GYN Surgery

Question 1

What does a D&C consist of?

Answer 1

Removal of uterine contents or uterine lining by scraping with a thin medal rod or suction

Question 2

What two drugs can be given to help relax the uterus for a D&C?

Answer 2

Terbutaline and NTG

Question 3

What utertonic drug is a naturally produced hormone?

Answer 3

Oxytocin

Question 4

Where is Oxytocin produced and how is it released into circulation?

Answer 4

Produced in the hypothalamus or haring bodies of the posterior pituitary gland
Released by the posterior lobe of the pituitary gland

Question 5

What are the uses for utertonic drugs?

Answer 5

Prevent/treat postpartum hemorrhage
Ripen cervix and induce labor
Manage incomplete or elective abortions

Question 6

What is the dose of Hemebate?

Answer 6

250mcg IM

Question 7

What is the dose of Methergine?

Answer 7

0.2mg

Question 8

Why is it important not to administer Methergine IV?

Answer 8

Can cause extreme HTN

Question 9

What is the only FDA approved abortion pill?

Answer 9

RU486 Mifeprex

Question 10

What is the limit to take Mifeprex?

Answer 10

Must be taken within the first 49 days of pregnancy

Question 11

When is a D&C typically performed?

Answer 11

Between 6-12weeks of pregnancy

Question 12

When is a D&E performed?

Answer 12

Between 12-24 weeks of pregnancy

Question 13

Why is a conization of the cervix typically performed?

Answer 13

Diagnosis of squamous or glandular intraepithelial lesions

Question 14

What methods can be used for a conization of the cervix?

Answer 14

Scalpel (cold-knife)
Laser
Electrosurgical excision loop (LEEP)
Large loop excision of the transformation zone (LLETZ)

Question 15

What method of conization will give the cleanest specimen?

Answer 15

Scalpel (cold-knife), but requires GA

Question 16

Why do some surgeons prefer GA for conization of the cervix when it can be under regional?

Answer 16

It minimizes the potential for patient movement and hence thermal injury

Question 17

What is the purpose of injecting fluids into the uterus for a hysteroscopy?

Answer 17

To help expand the uterus and allow for better visualization

Question 18

Why is it so important to monitor fluid deficits after dilation of the uterus has been done with a hypotonic solution?

Answer 18

Water intoxication
Fluid overload
Electrolyte abnormalities

Question 19

How many liters usually have to be absorbed for S/S to appear?

Answer 19

Usually greater than 2L

Question 20

What are early signs and symptoms seen with water toxicity?

Answer 20

HTN
Dyspnea
EKG changes
Dilutional Hyponatremia

Question 21

How should the provider proceed with treating water toxicity?

Answer 21

Restrict IVF, high salt diet and may need diuretic

Question 22

As a general rule, how much does serum Na levels decrease by for every liter of hypotonic fluid absorbed?

Answer 22

Decreases by 10mmol/L

Question 23

What are the three types of tubal ligation?

Answer 23

Banded
Cauterized
Tied and cut

Question 24

Where is the most common place for an ectopic pregnancy?

Answer 24

Fallopian tube

Question 25

What is the second leading cause of maternal mortality?

Answer 25

Ruptured Ectopic pregnancy

Question 26

Where can referred pain be felt if a ruptured ectopic pregnancy occurs?

Answer 26

Shoulder pain from blood leaking up and irritating the diaphragm

Question 27

What is the second most common surgery performed on women of child bearing age?

Answer 27

Hysterectomy

Question 28

What are the three types of laparoscopic hysterectomies?

Answer 28

Total laparoscopic hysterectomy Laparoscopically assisted vaginal hysterectomy Robot assisted laparoscopic hysterectomy

Question 29

What are advantage to a laparoscopic hysterectomy versus an open?

Answer 29

Less pain Shorter hospital stay/recovery Smaller incision/less risk of infection

Question 30

What situations is an open hysterectomy best to in?

Answer 30

Large tumors and Cancer

Question 31

What does a radical hysterectomy consist of?

Answer 31

Removal of the uterus, cervix, ovaries, fallopian tubes, upper vagina, parametrium and pelvic lymph nodes

Question 32

Why might a surgeon request indigo carmen during a hysterectomy?

Answer 32

To help identify if an injury has occurred and its location

Question 33

What symptoms does a woman typically have if a myomectomy is required?

Answer 33

Heavy bleeding Pelvic pain Anemia

Question 34

What surgical history would be of concern to the provider that is taking care of a laboring mother?

Answer 34

Previous myomectomy can cause uterine rupture

Question 35

What is the most accurate method of assessing disease status in ovarian cancer?

Answer 35

Second look laparotomy

Question 36

What procedure is performed to determine extent of cancer?

Answer 36

Staging laparotomy

Question 37

What does a radical vulvectomy consist of?

Answer 37

Removal of the groin tissue and entire vulva deep fascia of the thigh, periosteum of pubis, and inferior fascia of urogenital diaphragm, medial thigh, groins, and lower abdomen; resection of the inguinal and often pelvic lymph nodes

Question 38

What age range is vulvar cancer most common?

Answer 38

Women older than 60 years of age

Question 39

What is a pelvic exenteration?

Answer 39

Remove all cancer tissue from the pelvis and create a | surgical diversion for urine and stool

Question 40

How is urine eliminated after a pelvic exenteration?

Answer 40

Urostomy

Question 41

What causes an increase incidence of renal disease postop pelvic exenteration?

Answer 41

UTI and Obstruction

Question 42

What is one of the most common complaints with GYN surgeries?

Answer 42

PONV

Question 43

What interventions can be done to reduce baseline risk of PONV?

Answer 43

``` Consider regional anesthesia Gastric suctioning prior to extubation IV hydration Avoid HoTN Minimize opioids ```

Question 44

What adverse effect is the lithotomy position associated with?

Answer 44

Compartment syndrome