1. GYN / GU

2. Anatomy Fascia surrounding kidney? Gerota’s
List the hilar structures in order from anterior to posterior.
Vein, artery, pelvis
The right renal artery lies ____ to the IVC.
Posterior
The ureters cross _____ the Iliac vessels.
Over
Most common cause of acute renal failure after surgery.
Hypotension

3. Kidney Stones Most common stone Calcium oxalate Struvite Uric Acid
Cysteine

4. Which stones are radiopaque?
Calcium oxalate
Struvite
Uric Acid
Cysteine

5. Indications for surgery
Intractable pain or infection
Progressive obstruction
Progressive renal damage
Solitary kidney
> 4mm

6. Testicular CA True/False
Number one cancer killer age 25-35
Not all testicular masses require surgery
Perform orchiectomy via trans scrotal incision
Mets go to lung, retroperitoneum and mediastinum
75% are Germ cell – seminoma or non seminoma
LDH correlates w/ tumor bulk

7. Seminoma True/False #1 Testicular tumor
All are have beta-HCG elevation
All have AFP elevation
Spread to retroperitoneum
Are treated w/ chemotherapy (Cisplatin, bleomycin, VP-16)
All require XRT

8. Nonseminomatous tumors True/False
Are made up of Embryonal, Teratoma, Choriocarcinoma, Yolk sac
90% (+) HCG and AFP
Teratomas not likely to spread to retroperitoneum
Require prophylactic retroperitoneal node dissection
All stages are treated w/ XRT, orchiectomy, and chemo

9. Prostate CA Most likely present in anterior or posterior lobe?
Most common site of metastasis
Bone (check Alk Phos)
All stages require prostatectomy
Intracapsular depend on age/health
Extracapsular treated w/ Leupron, flutamide, b/l orchiectomy, ketoconazole, XRT (bone pain)
PSA should go to 0 after 3 weeks

10. Renal Cell CA Most common site of metastasis Lung
Treatment of lung or colon mets
Metastectomy (1/3 have mets)
Growth into the IVC precludes resection
NO! Can pull tumor thrombus out.
Adrenal gland is spared during radical nephrectomy
NO! Includes Kidney, adrenal, fat, gerota’s fascia and regional lymph nodes

11. Most common tumor of the kidney
Met from lung
Met from colon
Primary Renal cell CA
Met from Breast

12. What is Von Hippel-Lindau Syndrome
Multifocal and recurrent RCC, Renal Cyst, CNS tumors, and Pheochromocytomas

13. Which of the following are associated RCC paraneoplastic syndromes?
Erythropoieten
PTHrp
Glucogon
Insulin
ACTH
Aldosterone

14. Bladder CA Type of bladder CA associated w/ schistosomiasis
Squamous CA
Most bladder CA is transitional

15. True/False
May treat with intravesical BCG or transurethral resection if muscle not involved.
Muscle wall invasion = T3 or greater
Treatment of >T2 is cystectomy, chemo and XRT
Causes painful hematuria

16. Testicular torsion Peaks at age 10 Usually testicle is viable
Torsion is toward the midline
Treatment
b/l orchiopexy or resection of involved testicle w/ orchiopexy of contralateral testis

17. Ureteral trauma Type of suture used and why.
Absorbable to avoid stone formation
Should always stent and leave drain?
To avoid stenosis and to identify/treat leak

18. What is post TURP syndrome?
Hyponatremia second to irrigation, which can precipitate seizures from cerebral edema.
Treatment of BPH
Alpha-blockers and 5-alpha-reductase inhibitors
Side effect of TURP
Retrograde ejaculation

19. Neurogenic Bladder
Neurogenic Obstructive Bladder
Injury above T12
Injury below T12
Incomplete emptying
Frequent urination
Treated w/ surgery
Treated w/ catheratization

20. Name types of incontinence
Stress
Urge
Neuropathic
Overflow
Congenital

21. Treatment of SCC of penis
Penectomy w/ 2cm margins
Used to test for leaks.
Indigo carmine or methylene blue
Hypospadius
Ventral
Epispadias
Dorsal
Varicocele of the left gonadal vein
Suspicious for renal tumor compressing renal vein
Success rate of vasectomy reversal
50%

22. Phimosis – failure of
foreskin to retract.
Can treat w/ surgery
and topical steroids.

23. Infundibular
ligament
Round
ligament

24. Abortion
Missed – 1st trimester bleeding, closed os, positive sac on US, no heartbeat
Treatened – 1st trimester bleeding, heartbeat
Incomplete – tissue in os
Ectopic – acute abd pain, (+) HCG, negative US, missed period, vaginal bleeding, hypotension

25. Ectopic Level of HCG which raises ???
If < repeat in 48hrs (>66% - US)
3 risk factors for ectopic
Previous tubal manipulation, PID, hx of ectopic

26. Endometriosis Symptoms Vaginal bleeding Dysmenorrhea Infertility
Dyspareunia
Blue mass on rectal edoscopy

27. Most common site of endometriosis
Ovaries
Treatment
OCPs
Diagnosis
Laparoscopy

28. Pt comes in with fever, pain, nausea, vomiting, and vaginal discharge during menstration.
PID
Risk factor
Sleeping w/ Davidyock
Treatment
Rocephin, Doxy

29. Chlamydia
HSV
Syphillis
Gonorrhea
Chancre
Vessicle
Granuloma
lymphadenopathy
Foul thick discharge w/ GNC

30. Due to a ruptured ovarian follicle which occurs 14 days after menses and can be confused with appendicitis.
MITTELSCHMIRTZ

31. Type of cancer associated with vaginal CA
Squamous
Adenocarcinoma
Transitional CA
Clear Cell
Rhabdosarcoma
Treatment is XRT

32. Vulvar CA Associated w/ multiparous, thin, elderly Usually unilateral
<2cm treated with WLE and ipsilateral inguinal lymph node dissection
>2cm Vulvectomy, ipsilateral ILN dissection
XRT if margin <1 cm

33. Ovarian CA Increased risk
nulliparity, late menopause, early menarche (ie. Estrogen exposure)
Decreased risk
OCPs and bilateral tubal

34. Types of ovarian CA Teratoma Granulosa-theca Sertoli-Leydig
Struma ovarii
Choriocarcinoma
Mucinous
Serous
Papillary
Thyroid tissue
Estrogen secreting
beta-HCG
Androgen secreting

35. Staging One or both ovaries Distant metastases Limited to pelvis
Spread thoughout abdomen
Stage I
Stage II
Stage III
Stage IV

36. Treatment of Ovarian CA
Debulking followed by chemo (cisplatin and taxol
Initial site of spread
Other ovary

37. What is Meige’s syndrome
Pelvic ovarian fibroma which ruptures and leads to ascites and hydrothorax.
How do you treat?
Resection of tumor resolves symptoms

38. Krukenberg tumor
Stomach CA which metastasized to ovary

39. Pt is a 50 yo female w/ hx of breast CA who now appears with vaginal bleeding.
DX: Endometrial CA

40. Endometrial CA Most common malignant tumor in female genital tract.
Serous and Papillary – worst prognosis
Risk factors – nulliparity, late 1st preg, obesity, unopposed estrogen, tamoxifen

41. Endometrial staging TAH or XRT I - confined to endometrium II – Cervix
TAH and XRT
I - confined to endometrium
II – Cervix
III – Vagina, Peritoneum, ovary
IV – Bladder, Rectum

42. Cervical cancer is associated with HSV?
16 and 18
Most common type
Squamous
Nodal basin
Obturator

43. Cervical staging I – Cervix II – Upper 2/3 of vagina
III – Pelvis, side wall, lower 1/3 vagina, or hydronephrosis
IV – Bladder, rectum
Stages I & IIa – TAH
Stages IIb to IV - XRT

44. Ovarian Cyst
US demonstrates septation, Increased vascular flow, solid components, or papillary projections?
If postmenopausal – oophorectomy w/ intraop frozen and if CA –TAH
If premenopausal – oophorectomy w/ intraop frozen and if CA need to decide how aggressive and if pt wants children

45. Incidental Ovarian mass at time of laparotomy
Follow same algorithm as for cyst.

46. Random Contraindications to estrogen therapy
endometrial CA, thromboembolic disease, undiagnosed vaginal bleeding, breast CA
Most common vaginal tumor
Invasion of surrounding or distant structure
Appendicitis in pregnancy
Increased risk of premature labor and fetal mortality.
Remember always treat mother as if not pregnant in life and death situations. No mother no baby.