Surgery - Postop(SBA-EMQ)-Surgery and postop_Module_part2

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Ms. XY is 35 years old. She is a para 3 with 2 previous caesarean sections and desires
permanent contraception. She has opted to have a laparoscopic tubal occlusion/

sterilisation procedure. Her BMI is 33. She has had a successful Veress needle insuffl ation
(fi rst pass). What level of pressure must be obtained before passing the trocar?

2) An 18-year-old woman comes with abdominal pain to the gynaecology

emergency unit. A clinical examination reveals tender abdomen. An

ultrasound scan of pelvis is normal. Clinically there are no signs of infection.

She was taken to theatre for diagnostic laparoscopy. A Veress needle was

inserted for gas insufation.

What is the recommended pressure for port insertion?

3) .Sepsis at the site of the sphincter repair


. A 56-year-old woman has a staging laparotomy for stage 3 ovarian cancer.
Te following measures improve the best possible outcome with regards to
abdominal incisions except for one. Which statement is the exception?


Safety measures to prevent laparoscopic electrosurgical complications include
all of the following except:


A surgical position which involves the patient in supine position of the body with
hips fl exed at 15° as the basic angle and with a 30° head-down tilt is known as:

7) All of the following are true about surgical needles except:


The ilioinguinal and iliohypogastric nerves can be injured during a gynaecological
surgery. Which of the following describes these nerves the best?


You are performing a diagnostic laparoscopy for a 31-year-old para 1
with a 10-month history of pelvic pain. You attempt insertion of the
Veress needle twice. T e intra-abdominal pressure is 15 mm Hg.
What is your most appropriate next step?


A 56-year-old woman is undergoing an abdominal hysterectomy for uterine
fibroids. The surgeon attempts to open the vaginal vault to introduce a clamp on
the vaginal angles and makes a stab wound in the midline on the vaginal vault just
below and anterior to the cervix. The woman bleeds from the vaginal vault. Which
vessel is the main source of this bleeding?


What proportion of ureteric injuries are recognised intraoperatively during
laparoscopic surgery?

12) Which of the following is an example of a self-retaining retractor?


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:


Which nerve is particularly susceptible to damage when self-retaining retractors
are used in gynaecological surgery?

58-year-old woman underwent a total abdominal hysterectomy and bilateral salpingoophorectomy
under general anaesthetic for a complex endometrial hyperplasia. She developed pyrexia of 38°C, 12
hours after surgery. There were no other symptoms.

15) Which of the following is the most likely cause of her pyrexia?



22-year-old woman is brought in by ambulance to A&E with acute pelvic pain. On admission, her
urine pregnancy test is positive and a bedside ultrasound scan in A&E demonstrates free intraabdominal fluid. You, as the gynaecology registrar, are fast bleeped to review her as she has become
unconscious with a BP of 70/40 mmHg and pulse of 140 bpm. A ruptured ectopic pregnancy is suspected.
What is the most appropriate option of obtaining consent for proceeding to theatre?


A 29-year-old woman has just undergone a knife cone biopsy of her cervix. Both
angles of the cervix are bleeding profusely. A suture needs to be inserted to arrest
this bleeding. Which blood vessel is the main contributor to this bleeding?


Select the single most appropriate statement with reference to abdominal incisions
and preoperative preparations in a gynaecological surgery:

19) Which of the following is least likely to be a complication of lower segment caesar ean section?

20) A 38-year-old woman, para 1, presents to the labour ward at 41 weeks of

gestation with regular contractions every 3 minutes. Abdominal examination

reveals ballotable head and vaginal examination reveals early labour. An hour

later, she has a spontaneous rupture of membranes and cord prolapse. She

is pushed to theatre for crash caesarean section. What is her risk of bladder



21) The most effective method of preventing enterocele formation after vaginal hyster ectomy is:


A downward and inward muscle-splitting incision from the McBurney point that
allows extraperitoneal drainage of abscesses is called:


Thromboembolic event comprising deep vein thrombosis and pulmonary
Risks following repair of obstetric anal sphincter injury


All of the following are safe surgical principles during placement of a primary tro car in laparoscopic
surgery except:


Your hospital has introduced Enhanced Recovery (ER) in gynaecology, which aims to facilitate a
rapid recovery and return to normal activity following elective gynaecological surgery.
When should preoperative risk assessment of the patient's health and fitness for a surgical procedure


During a primary caesarean section, at what point during the operation is a
bladder injury most likely to occur?


A 45-year-old nulliparous woman who is otherwise fit and well attends for an
outpatient hysteroscopy to investigate a potential polyp, which was suggested on
an ultrasound scan.
What pharmacotherapy would be recommended to reduce pain in the
immediate postoperative period?


Ms. XY, 48 years old, a Para 3, is due to undergo a NovaSure endometrial ablation
in theatre for heavy menstrual bleeding. A WHO surgical safety checklist is in prog ress. Which of the
following components of the checklist need to be completed
before the surgical procedure begins?

29) The best route to perform a hysterectomy (if technically feasible) is:


.44-year-old woman with no past medical history is undergoing laparoscopic hysterectomy for heavy
menstrual bleeding.
When considering venous thromboembolism prophylaxis in the immediate postoperative period, which
of the following statements is the most accurate?


You see a 75-year-old patient who had an abdominal hysterectomy 2
days previously. She complains of muscle weakness, palpitations and
paraesthesia, and she is oliguric. An ECG shows loss of P-waves, wide
QRS complexes and peaked -waves. T e K+
level is 6.3 mmol/L.
What is the most appropriate immediate intervention?


During primary entry with a force of 3 kg for gynaecological laparoscopy, what is
the depth below the indented umbilicus with a peritoneal insufflation pressure of
25 mmHg?


.38-year-old woman has had an emergency laparotomy and salpingo-oopherectomy for a
symptomatic tuboovarian abscess unresolved after medical management. Her BMI is 45. She smokes 20
cigarettes a day and is a poorly controlled diabetic on metformin.
What is the most appropriate step to reduce the incidence of scar dehiscence?


What is the risk of major vessel injury with the Hasson (open) technique of
laparoscopic entry?


A 25-year-old woman is admitted to the gynaecology ward following an
evacuation of retained products of conception for a presumed molar pregnancy.
On examination, her vital signs are within the normal range and stable. She is
continuing to vomit and is unable to tolerate oral feed or fluids.
What volume of fluid should be used for maintenance intravenous therapy?

36) The risk of damage to the urinary system, including the ureter and the bladder, and the long-term urinary dysfunction.

37) .Which absorbable suture has the greatest tensile strength?


A 45-year-old woman undergoes an abdominal hysterectomy for a large fi broid
uterus. She is found to have a fi broid in broad ligament, and there is a concern that
her ureter may have been damaged during the diffi cult surgery. Which of the follow ing is the least
possible site of ureteric injury in this surgery?


What is the most appropriate suture material to repair the anorectal mucosa in a
fourth-degree perineal tear?

40) Regarding the use of adhesion prevention agents, which of the following is true?


41) .An overwhelming desire to pass stools


You are assisting in a total laparoscopic hysterectomy and BSO for
extensive endometriosis. T e le ureter is accidentally transected at the
time of coagulation and division of the uterine artery.
What is the most appropriate intervention?

43) Loss of blood requiring a blood transfusion.


Regarding nonabsorbable suture materials, which of the following statements is

45) The following statements regarding energy sources in endoscopy are true except:


An 18-year-old woman comes with abdominal pain to the gynaecology
emergency unit. A clinical examination reveals tender abdomen. An
ultrasound scan of pelvis is normal. Clinically there are no signs of infection. She was taken to theatre for
diagnostic laparoscopy. She had one suprapubic
7 mm port, one 10 mm umbilical port and one lateral 7 mm port on the lef
side and one lateral 5 mm port on the right side.
Which of the following port sites rectus sheath should be closed with Vicryl 1?

47) The overall risk of the patient having any complication after such surgery.

48) Pain in the perineum or during intercourse.


.A 38-year-old woman attends for hysterectomy for a fibroid uterus. Due to the size of the uterus
there are concerns regarding the course of the ureter. Following surgery there are concerns regarding
urine output despite adequate fluid intake.
Which is the most appropriate investigation?

Your score is