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Boards - UROGYN General
OBGYN Qualifying Exam
275
Other
Post-Graduate
07/09/2020

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Cards

Term
when to refer to urogyn for incontinence - 5
Definition
uncertain diagnosis after basic evaluation, lack of correlation between symptoms and clinical findings, hematuria without infection, neurologic disease, failure to respond to therapy, long term voiding dysfunction after sling
Term
when to refer to urogyn for mesh - 6
Definition
pain with non-exposed mesh, erosion into bladder/urethra/vagina, large volume exposure, granulation tissue, sinus tracts, exposure from transabdominal mesh
Term
when to refer to urogyn for sacrocopopexy complications - 3
Definition
osteomyelitis, disciitis, de novo visceral pain (may require complete excision)
Term
what is a gardner duct cyst
Definition
mesonepheric/wolfian remnant with a serous or mucinous cyst
Term
signs of a gardner duct cyst
Definition
unable to insert tampon
Term
location gardner duct cyst
Definition
posterior lateral vagina
Term
risks of urethral diverticula = 2
Definition
parous, African american
Term
signs of a urethra diverticulia
Definition
3cm distal on anterior vagina, adult, dysuria, dysparunea, post void dribbling, urethral discharge
Term
diagnosis of urethral diverticulia
Definition
MRI
Term
treatment of urethral diverticulia
Definition
diverticulectomy (closed in many layers) +/- flap, autologous sling if SUI (although must educate that it isn't as good as a MUS and would have to wait 6wk pos diverticulectomy for MUS)
Term
location of bartholins
Definition
4 and 8 o clock inside hymen
Term
recurrence of bartholins
Definition
25%
Term
when to biopsy bartholins, why
Definition
increased adenocarcinoma, biopsy >40yo
Term
%>60yo with adenocarcinoma if bartholins
Definition
5%
Term
location of the skenes gland
Definition
lateral to urethra
Term
function of the skenes gland
Definition
lubrication
Term
define urethral caruncle
Definition
prolapse of the urethra that isn't circumfrential
Term
define urethral prolapse
Definition
circumfrential prolapse of the urethra
Term
risks for urethral caruncle
Definition
children, PMP
Term
signs of urethral caruncle, other than the caruncle - 3
Definition
bleeding, dysuria, urinary obstruction
Term
signs a urethral caruncle could be a malignancy - 4
Definition
>2cm, firm, extension to surrounding tissues, inguinal adenopathy
Term
treatment of urethral caruncle - 2
Definition
estrogen or 2-3mo (daily for 2w then 2x/wk), surgical excision if refractory
Term
complication of caruncle excision 1
Definition
urethral stenosis
Term
% of reproductive age women with asymptomatic bacturia
Definition
6
Term
% of women >65yo with asymptomatic bacturia
Definition
20
Term
% of women who get multiple UTIs a year
Definition
5%
Term
% of women who get 1 UTI a year
Definition
12
Term
define recurrent UTI
Definition
2+ in 3mo or 3+ in 1y
Term
risks for UTI - 9
Definition
pregnancy, DM, obesity, sickle cell, sex, specmicide, catheters, hygiene, GU abnormalities
Term
risk of infection per day with a catheter in place
Definition
3-10%
Term
% of symptomatic infection when a catheter is in place
Definition
20%
Term
management of catheter UTI
Definition
only treat if symptomatic
Term
4 options for UTI prevention and their effectiveness
Definition
E3 (UTI 6 to 0.5% in PMP), Macrobid 95%, methamine salts and vitamin C (?), cranberry and vitamin C (not juice) (helps some but least effective)
Term
if a PMP women does not respond to estrogen for recurrent UTI what do you do
Definition
CT urogram
Term
how long can you try Macrobid for UTI prevention
Definition
6-12mo then reassess
Term
contraindications to macrobid
Definition
chronic interstitial lung disease in elderly
Term
methamine salts and vitamin C MOA for UTI prevention
Definition
turn urine to formaldehyde and vitamin C increases the acidity which kills bacteria
Term
SE of methamine salts - 3
Definition
hematuria, dysuria, GI acidity
Term
define nocturia
Definition
2+ voids a night
Term
define noctournal polyuria
Definition
>35% of volume is voided at night
Term
causes of nocturia - 8
Definition
excess fluids, CHF, venous insufficiency, medications, OSA, RLS, desmopressin, bladder outlet obstruction
Term
complication of nocturia
Definition
falls in the elderly
Term
treatment of noctournal polyuria and nocturia
Definition
both just address cause, in polyuria you can do desmopressin if refractory
Term
complication of desmopressin
Definition
hyponatremia
Term
rate of recognized and total 4MLL
Definition
5% seen, 30% total rate
Term
rate of anal incontinence post delivery
Definition
40% - but most is resovled within 6wk
Term
define the laceration grades
Definition
1- skin mucosa
2- perineal body, bulbocavernosis
3A- <50% EAS
3B- >50% EAS
3C- EAS and IAS
4- anal epithelium
Term
level A and B evidence prevention for perineal laceration
Definition
level A - warm compresses
level B - perineal massage
Term
perineal massage - evidence for laceration prevention
Definition
may reduce 3-4MLL when done in the second stage of labor, but not 1-2MLL or overall rate of laceration
Term
perineal support - evidence for laceration prevention
Definition
insufficient evidence, one trial showed no help, one trial showed helped prevent OASIS
Term
warm compresses - evidence for laceration prevention
Definition
reduces 3-4MLL but not total laceration rate
Term
supine or upright birth positions - evidence for laceration prevention
Definition
decreased episotomy and operative delivery but increased 2MLL
Term
lateral position - evidence for laceration prevention
Definition
with delayed pushing decreased overall incidence of laceration, but not alone
Term
delayed pushing - evidence for laceration prevention
Definition
with lateral position decreased overall incidence of laceration, but not alone
Term
risk factors for perineal laceration in order from highest to lowest - 14
Definition
FAVD+midline > FAVD > VAVD > midline > big baby > primip > OP > Asian > epidural > augmentation > mother had OASIS > sister had OASIS > induction > other: shoulder dystoica
Term
recurrence rate of 3-4MLL
Definition
10%
Term
which has more midline vs mediolateral - bleeding
Definition
mediolateral
Term
midline vs mediolateral - 3-4MLL
Definition
midline
Term
which has more midline vs mediolateral - pain
Definition
mediolateral - dysparunena later as well
Term
which has more midline vs mediolateral - difficult repair
Definition
mediolateral
Term
preferred episotomy by ACOG
Definition
mediolateral
Term
2 alternative episotomy types
Definition
J/hockey stick, 1+2=T
Term
what is reattached in a paravaginal repair
Definition
pubocervical fascia to arcus tendinous
Term
suture used in 1MLL
Definition
3-0 to 4-0 absorbable
Term
suture used in 2MLL
Definition
3-0 delayed absorbable
Term
suture used in 3MLL
Definition
2-0 delayed absorbable
Term
suture usedin 4MLL on rectal mucosa
Definition
4-0 absorbable
Term
suture used in 4MLL on IAS
Definition
3-0 vicryl or PDS
Term
suture used in 4MLL on EAS
Definition
2-0 vicryl or PDS
Term
suture used in 4MLL on second degree
Definition
2-0 vicryl
Term
acute complications of OB lacerations - 4
Definition
hematoma, abscess, dehiscinence, necrotizing fasciitis
Term
chronic complications of OB lacerations - 3
Definition
incontinence, dysparunea, fistula
Term
risk factors for OASIS top 2
Definition
#1 FAVD (3x VAVD), #2 VAVD
Term
non-top 4 risk factors for OASIS -
Definition
primip, Asian,Hispanic, AMA, big baby, prolonged second stage, midline episotomy, OP 2x, low BMI, lithotomy/squatting 2x
Term
rate of OASIS in OB lacerations
Definition
2-20%
Term
rate of laceration breakdown
Definition
3-7%
Term
signs of laceration breakdown - 7
Definition
pain, bleeding, discharge, occurs within 7-14d, incontinence, fistula, cloaca
Term
risks factors for laceration breakdown - 13
Definition
smoking, FAVD, infection, midline episotomy, obesity, 4MLL, intercourse, hematoma, bleeding, prolonged second stage, edema, poor nutrition, poor surgical skills
Term
initial management before repair of laceration breakdown - 5
Definition
debriment, betadine scrub, antibiotics, estrogen topical, bowel regimen
Term
benefits to immediate laceration repair after breakdown
Definition
less litigation
Term
risks to immediate laceration repair after breakdown - 2
Definition
infection may cause you to delay anyways, edema makes surgery hard
Term
how do you treat infection of an OB laceration
Definition
cipro
Term
benefits of delayed laceration repair - 2
Definition
less edema and infection
Term
risks of delayed laceration repair - 3
Definition
longer time in pain and with incontinence, longer time until return to sexual activity
Term
boundries of a vulvar hematoma
Definition
pubic fascia of the thigh or colles fascia, ischiopubic ramus, anal fascia, superficial transverse perineal muscle, urogenital diaphragm, perianal fascia
Term
risks for vulvar hematoma - 9
Definition
primip, operative delivery, big baby, prolonged second stage, vulvar varicosities, lacerations, coagulopathy, multiples, episotomy
Term
complications of a vulvar hematoma - 5
Definition
recurrence, persistence, skin pressure necrosis, necrotizing fasciitis, secondary infection
Term
treatment of vulvar hematoma
Definition
if <5cm and stable - mark borders, ice, pressure, analgesia, foley, I/Os
if >5cm or unstable - I+D antibiotics, close dead space, drain and pack
Term
management of recurrent or persistent vulvar hematoma
Definition
arteriel embolization
Term
associated condition with ecopic ureter
Definition
80% have a duplicated collecting system
Term
cause of ectopic ureter
Definition
bud of the mesonepheric duct
Term
male signs of ectopic ureter - 2
Definition
hydronephrosis, UTI
Term
female signs of ectopic ureter - 1
Definition
incontinence only if past the sphincter
Term
ureter injury TAH vs TVH
Definition
TAH >TVH
Term
% of ureter injuries in GYN surgeries
Definition
75%
Term
% of GYN surgeries with ureter injuries
Definition
1-2%
Term
% of ureter injuries unrecognized
Definition
70%
Term
risks for ureter injury - 8
Definition
EBL >800, big uterus, long surgery, obesity, TVH with POP, radical surgery, prior radiation, endometriosis, prior pelvic surgery
Term
symptoms of ureter injury - 10
Definition
colicky flank pain, ileus, nausea, vomiting, elevated Cr and CRP, hematuria, leukocytosis, oliguria, fistula
Term
dyes used for ureter flow visualization - 6
Definition
indio carmine, methylene blue, indocycanin green, Na flouricine, D10 bladder instillation, pyridium pre-op
Term
which dye for cysto can cause UTI
Definition
D10 instillation
Term
imaging for ureter injury gold standard
Definition
IVP
Term
why do obese people have higher ureter injury
Definition
in 12% of them it is 0.5cm closer to the cervix
Term
prevention of ureter injury - 2
Definition
stents (pollack, 5-6F), supracervical hysterectomy, development of vesicouterine space away from the vagina
Term
5 steps to working up no jets
Definition
1 - dyes, fluids, time
2 - remove a stictch
3 - IVP
4 - place drains if needed (nephrostomy, JP retroperitoneal, foley)
5 - repair
Term
what type of suture is used to repair the ureter
Definition
4-0 delayed absorbable
Term
2 ways to repair the upper 1/3 of the ureter
Definition
if <50% and no tension - stent for 4-6wk
if >50% or on tension - transureterouretal anastomosis (connect it to the other ureter?)
Term
management of ureter injury in middle 1/3 of the ureter
Definition
ureteroureteral anastomosis - just reconnect it
Term
management of injury in the lower 1/3 of the ureter
Definition
ureteroneocystotomy - connect it to the bladder
Term
4 types of ureterneocystoyomy
Definition
submucosal tunneling, fish mouth, psoas hitch, biori flap
Term
explain submucosal tunneling
Definition
tunnel for 3-5cm in oblique direction and attach ureter to the bladder in oval shape
Term
explain fish mouth procedure
Definition
cut the bladder from 9 to 3 and then squish it in the opposite direction of your cut to make a tube to attack to the ureter off tension
Term
explain psoas hitch
Definition
sew the bladder to the psoas to keep the ureter off tension
Term
explain biori flap
Definition
psoas hitch plus a transverse bladder flap made into a tube to connect to the ureter
Term
signs of bladder injury 5
Definition
fistula, uroma, hydroureter, hydronephrosis, abscess, urine ascites
Term
types of bladder injury where you can just drain the bladder, no repair
Definition
veres,
Term
what do you do if you cant reach the bladder injury to repair it
Definition
interntional anterior cystotomy
Term
after you made an injury in the trigone (or <1cm from the uteter) and urology fixed it, how will the patient follow up
Definition
foley 7d, image BEFORE pulling
Term
what size dome injury can you repair
Definition
<2cm
Term
when you make a dome injury >2cm and uroogy repairs it what is the folloe up for the patient
Definition
foley for 1-3d, can you image before pull, but if you check urine and there is no microhematuria you don't have to
Term
how do you repair a dome injury
Definition
running locking the mucosa, imbricating the seromuscular layer, prove its water tight, use 3-0 delayed absorbable
Term
follow up after <2cm dome injury
Definition
foley or not up to you
Term
#1 cause of a fistula in the USA
Definition
TLH
Term
rate of a fistula with hysterectomy
Definition
1%
Term
#1 cause of fistula in the world
Definition
OB trauma
Term
risks for fistula - 16
Definition
GYN surgery, OB trauma, bladder injury, cancer, radiation, early coitus after surgery, IBD, infection, malnutrition, UAE, diverticulitis, adhesions, athlerosclerosis, DM, endometriosis, fibroids
Term
when does a fistula usually happen
Definition
7-10d after insult/surgery up to 30d
Term
signs of a fistula - 7
Definition
discharge, hematuria, fever, pain, infection, incontinence, vaginal flatus
Term
diagnosis of vesicovaginal fistula - 7
Definition
pyridium, methylene blue, CT urogram, reterograde pyelogram, Cr serum > urine, fistulogram, vaginoscopy
Term
explain the pydirium methylene blue test for vesicovaginal fistula
Definition
give pyridium if tampon is orange it could be bladder or ureter fistula, drain bladder, give methylene blue if blue it is a bladder fistula, if white or orange ureter fistula
Term
#1 location of a vesicovaginal fistula
Definition
high vault - 75% of post-hyst fistulas
Term
if someone has a high vault vesicovaginal fistula what do you need to check RIGHT AWAY
Definition
the ureter, 15% chance the ureter is injured/fistula too
Term
treatment if a small vesicovaginal fistula
Definition
<1cm expecting management, 15% heal in 2-3wk, drain the bladder for 4-6wk
Term
when do you repair a larger vesicovaginal fistula
Definition
if infected treat and repair in 8-12wk, if not repair within 1-2wk
Term
2 ways to repair a vesicovaginal fistula >1cm and the indication for each
Definition
modified latzko - supratrigonal, interposition flap - complicated fistula
Term
explain modified laszko
Definition
remove vesicovaginal fistula tract and use anterior posterior vaginal to make a partial colpocliesis
Term
explain interposition flap
Definition
martius bulbocavernosis fat pad graft used to repair complicated fistulas
Term
after repair of fistula >1cm what is the follow up - 4
Definition
foley 2wk, estrogen topical, stool softeners, pelvic rest
Term
complications of a vesicovaginal fistula repair - 5
Definition
hemorrhage, ureter obstruction, breakdown, recurrence, incontinence
Term
options for treatment of a ureterovaginal fistula - 5
Definition
stents, diversion, reimplantation, anastomosis,nephrostomy
Term
3 types of vesicouterine fistula
Definition
1- Yousef - amenorrhea, menorrhea, continence
2 - dual flow - normal menses, menorrhea, and vaginal urine
3 - normal menses and menuria
Term
diagnosis of a rectovaginal fistula
Definition
vaginal bubbles when air is instilled in the rectum
Term
treatment of small rectovaginal fistula
Definition
if <0.5cm 40% will close
Term
what population is a fibrin plug used for
Definition
rectovaginal fistula in patients with IBD first line
Term
management of a rectovaginal fistula that is >0.5cm - 4 ways and why
Definition
distal location - transperitoneal
mid to high location - latzjo
high location - abdominal
proximal location - goligher, York, or mason
Term
what do you dissect into when doing a transperitoneal fistula repair and what kind of fistula is it
Definition
rectovaginal fistula >0.5cm, rectovaginal septum
Term
what is a golgher repair
Definition
repair of a rectovaginal fistula >0.5cm that is via vagina, rectal, or perineal approach
Term
what is a York or mason repair
Definition
repair of a rectovaginal fistula that is >0.5cm that is of a transphincter approach
Term
diagnosis of a colovaginal fistula - 7
Definition
methylene blue intraperitoneal, cystoscopy, barium enema, fistulogram, bud of granulation tissue at top of vagina, CT, MRI
Term
treatment of a colovaginal fistula - 3
Definition
resection of part of colon, diversion colostomy, repair of vaginal defect
Term
causes of chronic urinary retention - 9
Definition
DM, CVA, MS, anticholinergics, muscle relaxers, antidepressants, a adrenergics, B adrenergics, antihistamines
Term
signs of chronic urinary retention - 7
Definition
painless, hesitancy, post void dribbling, frequency, straining, overflow incontinence, UTI
Term
evaluation of chronic urinary retention - 4
Definition
BUN, Cr, uroflo, uroD
Term
long term complications of catheter - 2
Definition
cancer, infection
Term
if long term catheter what screening is needed
Definition
yearly cystoscopy
Term
treatment options for chronic urinary retention - 6
Definition
self cath, stop causative meds, a-blockers, cholinergics, neuromodulation, behavorial modification
Term
what a-blockers are used for chronic urianry retention - 2
Definition
Tamsulosin, phenoxybenzamine
Term
what cholinergics are used for chronic urinary retention - 1
Definition
bethancol
Term
early signs of acute urinary retention - 5
Definition
unable to void, incomplete voiding, pain, post void dribbling, frequency
Term
late signs of acute urinary retention - 5
Definition
renal failure, hydronephrosis, pyelonephritis, bladder stones
Term
evaluation for acute urinary retention - 8
Definition
PVR >150, UA, UCx, cysto if concern for urethral issue, consider if injury (VCUG, CT, IVP, uroflo)
Term
cause of acute urinary retention - detrusor - 6
Definition
trauma, edema, anesthesia, anticholinestergic, inflammation, decreased function due to infection
Term
5 steps in mamagement of acute urinary retention
Definition
1 - immediate decompression
2 - if PP can self cath or foley for 1-2d
3- foley 2-7d then trial
4 - foley or self cath for 7d then trial
5 - self cath for 14d then trial
Term
what size is a self cath
Definition
8F
Term
complications of overfilled bladder 2 and at how many cc
Definition
750cc bladder hemorrhage and IVC compression
Term
medication options for non-obstructive acute urinary retention - 5
Definition
bethanechol, prostigmin, prazosin, Tamsulosin, valium
Term
contraindications to bethanechol
Definition
asthma
Term
SE to bethanechol - 2
Definition
flushing, diarrhea
Term
how is prazosin used for urinary retention
Definition
use x5 until void
Term
which medication for acute urinary retention is best for contracted pelvic floor
Definition
valium
Term
% women with painful bladder syndrome
Definition
2-6%
Term
age of women with painful bladder syndeom
Definition
>40yo usually
Term
define painful bladder syndrome
Definition
pain perceived to be from the bladder for >6wk without other cause
Term
define interstitial cystitis
Definition
urgency, frequency, nocturia, pain on filling, relief with emptying, without cause
Term
possible causes of painful bladder syndrome
Definition
autoimmune, infection, defective urethral GAG barrier
Term
markers that make us think that IC is autoimmune - 3
Definition
c-fibers, mast cells, substance P
Term
why does the GAG layer defect lead to IC - 3
Definition
increased permability, increased sensitivity of pain receptors, increased inflammation
Term
lab association with painful bladder syndrome
Definition
50% have microscopic hematuria
Term
other associations with painful bladder syndrome - 12
Definition
anxiety, CPP, dysparunea, depression, sleep dysfunction, social difficulities, sexual difficulities, catastrophizing, OAB, vestibulitis, vulvydenia, fibromyalgia
Term
things that can cause flares of painful bladder syndrome - 7
Definition
menstruation, sex, allergy, stressors, acidic food, caffeine, alcohol
Term
5 possible ways to didagnosis painful bladder syndrome
Definition
urinary biomarkers (experimental), PUF questionarre, K sensitivity test, cystoscopy, O'Leary santac symptom scale
Term
what is the gold standard for IC diagnosis
Definition
cystoscopy
Term
signs of cystoscopy for IC - 3
Definition
glomerulrizations (hemorrhage, petechiae), hunners ulcers 20%
Term
what 3 tests for IC have a high association with eachother
Definition
PUF questionarre, K sensitivity test, cystoscopy
Term
how does a K sensitivity test work
Definition
deficient GAG layer causes bladder to be sensitive to KCL normal bladder isn't, if >/=2 pain difference from filling with water and KCl it is positive
Term
what is the PUF questionarre - 6
Definition
pain, urgency, frequency, nocturia, sexual issues, quality of life
Term
what are the 2 biomarkers for IC
Definition
glycoprotein 5 decreased, antoproliferative factor increased
Term
conservative treatment for IC - 4
Definition
pelvic PT 39% effective, stress reduction, diet changes (acids, caffeine, alcohol), fluid restrictions
Term
what do they do at pelvic PT that works at 39% effectiveness for IC
Definition
myofascial
Term
% of IC that has triggers for symptoms
Definition
90
Term
surgical treatments for IC - 4
Definition
hydrodistention, urinary diversion, sacral neuromodulation, augmentation cystoscopy
Term
minimally invasive treatments for IC - 4
Definition
pentosane Na, intravesticular instillation of medication, stabilization of mast cells, decreasing neuro sensitivity
Term
MOA pentosane Na
Definition
heparinoid replaces GAG layer
Term
SE pentosane Na - 5
Definition
alopecia, bleeding, diarrhea, nausea, headache
Term
effectiveness of pentosane Na for IC
Definition
50% in 3mo, 70% in 6mo
Term
meds you can do intravesicular for IC - 4
Definition
pentosane Na, DMSO, heparin, lidocaine, NaHCO3
Term
meds you can use to stabilize mast cells for IC - 3
Definition
atarax, Zyrtec, vistaril
Term
meds you can use to decrease neuro hyperactivity in IC - 3
Definition
amytruptline, doxepin, gabapentin
Term
% of women with bladder cancer
Definition
2
Term
% of asymptomatic hematuria that is bladder cancer
Definition
5%
Term
% of asymptomatic hematuria that has a cause
Definition
80
Term
% of asymptomatic hematuria without a cause that will be cancer
Definition
3
Term
if someone without risks has asymptomatic hematuria what is their risk of cancer
Definition
<0.5%
Term
if someone with risks has asymptomatic hematuria what is their risk of cancer
Definition
10%
Term
risks specific to women for bladder cancer - 5
Definition
>60yo, smoker, gross hematuria, >25 RBC, painless
Term
toxins that can cause bladder cancer - 4
Definition
cyclophosphamide, benzenes, aromatic amines, food coloring
Term
genetic conditions that can cause bladder cancer - 3
Definition
retinoblastoma, cowden, lynch
Term
general risks for bladder cancer - 13
Definition
male, >50yo, smoker x3, gross hematuria, pelvic RT, chemo, FHX, irritative voiding, analgesia abuse, chronic UTI, white x2, genetic conditions, toxins
Term
#1 cause of asymptomatic hematuria - 3 things
Definition
GYN contamination, UTI, stone
Term
dyes that can cause false positive asymptomatic hematuria - 4
Definition
beets, cyclophosphamide, chlorpromazine, hydrochloride
Term
medical conditions that can cause false positive asymptomatic hematuria - 3
Definition
myoglobinemia, porphyria, rhabdo
Term
every day things that can cause asymptomatic hematuria - 4
Definition
exercise, sex, trauma, viruses, menses
Term
drugs that can cause asymptomatic hematuria (not false) - 4
Definition
anticoagulants, NSAIDS, chemo, rads
Term
urologic conditions that can cause asymptomatic hematuria -
Definition
nephritis, nephropathy, diveritcula, stone, pyelo, renal cell carcinoma, transitional cell carcinoma, renal emboli, obstruction, trauma, reflux, infection, cystolithiasis, IC, irritant, foreign body, urethritis
Term
gyn conditions that can cause asymptomatic hematuria - 7
Definition
caruncle, fistula, atrophy (bladder, vaginal), PMP bleeding, menses, cervicitis
Term
asymptomatic hematuria screening
Definition
yearly UA for 65yo+
Term
SS for dipstick for asymptomatic hematuria
Definition
98/75
Term
definition of dipstick RBC measurement
Definition
trace 0-3 RBC/HPF
1+ is 6-10
2+ is 10-20
3+ is 40-60
Term
asymptomatic hematuria definition
Definition
>/= 3+ RBC per HPF without other cause
Term
if someone has >/=3RBC/HPP but also has WBC, bacteria, nitrites, before you can diagnose asymptomatic hematuria you need
Definition
a negative urine culture
Term
signs of glomerular disease in urine testing - 3
Definition
casts, dysmorphic RBC, protein >1000 in 24h
Term
management of asymptomatic hematuria age of discrimination
Definition
50yo
Term
management of asymptomatic hematuria <50yo no risks
Definition
nothing
Term
asymptomatic hematuria management >50yo or with risks - 6
Definition
cystoscopy, BUN, Cr, CrCl, CT urogram if concern for stone
Term
what do you do if asymptomatic hematuria persists with negative work up
Definition
yearly UA (DC when normal x2y), yearly microscopy, repeat full work up q3-5y
Term
define fecal incontinence
Definition
loss of stool
Term
define anal incontinence
Definition
loss of stool and gas
Term
risks for fecal incontinence - 16
Definition
age, loose stool, DM, BMI >30, 3-4MLL, UI, chronic illness, psych meds, CVA, MS, dementia, behavorial, radiation, IBF, cholecystectomy
Term
physiology of fecal incontinence - 11
Definition
motility, consistency, compliance, sensation, sphincter, pelvic floor, neuropathy, CNS, overflow, psych, inflammation
Term
inicidence of fecal incontinence
Definition
9%
Term
age with most fecal incontinece
Definition
>70yo 16%
Term
cause of most fecal incontinence
Definition
atraumatic deinnervation 15-50%
Term
exam for fecal incontinence - 5
Definition
bulbocavernosis reflexes, clitoral wink, dovetail (no creases), DRE for masses/tone, fistula exam if nothing else is showing anythinig
Term
studies for fecal incontinence - 6
Definition
EMG, manometry, pudendal nerve terminal motor latency test, fistula work up, colonoscopy, balloon explusion
Term
complications of fecal incontinence - 3
Definition
effect on daily living, institutionalization, perianal dermatitis
Term
7 steps in working up and treating fecal incontinence
Definition
1 - treat stool looseness
2 - biofeedback
3 - anal manometry, if weak US
4 - balloon explusion test
5 - rectal sensation test
6 - sacral neuromodulation
7 - surgery
Term
if the rectal sensation test is positive for defect what do you treat with
Definition
biofeedback
Term
effectiveness of biofeedback for fecal incontinence
Definition
80% effective, increases strength
Term
what do you use to treat loose stool when treating fecal incontinence - 4
Definition
loperamide, immodium, fiber, fluid management
Term
if in the work up of fecal incontinence the anal manometry shows weakness what do you do next
Definition
endoanal US for internal sphincter, 2D US or MRI for external sphincter, scars, atrophy
Term
surgery for fecal incontinence - 4
Definition
sphincteroplasty, dextranometer, neosphincter / gracilis flap, colostomy
Term
success rate of sphincteroplasty
Definition
<50%
Term
success rate of dextranometor
Definition
50% only short term, no long term studies
Term
prevalence rectal prolapse
Definition
0.5%
Term
#1 cause of fecal incontinence
Definition
loose stool 3x risk
Term
risks for rectal prolapse
Definition
colpocliesis - makes normally low pressure vaginal higher than rectum
Term
signs of rectal prolapse - 6
Definition
increased pressure, sensation of incomplete emptying, fecal incontinence, rectal bleeding, bowel incarceration, ulceration
Term
if someone has rectal prolapse what do you have to rule out
Definition
colonoscopy to make sure there isn't a lead point mass
Term
treatment of rectal prolapse - 3
Definition
early surgery! intrabdominal rectopexy with mesh, transperitoneal surgery (altemeier, delorme)
Term
when do you choose altemeier or delorme
Definition
altemeier is the best, delorme is for elderly or with comorbidities
Term
what is altemeier
Definition
full thickness circumfrential incision above the dental line, bowel resection and reanastamosis
Term
what is delrome
Definition
mucosal stripping via submucosal rectal dissection, plication of the muscular layer, anastomosis of mucosa, proximal to dentate line
Term
cause of autonomic hyperreflexia
Definition
cord injury above T6 with viable distal cord
Term
physiology autonomic hyperreflexia
Definition
increased sympathetic response
Term
irritants for autonomic hyperreflexia - 4
Definition
bladder filling, catheterization, bowel distention, GI procedures
Term
symptoms autonomic hyperreflexia - 4
Definition
HTN, HA, flushing, bradycardia
Term
treatment of autonomic hyperreflexia - 4
Definition
stop the thing causing it, treat HTN (a-blocker, nitrate, hydralazine)
Term
when does spinal shock happen
Definition
6-12wk post surgery
Term
symptoms of spinal shock
Definition
atonic bladder that wont empty
Term
treatment of spinal shock
Definition
indwelling followed by intermittent cath (5x/d with goal <500cc)
Term
what is detrusor sphincter dysnergia
Definition
detrusor contracts against closed sphincter which leads to urge and overflow incontinence
Term
risk for detrusor sphincter dysnergia
Definition
spinal cord injury
Term
detrusor sphincter dysnergia treatment initial
Definition
intermittent cath, anticholinergics
Term
when should you skip detrusor sphincter dysnergia initial treatment and go right to surgery - 2
Definition
detrusor does not respond to anticholinergics, poor compliance (leak point pressure is > 40mmHg)
Term
detrusor sphincter dysnergia surgery - 3
Definition
ileocystoplasty, augmentation cystoplasty with catheterizable stoma, ileal conduit
Term
what is a ileocystoplasty
Definition
treatment for detrusor sphincter dysnergia, attach ileum 15cm from valve to bladder
Term
what is an augmentation cystoplasty with catheterizable stoma and its complications
Definition
detrusor sphincter dysnergia surgery, stomal stenosis, incontinence
Term
which surgery for detrusor sphincter dysnergia is best if the patient cant self cath
Definition
augmentation cystoplasty with catheterizable stoma
Term
what is an ileal condiut
Definition
treatment for detrusor sphincter dysnergia, connect ureter to ileum
Term
detrusor sphincter dysnergia surgery who cannot get an ileal conduit
Definition
risk of urethral leaking
Term
risk factors for pubic diastasis - 2
Definition
connective tissue disorders, McRoberts
Term
normal pubic separation
Definition
6mm at 30yo, 4.6mm in multip
Term
normal pubic relaxation during pregnancy (weeks, cause)
Definition
29-32wk, relaxin, progesterone
Term
management of pubic diastasis
Definition
PT, rest, surgery if severe
Term
surgery for pubic diastasis - 3
Definition
internal/external fixation, hip sica cast, pelvic sling
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