Rosh Review Incorrect Flashcards
What is May Thurner Anatomy?
It occurs when the left common iliac vein is compressed by the right tcommon iliac artery against the 5th lumbar vertebrae. Very common in pregnant patients and increases likelihood of VTE/DVT.
What should be administered after 4 units of any blood product?
1g of IV calcium chloride
When should patients be referred for multichannel urodynamic testing during the assessment of incontinence?
Unclear dx–sx do not correlate with physical exam
No impvt with sx after tx
Pt has undergone prior incontinence or pelvic floor surgery
What can be used to avoid ureteral injury ina robotic hysterectomy that is complicated by thick pelvic adhesions?
indocyanine green 25 mg dissolved in 10 mL of sterile water can be injected through a 6-F ureteral catheter. The dye reversibly stains the inside lining of the ureter.
What is the cause of postop fever POD1-3? What are the sx, physical exam, and tx?
Sx: Fever, Tachycardia, Tachypnea
PEx: Inspiratory rales at the lung bases
Tx: Incentive spirometry
What number of metabolic equivalents has been associated with positive postop outcomes?
4 Metabolic Equivalents
Name 4 Postop Cardiovascular complications?
Hypotension
Hypertension
Dysrhythmias
Myocardial injury after noncardiac surgery
What are the appropriate dosages for ancef in pts undergoing hyst?
2g for pts <120kg
3g for pts >120 kg
How often do abx used for laparascopic hysts need to be redosed?
Ampicillin/Sulbactam (Unasyn) & Cefotetan 2hrs
Aztreonam and Ancef q4hrs
Clindamycin q6hrs
No redosing for Levofloxacin, Flagyl and vanc
What is the MOA of GnRH receptor agonist and what condition is it used commonly to treat?
Downregulates the HPO axis
Causes an increase in gonadotropin release and increases estrogen production by stimulating gonadotropin receptors until they are desensitized.
This suppresses the HPO axis and leads to a DECREASE in estrogen and causes a pseudomenopause state. Patients can develop hot flashes and insomnia. If sx are severe low dose estrogen can be prescribed.
Dosage
1. 3.75mg IM or SC q1mo
2. 11.25mg IM or SC q3mos
Treatment length: 6mos. Patients should NOT be on it longer than 6 mos
Treatment for fibroids. Serves as a bridge to surgery. It is only approved for presurgical intentions so that one can reduce the size of fibroids so that the pt can avoid a laparotomy and move forward with a minimally invasive approach. Causes a 35-65% decrease in fibroid volume in 3 mos.
PB 221: Mgmt of Symptomatic Uterine Leiomyomas
What is the most common cause of urogenital fistulas in resource-rich countries?
Hysterectomy
How do urogenital fistulas typically present?
Urinary leakage or watery discharge from the vagina.
What is Youssef’s syndrome?
A specific type of vesicouterine fistula
Cause: iatrogenic injury during a LUS Csection
Sx: cyclic hematuria, amenorrhea, urinary continence
What is the flat tire test?
A method of assessing bowel integrity intraoperatively, where the bowel is occluded proximally, the pelvis is filled with fluid, and air is instilled through the rectum. If bubbles appear, full-thickness injury should be suspected.
What is the timeline for initial vaccination and catch up vaccination for the HPV vaccine?
What test for Factor V Leiden cannot be used while the patient is taking anticoagulants?
Activated protein C resistance assay
When is a gestational sac visualized in pregnancy? When is a GS + YS visualized?
GS- 4-5wks
GS + YS - 5-6wks
What is the ROME IV Criteria?
What is the first line treatment for vaginal cuff cellulitis?
Amoxicillin-Clavulanate (Augmentin)
How many days before surgery should antiplatelet agents be stopped?
Stop ASA 7-10 days before surgery.
Plavix should be stopped 5-7 days before surgery
DIscuss the different anticoagulation mgmt ofr warfarin, DOAC, antiplatelet angets.
What drug class is ulipristal?
Selective progesterone receptor modulator
The left ovarian vein drains into which vessel? The right ovarian vein drains into which vessel?
Left ovarian vein–> Left renal vein–> IVC
The LEFT side takes the LONG way
Right ovarian vein–> IVC
What is the difference between ileus and SBO?