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Past MCQs > Gynae surgery > Flashcards

Gynae surgery Flashcards

1
Q

Obese lady day 6 post hysterectomy. She was febrile and placed on IV antibiotics. On day 3 the wound began to discharge large amount of a clear fluid. Your management will be:

a - change antibiotics
b - perform erect and supine abdominal Xray
c - return to operating theatre

A

c - return to operating theatre

Working diagnosis is sheath dehiscence

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2
Q

What is the tissue effect if an electrosurgical waveform has high current, low voltage and high temperature (>100 degrees)?

a - cutting
b - coagulation
c - fulgaration
d - dessication

A

a - cutting

Fulguration

  • Electrical current jumps or arcs between the tip and the nearby tissue –> char
  • Used to control bleeding over a wide area
  • Coag, Non-contact

Dessication

  • At higher temp, both dehydration and protein denaturation occur –> desiccation
  • Cut or coag, contact
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3
Q

The proven benefits of subtotal hysterectomy include:

A - reduced hospital stay
B - better sexual function
C - reduced risk of vault prolapse
D - all of the above
E - none of the above
A

E - none of the above

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4
Q

A 30 yo with TAH for intraepithelial Ca of the cervix. Flushed, temp 39 C, PR 140/min, RR 24, clear chest. Most likely diagnosis?

A - PE
B - Pelvic sepsis secondary to bacteroides fragilis
C - Beta Strep
D - Pelvic vein thrombosis
E - Reaction to blood
A

B - Pelvic sepsis secondary to bacteroides fragilis

bacteroides fragilis
- normal microbe of human colon

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5
Q

You are performing an endocervical curettage, which of the following is true?

A - dilate the internal os, perform the endocervical curettage, then uterine curettage
B - dilate the internal os, perform the uterine curettage, then perform endocervical curettage
C - perform endocervical curettage, dilate internal os, then perform uterine curettage
D - perform uterine curettage, dilate the internal os ,then perform endocervical curettage

A

C - perform endocervical curettage, dilate internal os, then perform uterine curettage

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6
Q

When is the least sensible time to remove a 45 yo woman’s ovaries?

A - during operation for a fibroid uterus with a family history of ovarian cancer
B - during operation for endometriosis with bowel involvement

A

B - during operation for endometriosis with bowel involvement

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7
Q

During a TAH for severe endometriosis a 1cm longitudinal laceration is made in the sigmoid colon. Your management would be:

A - anterior resection
B - hemicolectomy
C - repair defect in colon
D - repair defect and form transverse loop colostomy
E - repair defect and form caecostomy
A

C - repair defect in colon

Anterior resection - involves sigmoid and part of rectum

Up To Date - for discrete large bowel injuries, colostomy is rarely needed

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8
Q

The most likely place of damage and haemorrhage in suction D&C?

a - anterior laceration of corpus
b - posterior laceration of corpus
c - lateral laceration of corpus
d - cervical laceration

A

d - cervical laceration

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9
Q

ND YAG laser hysteroscopy. Which medium?

A - CO2
B - Glycine
C - Dextrose
D - Sorbitol
E - N Saline
A

A - CO2

Old school
doubt this is useful

Is using coag / current, need to use glycine as distension medium as non-conducting

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10
Q

Operative hysteroscopy – when are you most likely to perforate?

A - dividing septum
B - submucous fibroid resection
C - rollerball

A

A - dividing septum

GUESS

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11
Q

Ten days after a vag hyst a patient developed a watery vaginal discharge. IVP demonstrated a uretero-vaginal fistula 3cm above the ureterovesical junction. What is the appropriate treatment?

A - uretero-ureteral reanastamosis
B - reimplantation of the ureter
C - perform a Boari flap
D - end to end reanastomosis
E - insertion of a suprapubic catheter and await spontaneous closure
A

B - reimplantation of the ureter

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12
Q

Advantages of hysteroscopic scissors which slip over scope but in sheath.

A - cost
B - flexible distance between scope and scissors
C - heavier more robust rigid scissors possible
D - scissors only take up 1/4 of view

A

D - scissors only take up 1/4 of view

THIS IS A STUPID AND IRRELEVANT QUESTION

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13
Q

Way to minimise adhesions after excision of ovarian endometrioma once haemostasis achieved and ovarian cortex edges opposed?

A - catgut
B - interrupted Dexon
C - continuous Dexon
D - surgical glue
E - leave alone
A

E - leave alone

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14
Q

At end of TAH there is fluid in pelvis which looks like urine. What do you do?

A- sterile milk into bladder
B - dissect out ureters
C - ask anaesthetist to give IV indigo carmine
D - redivac drain and close
E - IDC x 10 days and close
A

C - ask anaesthetist to give IV indigo carmine

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15
Q

The main cause of mortality from tubal ligation?

A - sepsis
B - vascular injury
C - anaesthetic

A

C - anaesthetic

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16
Q

The patient had a radical hysterectomy and in the immediate post-operative period has difficulty walking and the next day she has paraesthesia over her left thigh as well as an absent patella jerk. Which of the following nerves would be appropriate?

A - obturator
B - femoral
C - internal pudendal
D - sciatic

A

B - femoral

17
Q

Difficult hysterectomy with endometriosis, significant blood loss of 2 litres throughout the procedure. At the end of the procedure is noted to have a haemostatic suture too close to what you thought was the ureter. Your next options are:

A - do nothing but closely observe in the next couple of days
B - remove the suture
C - IV indigo carmine and watch the dye through the ureter
D - Do a cystotomy at the operation and pass some catheters up the bladder to make sure the ureter is patent

A

C - IV indigo carmine and watch the dye through the ureter

All are bad options

18
Q

A patient undergoes difficult vaginal hysterectomy, with post operative fever. On day 5 she develops a watery brown vaginal discharge. The MOST APPROPRIATE next step in management is

a. Return to theatre for EUA
b. IV pyelogram
c. CT abdomen and pelvis
d. Vaginal packing
e. Intravenous antibiotics

A

e. Intravenous antibiotics

19
Q

Which one of the following is a branch of the posterior division of the internal iliac artery

a. Uterine artery
b. Lateral sacral artery
c. Obturator artery
d. Middle rectal artery

A

b. Lateral sacral artery

I 	Iliolumbar
Love	Lateral sacral
Sleeping	Superior gluteal
In	Internal pudendal
Only	Obturator
If	Inferior gluteal
Unwilling	Uterine
Virgins	Vaginal
Makes	Middle rectal
Sex	Superior vesical
20
Q

In Australia, the MOST COMMON cause of vesicovaginal fistula is

a. Anterior colporrhaphy
b. Radiation
c. Vaginal hysterectomy
d. Abdominal hysterectomy
e. Obstetric trauma

A

d. Abdominal hysterectomy

21
Q

Which artery should be ligated in order to remove the omentum?

a. Omental branch of abdominal aorta
b. Middle colic
c. Gastroepiploic
d. Left colic

A

c. Gastroepiploic

22
Q

A 44yo woman is having a TLH. During surgery a 3cm hole was found in the bladder. The CORRECT MANAGEMENT is:

a. Repair laceration with surgical glue in 2 layers and insert SPC for 5 days
b. Repair laceration with Vicryl in 2 layers and insert IDUC for 7 days
c. Repair laceration with PDS in 2 layers and insert IDUC for 2 days then perform lateral cystogram prior to removal
d. Repair laceration in 2 layers with PDS and omental patch, IDUC for 10 days.

A

b. Repair laceration with Vicryl in 2 layers and insert IDUC for 7 days

23
Q

The photobiologic basis for the CO2 laser is tissue absorption of CO2 laser energy by

a. Mitochondria
b. Cell membrane
c. Intracellular water
d. Intracellular protein

A

c. Intracellular water

CO2 laser energy is highly absorbed by water, and because water is the primary component of most biologic tissue, CO2 laser energy is highly absorbed by most tissues.

24
Q

A slim 55yo woman has had an abdominal hysterectomy for complex atypical endometrial hyperplasia. The operative procedure is technically easy, exposure is good with the aid of a self-retaining retractor and operating time is 65 minutes. On the first post-operative day she complains of weakness and inability to weight bear on the left leg. There is numbness and reduced sensation over the anterior left thigh, the patella reflex is absent. The injury described is usually associated with:

a. Pressure from a haematoma surrounding the nerve
b. Stress from Trendelenburg position
c. Pressure of the retractors on the psoas muscle and underlying nerve
d. Pressure from the restraining strap across the patients thighs
e. Pressure from a haematoma on the lateral pelvic wall

A

c. Pressure of the retractors on the psoas muscle and underlying nerve

Retraction at hysterectomy can damage the:

  • femoral nerve as it emerges from the psoas muscle
  • genitofemoral nerve (lies of the belly of the psoas muscle, sensory perineum and upper thigh)
  • lateral cutaneous nerve (lies on the belly of the posts muscle, numbness and pain radiate down thigh towards knee)
25
Q

What effect does an electrical waveform have if it is high-current, low-voltage and elevates the tissue temperature rapidly (>100 degrees celcius) to produce vaporisation?

a. Cutting
b. Fulguration
c. Coagulation
d. Dessication
e. Blend

A

a. Cutting

26
Q

Upon inserting your main umbilical trochar during a diagnostic laparoscopy and prior to inserting the laparoscope, you notice that there is faecal matter in the tip of the trochar. Should the surgeon

a. Remove the cannula, discontinue the operation, give antibiotics and wait and see?
b. Remove the cannula and perform laparotomy to find and repair the damaged bowel
c. Leave the cannula where it is, perform laparotomy using a low transverse incision
d. Leave the cannula where it is, perform laparotomy using a midline incision
e. Insert the telescope through a new puncture and attempt repair of the bowel using new laparoscopic techniques for suturing

A

d. Leave the cannula where it is, perform laparotomy using a midline incision

27
Q

A 30yo woman has been shown to have Stage IV endometriosis on a diagnostic laparoscopy. Her Pouch of Douglas is completely obliterated with sigmoid colon adherent to the posterior uterus. She attends outpatient clinic to plan definitive surgery. The definitive surgery should be managed by

a. A general gynaecologist
b. Colorectal surgeons with a gynaecology assistant
c. An experienced Gynaecological laparoscopist with consultation with a colorectal surgeon
d. Gynaecologic oncologists

A

c. An experienced Gynaecological laparoscopist with consultation with a colorectal surgeon

28
Q

A 30yo woman has been shown to have Stage IV endometriosis on a diagnostic laparoscopy. Her Pouch of Douglas is completely obliterated with sigmoid colon adherent to the posterior uterus. She attends outpatient clinic to plan definitive surgery. The definitive surgery should be managed by

a. A general gynaecologist
b. Colorectal surgeons with a gynaecology assistant
c. An experienced Gynaecological laparoscopist with consultation with a colorectal surgeon
d. Gynaecologic oncologists

A

c. An experienced Gynaecological laparoscopist with consultation with a colorectal surgeon

29
Q

A 45yo woman underwent TAH 3 weeks prior and complains of a constant watery vaginal discharge. Appropriate evaluation documents a 3mm vesicovaginal fistula above the trigone and opening into the vagina approximately 1.5cm below the apex of the vaginal vault. The most appropriate initial therapy for this patient is:

a. Vaginal repair with a gracilis flap
b. Continuous catheter drainage
c. Vaginal excision of the fistula
d. Oestrogen administration prior to operative therapy

A

b. Continuous catheter drainage

30
Q

All of the following about bilateral oophorectomy in a 45yo woman are correct EXCEPT that

a. It should be followed by HRT even in the presence of essential hypertension
b. It is not indicated at the time of surgery for endometriosis involving the bowel
c. It increases the risk of developing ischaemic heart disease
d. It increases the risk of developing osteoporosis

A

b. It is not indicated at the time of surgery for endometriosis involving the bowel

Past MCQs (18 decks)

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