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Which artery if transected during uterine artery ligation can result in gluteal ischemia?
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Choice A is the major blood supply to gluteus maximus and minimus. Choice B provides branches to gluteus maximus and an anastomotic branch contributes to the cruciate anastomosis of the back of the thigh. Choice C supplies the sacrum and coccyx. Choice D supplies the bone and muscles of the iliac fossa.
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Describe the relationship of ureter in reference to the cervix.
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A. The ureter can be found extremely lateral from the internal cervical os
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B. At approximately 2 cm from the cervix, the uterine artery crosses above and in front of the ureter
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C. At approximately 2 cm from the cervix, the uterine artery crosses below and in front of the ureter
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D. Supracervical hysterectomy is only performed to avoid ureteral injury
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The ureter runs under the uterine artery (remember, “water under the bridge”) and they cross at a point approximately 2 cm from the cervix. This point is also called point A in radiation oncology (2 cm anterior and 2 cm lateral from the cervical os). A is incorrect because the ureter runs near the internal cervical os. C is incorrect because the uterine artery crosses above the ureter (the correct choice B). There are a number of reasons to opt to perform a supracervical hysterectomy but the sole reason is not to avoid ureteral injury.
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What level of radiation exposure is thought to be safe in pregnancy?
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Less than 5 rad has not been associated with an increase in fetal anomalies or pregnancy loss.
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The incidence of hypertensive disease in pregnancy.
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Depending on the study population, studies have shown that the incidence of hypertensive disease (gestational hypertension, preeclampsia, eclampsia) is 12% to 22%.
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Tumor marker used to assess progression of disease in ovarian cancer:
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Elevated CA-125 can indicate ovarian cancer (as well as tubal and primary peritoneal cancer). Increasing CA-125 after treatment often indicates progression of disease. Choice B is associated with colon/GI cancer; choice C, pancreatic cancer; choice D, gestational trophoblastic disease/neoplasia.
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Which space is traversed by trocars during a retropubic midurethral sling procedure?
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The space of Retzius is located between the urinary bladder and the symphysis pubis. During a retropubic midurethral sling procedure, trocars are passed from the area of the midurethra up through the urogenital diaphragm, with the trocar hugging the posterior of symphysis pubis. The trocar should pass laterally to the bladder. Bladder perforation is a risk of this procedure.
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How long is fetal monitoring required after the mother sustains major trauma?
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A. Until the nonstress test is reactive
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Following major trauma, fetal monitoring is required for at least 24 hours. After minor trauma, a minimum of 4 hours is required. The risk of a placental event (eg, abruption) is highest during these time frames and may necessitate delivery.
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Which is NOT a symptom of pelvic inflammatory disease?
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B. Cervical motion tenderness
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Cervical motion tenderness is a sign not a symptom. The symptoms of clinically suspected pelvic inflammatory disease are abdominal pain, abnormal discharge, intermenstrual bleeding, postcoital bleeding, fever, urinary frequency, low back pain, and nausea/vomiting.
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Which is the most common gynecologic cancer?
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Endometrial cancer is the most common gynecologic cancer with approximately 40,000 new cases diagnosed each year. It is the fourth most common cancer in women after breast, lung, and colon cancers. Ovarian cancer is the most common cause of gynecologic cancer mortality.
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The risk of endometrial and ovarian cancers is increased in which hereditary cancer syndrome?
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D. Peutz-Jeghers syndrome
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Lynch II syndrome increases risk of colorectal, endometrial, ovarian, gastric, hepatobiliary, small bowel, and brain cancers; Cowden—thyroid, breast, mucocutaneous lesions, colonic neoplasms; Li-Fraumeni—soft tissue sarcoma, leukemia, breast, brain, adrenocortical, pancreatic, lung and possibly prostate cancer, melanoma, gonadal germ cell tumors; Peutz-Jeghers—abnormal melanin deposits, GI tract polyposis and cancer, sex cord tumors, breast cancer.