Nerve injuries, suture materials, incisions -ANC module part 2

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1) A 57-year-old para 4 undergoes vaginal hysterectomy and

sacrospinous ligament xation. She complains of postoperative gluteal

pain that worsens in the seated position.

Her symptoms are most likely caused by injury to which of the following?

A) Lateral cutaneous nerve.

B) Genitofemoral nerve.

C) Ilioinguinal nerve

D) Pudendal nerve.

E) Femoral nerve

2) 37. Polydioxanone (PDS) is synthetic, absorbable mono lament surgical

suture material. It is particularly useful when a combination of an

absorbable suture and extended wound support is desirable.

Which of the following best describes the breaking strength retention

(tensile strength) of 3-0 PDS at 6 weeks?

A) 40%.

B) 50%.

C) 60%.

D) 70%.

E) 80%

3) CSPO2

Select the single most appropriate statement with reference to abdominal incisions

and preoperative preparations in a gynaecological surgery:

A) Horizontal incisions cause minimum nerve damage.

B) Preoperative showering with antiseptics reduces the infection rate to almost half.

C) A scalpel should be changed after superfi cial incision for a deep incision.

D) Vertical skin incisions have better cosmetic results and greater strength.

E) Wound infection rates are less if no hair is removed as compared to depilatory preparation

4) 20. T e Smead–Jones closure is a mass closure technique of the anterior

abdominal wall using a far–far, near–near approach. T e closure is

performed using a delayed absorbable suture to include all the abdominal

wall structures on the far–far portion and only the anterior fascia on the

near–near portion. T is allows good healing without intervening fat or

muscle.

Which of the following best describes the rate of fascial dehiscence with

running mass closure of the abdomen?

A) 0.04%.

B) 0.4%.

C) 4%.

D) 14%.

E) 24%.

5) While operating on a patient in lithotomy position, the padding between the lateral

fi bular heads and the stirrup prevents injury to:

A) Common peroneal nerve

B) Lateral cutaneous nerve of the thigh

C) Obturator nerve

D) Pudendal nerve

E) Tibial nerve

6) 21. You are assisting your consultant in a Burch colposuspension

procedure for urodynamic stress incontinence a er an unsuccessful V

procedure.

Which of the following transverse skin incisions allows the easiest access

to the space of Retzius?

A) Pfannenstiel incision.

B) Kustner incision.

C) Cherney incision.

D) Maylard incision.

E) Joel–Cohen incision

7) 14. A 31-year-old para 1 undergoes radical vaginal trachelectomy and

laparoscopic bilateral lymph node dissection for early cervical cancer. She

presents with paraesthesia over the mons pubis, labia majora and the

femoral triangle.

Her symptoms are most likely caused by injury to which of the following?

A) Lateral cutaneous nerve.

B) Genitofemoral nerve.

C) Ilioinguinal nerve.

D) Femoral nerve.

E) Pudendal nerve.

8) CSPO19

The ilioinguinal and iliohypogastric nerves can be injured during a gynaecological

surgery. Which of the following describes these nerves the best?

A) Both nerves pass laterally through the head of the psoas muscle before running diagonally along quadratus lumborum.

B) The iliohypogastric nerve is both sensory and motor, while the ilioinguinal nerve has a sensory function only

C) The ilioinguinal nerve arises from the L5–S1 nerve root, while the iliohypogas- tric nerve arises from the T12-L1 nerve root.

D) The ilioinguinal nerve pierces the external oblique aponeurosis above the super- fi cial inguinal ring, while the iliohypogastric nerve emerges through it

E) The reported incidence of ilioinguinal or iliohypogastric neuropathy following a Pfannenstiel incision is less than 1 %.

9) CSPO6

Staples are used for wound closure. Which of the following statements about the use

of staples in a gynaecological surgery is incorrect?

A) A nonabsorbable staple made of stainless steel has the highest tensile strength of any wound closure material.

B) Contaminated wounds closed with staples have a lower incidence of infection compared with those closed with sutures

C) Disadvantages of staples include the potential for staple track formation, bacte- rial migration into the wound bed and discomfort during staple removal

D) Prior to stapling, it is useful to grasp the wound edges with forceps to evert the tissue so as to prevent inverted skin edges.

E) Staples have a high tissue reactivity.

10) CSPO5

A patient who underwent an abdominal hysterectomy a few days ago complains of

numbness over the skin over the anterior aspect of the upper thigh. This could be

attributed to neuropathy of the:

A) Femoral nerve

B) Obturator nerve

C) Peroneal nerve

D) Pudendal nerve

E) Sciatic nerve

11) CSPO8

Axonotmesis is best described as an iatrogenic nerve injury which involves:

A) Axon transection injury related to incorrect incision sites

B) Damage occurring to the axon with preservation of the supporting Schwann cells

C) Long recovery period usually extending to few years

D) Need for restorative surgery in most cases

E) Poor chances of regeneration despite restorative surgery

12) CSPO24

Ms. XY is in theatre for repair of a 3C tear. She has been given spinal anaesthetic

and antibiotics. Which suturing technique is most suited for the torn IAS (internal

anal sphincter)?

A) Continuous locked 3–0 PDS

B) Continuous unlocked 3–0 PDS

C) End-to-end technique (interrupted)

D) Figure-of-8 stitches

E) Overlap technique

13) CSPO4

Regarding nonabsorbable suture materials, which of the following statements is

correct?

A) all nonabsorbable sutures are monofi lamentous and have lower incidence of wound infection

B) olypropylene has higher tissue reactivity than polytetrafl uoroethylene.

C) Surgical silk has higher tensile strength than nylon.

D) The incidence of wound dehiscence and hernia is lower for nonabsorbable than

E) The incidence of prolonged wound pain and suture sinus is signifi cantly higher with a nonabsorbable suture.

14) . T e enhanced recovery approach to preoperative, perioperative and

postoperative care has major bene ts for many patients in relation to

quicker recovery following major surgery. It facilitates shorter hospital

stay with no increase in readmission rates. T is has clear bene ts for

patients and their families and for healthcare services.

Which of the following is not a component of the enhanced recovery

pathways?

A) Optimized preoperative haemoglobin level.

B) Avoidance of carbohydrate loading.

C) Use of regional blocks.

D) Minimal-access surgery.

E) Avoidance of systemic opiates.

15) CSPO20

Which of the following is not a known risk factor for nerve injury during a gynae-

cological surgery?

A) Entrapment of the psoas muscle

B) Narrow pelvis

C) Operating time more than 4 h

D) Thin-body habitus

E) Well-developed abdominal wall muscles

16) 36. Suture materials have di erent physical properties.

Which of the following is the property by which a suture is capable of

supporting acute angulation without breaking or opposing excessive

resistance?

A) Tensile strength.

B) Elasticity.

C) Flexibility.

D) Plasticity

E) Handling.

17) CSPO18

A downward and inward muscle-splitting incision from the McBurney point that

allows extraperitoneal drainage of abscesses is called:

A) Elliot incision

B) Gridiron incision

C) Kustner incision

D) Mouchel incision

E) Rockey–Davis incision

18) CSPO16

All of the following are true about surgical needles except:

A) Blunt-point needle is used for patients with hepatitis B.

B) Needles with ‘eye’ are rarely used nowadays.

C) Surgical needles have three basic components—the attachment point, the body and the point.

D) The deeper the pane of surgery, the more curved the needle should be.

E) The diameter of the needle is generally bigger than that of the suture material

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