concern in the ER was to perform a diagnostic laparoscpy due to her acute abdomen to find a source of her pain, and her US report as inconclusive, stating venous flow to the ovary but inconclusive arterial flow. Given that venous flow will typically be present in a torsion before arterial flow loss, this was not adding up. Upon entry, it was evident that her pain was due to the extent of her endometriosis and ruptured cyst. After evacuating the cystic fluid, pictures were taken to document the extent of disease. Based on her extensive adhesive disease and frozen pelvis, the decision was made to discontinue the procedure for several factors as continuing surgically would put this patient at increased risk of bleeding and/or needing a hysterectomy which would likely end up needing to be done as a laparotomy due to risks of bleeding, lack of exposure. I felt that referreing her ot gyn onc post operatively for a minimally invasive approach was safer for the patient and less risks of surgical injury.

Answer 32

1/1000 Perforation: experience level, PP insertion, breast feeding, extreme anteflexion/retroflexion

Answer 33

<20, HMB, dysmenorrhea, PP, post abortion, large submucosal fibroid

Answer 34

1) reduced bulk symptoms, reduced menstrual flow, reduced size, avoidance of hysterectomy 2)reduction in ovarian function, complications -15%

Answer 35

70% of women by menopausa 25% symptomatic Leading cause of hysterectomies solid tumor comprised of smooth muscle cell and fibroblasts AA have 2-3x more

Answer 36

does help decrease menstrual loss however no evidence specifically for treatment of AUB-L

Answer 37

unplanned hysterectomy: uterine perforation, intraperiotneal injury, hemorrhage rehospitalization: bacteremia from arteriotomy, myometritis, pulmonary embolus post embolization syndrome - fevers, chills, nausea, myometrial infarction, pelvic infection, discharge, failed procedure

Answer 38

pregnancy, desire for future children, active pelvic infection, post menopausal, contrast allergy, radiation history

Answer 39

UAE has a higher reintervention rate

Answer 40

Yes, I did offer her a myomectomy as well as a UAE as she was done with child bearing. This patient wanted to most minimally invasive surgical approach with the quickest return to work. With shared decision making, we decided that a radiofrequency ablation would be a better treatment for her due to smaller surgical incisions and less risk of requiring a hysterectomy. Due to the size of her fibroid, she would need a larger umbilical incision to remove the fibroid with a myomectomy. The fibroid was also located in the posterior uterus near the left uterine artery thus, there was an increased potential for vascular injury and requiring a hysterectomy should this be significant.

Answer 41

ER was concerned for sepsis due to tachycardia, HTN, and history of abortion 2 months ago... No leukocytosis HCG low She had no signs of septic abortion- adnexal tenderness, no fundal tenderness, afebrile

Answer 42

HR >90 Temp > 38 (or <36) RR >20 WBC > 12,000 or < 4,000

Answer 43

pregnancy <20 weeks history fo pregnancy, including termination pelvic pain, uterine tenderness, vaginal bleeding, and/or discharge, and/or fever Sepsis work up, cultures + blood cultures, Broad spectrum antibiotics (Pipercillin and Tazo= Zosyn), US guided suction D&C

Answer 44

rare... mortality rate: depends on the gestational age at the time of abortion of miscarriage, but in first trimester about 2%

Answer 45

Unfortunately, yes the cyst was ruptured when it was removed. Though every attempt was made to preserve the integrity of the cyst, the cyst wall was very thin and ruptured during the dissection.

Answer 46

complication of PID Pt presents with RUQ pain and definitive diagnosed of Laparoscopy Can cause infertility

Answer 47

Progesterone suppresses ovulation by preventing FSH release, thus less follicle development the follicle are then not secreting estradiol, so you don't get an LH surge

Answer 48

pain... This patient was transferred from the outpatient surgery center to the hospital for prolonged observation. AS her pain was controlled and vitals stable, I asked anesthesia to give the patient a scopolamine patch in addition to trying anti-emetics available at the surgery center (Zofran, companize, Phenergan). I assisted with the transfer and signed the patient out to my partner who was covering overnight. Advanced her diet slowly. The patient clinically improved with time and the above measures.

Answer 49

Nulligravidy, age < 30, decision made during traumatic event, single status, poor access to info about sterilization, short timbe between delivery and sterilization

Answer 50

CRL > 7 mm no heart beat MSD 25 mm and no fetal pole GS+ YS present and repeat US in 11 days without heart beat GS (no yolk sac) and repeat scan in 2 weeks and no heart beat

Answer 51

Expulsion rate is similar ... so offer it!

Answer 52

inherited thormbophilias commonly thought as a cause however only APLS has been shown to show significant association with EPL. Use of anticoagulants, ASA or both has not bee shown to reduce EPL in women with thrombophilias except in APLS

Answer 53

nearing 99%

Answer 54

Soaking 2 pads per hour for 2 consecutive hours

Answer 55

Patient was previously in the ER the day prior with complaints of bleeding and Hb was 13.7 at that time. Seen by a different provider planning expectant mgmt.. She was sent home and returned with heavy bleeding (EBL in ED approximately 1L), tachycardic, hypotensive and near syncopal.

Answer 56

Miscarriage (though molar can occur after a term pregnancy) history of molar pregnancy AMA, young age <20, smoking infertility history

Answer 57

1) 2% 2) close to 20% (15-18%)

Answer 58

Rising or plateauing HCG values Rising: in two weeks, rise of > 10% over 3 values Plateau: over 3 weeks, values within 10% of each other

Answer 59

> 40 yo high HCG > 100 K bilateral theca lutein cysts > 6 cm

Answer 60

Both maternal and paternal (69 XXX or 69 XXY)

Answer 61

all paternal XX or XY

Answer 62

Partial molar pregnancy is a result of the union of an ovum and two sperms. Therefore, the genetic content of the fetus is imbalanced with overrepresentation of paternal genetic material. Since the maternal chromosomes are present, the embryo can develop to a certain point.

Answer 63

The complete mole is the result of a union between an empty ovum and generally two sperms. No fetal tissue (empty egg)

Answer 64

broad spectrum, Zosyn