Gynecology

Question 1

Human Papilloma vaccination

Answer 1

• 2 HPV vaccines have been approved
• Both vaccines generate high concentrations of neutralizing antibodies to HPV L1 protein
• Prospective RCT have demonstrated that vaccination prevents nearly 100% of HPC subtype-specific precancerous cell changes
• HPV will NOT preven ~25 to 30% of cervical cancer

Question 2

Uterine leiomyomas

Answer 2

• Most common pelvic tumor
• Has a racial predilection
• Classified according to anatomic location
• AUB caused by leiomyomas is the most common indication for hysterectomy in the US

Question 3

Endometriosis

Answer 3

• Prevalent in patients suffering from chronic pelvic pain (*)%) and infertility (20-50%)
• Dissemination of endometrial glands include retrograde menstruation, lymphatic and vascular spread of endometrial glands and coelomic metaplasia
• Involves
  
  • ovariesm pelvic peritoneal organ, retroperitoneal septum, sigmoid colon, intraperitoneal organs, retroperitoneal space, ureters, incicional scars, umbilicus, thoracic cavity
• Can also icnreases in CA-125

Question 4

Pregnancy-related surgical conditions

Answer 4

• Trauma related hypovolemia may be compounded by pregnancy induced decreases in systemic vascular resistance
• Gastric motility is decreased leading to increased risk of aspiration
• Increase likelihood of thromboembolic events due to increase in several coagulation factors induced by pregnancy
• Fetal autoregulation of blood pressure occurs only in third trimester

Question 5

Typical indications of cesarean delivery

Answer 5

• Nonreassuring fetal status
• Breech or other malpresentations
• triplet and higher order gestations
• cephalopelvic disporportion
• failure to progress
• placenta previa
• active genital herpes

Question 6

Pelvic floor dysfunction includes ___

Answer 6

Urinary incontinence

voiding dysfunction

Pelvic organ prolapse

disorders of defecation

Question 7

Stress incontinence

Answer 7

• Can be due to lack of urethrovaginal support
• Can be due to intrinsic sphincter deficiency
• Goal of surgical repair is ot create a partial urethral obstruction

Question 8

Endometrial carcinoma

Answer 8

• Risk factors include obseity, smoking
• most common gynecologic malignancy, 4th most common cancer in women
• common in menopausal women
• increased exposure to estrogen without adequate opposition by progesterone
• prolonged use of tamoxifen

Question 9

Vulvar carcinoma

Answer 9

• Vulvar carcinomas are squamous in 90% of cases
• HPV-dependent pathway of carcinogenesis
• Spread of vulvar carcinoma
  
  • direct local extenson
  • lymphatic microembolization
• Staging and priamry surgical treatment are typically preformed as a single procedure and tailored to the individual patient

Question 10

Epithelial ovarian cancer

Answer 10

• Risk factors
  
  • events that appear to icnrease the number of lifetime ovulation
    
    • early menache, late menopause, nulliparity
• Decrease risk
  
  • pregnancym breastfeeding, oral contraceptives
  • history of tubal ligation or hysterectomy

Question 11

The objectives of surgery in EOC

Answer 11

• Establishing histological diagnosis
• Surgical staging
• surgical cytoreduction