FCPS Part-2 Written Essential Questions-SURGICAL SKILLS AND POST OPERATIVE CARE

1. Regarding the use of adhesion prevention agents, which of the following is true?

2. Which of the following is most appropriate regarding  abdominal incisions and preoperative preparations in a gynaecological surgery

3. You are performing TAH on a 45 years old woman for a large fibroid uterus. She is found to have a fibroid in broad ligament, you think that her ureter may have been damaged during the difficult surgery. Which of the following is the least possible site of ureteric  injury in this surgery?

4.  Which of the following statements is correct regarding non absorbable suture materials?

5.  You have performed an abdominal hysterectomy for HMB not responding to medical treatment.   3 days after surgery she complains of numbness over the skin over the anterior aspect of the upper thigh. Which of the following nerve is damaged most probably?

 6. You are performing a difficult surgery on patient, during surgery you experience massive blood loss,  massive blood transfusion, was performed to save patients life. what is the recommended dose of fresh frozen plasma to be administered to prevent coagulation problems?

7. In patients with previous abdominal surgery which of the following statements regarding laparoscopic entry is false?

8. A 24 years old P1 who has had an emergency caesarean section for failure to progress. Her epidural catheter was removed at 8:00 AM today, 6 h after her CS. You have to give her prophylactic LMWH daily, starting today for 10 days. Which of the following times is most appropriate for her to have the LMWH?

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

10.  A 35 years old P3 with 2 previous caesarean sections wants permanent contraception. She wants to have a laparoscopic tubal sterilisation procedure. Her BMI is 33. Veress needle was inserted successfully with insufflation. What level of pressure must be obtained before passing the trocar?

11.  Intraoperative cell salvage is a strategy to reduce the use of banked blood. If IOCS is done for nonsensitised rhesus negative women at the term of a term caesarean section, which of the following statements is true regarding the minimum dose of anti-D to be administered?

12.  Which one of the following is not true about surgical needles?

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

14. Which of the following is not a known risk factor for nerve injury during a gynaecological surgery?

15.   The inferior epigastric artery originates from:

16.  A 30 years old woman had a caesarean section after 24 hours of labour due to secondary arrest of labour and maternal exhaustion. Two hours after LSCS, she complained of acute onset left sided chest pain radiating to the left shoulder and arm along with breathlessness. She had no previous known medical conditions or family history of cardiac disease. Which of the following statements is true regarding investigations planned to rule out acute myocardial infarction?

17.  While operating on a patient in lithotomy position, the padding between the lateral fibular heads and the stirrup prevents injury to:

18. A 28 years old P2 is in theatre for repair of a 3C tear. Which suturing technique is most suited for the torn internal anal sphincter?

19. A 30 years old P1 is in scheduled for repair of a 3C tear. What structures are torn in a 3C tear?

20.  Which of following is is not a Safety measures to prevent laparoscopic electrosurgical complications?

21.  Which of the following statements regarding energy sources in endoscopy is not true?

22.  Which of the following is not a risk factor for diagnostic hysteroscopy?

23. A 35 years old who is Para 3 with two previous caesarean sections presented to you for permanent contraception.  She has opted to have a laparoscopic tubal occlusion/sterilisation procedure.  Her BMI is 33.  She has had two failed attempts  at  Veress needle insertion through the umbilical route. Which of the following treatment options are best suited to her?

24. Which of following is not safe surgical practice during placement of a primary trocar in laparoscopic surgery?

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

26. Which of the following statements is correct about defibulation?

27. T he most effective method of preventing enterocele formation after vaginal hysterectomy is:

28. Which of the following is least likely to be a complication of lower segment caesarean section?

29. You are performing a total abdominal hysterectomy. It was a difficult case with adhesions and a right broad ligament fibroid. While doing the dissection of the right side and before clamping the uterine artery, you suspected ureteric injury. What is your first reaction?

30.  You are performing TAH on an obese 44years old patient for HMB. She has previous 3 C/S. procedure is difficult due to limited approach and adhesions. You  call the urologist because you suspected ureteric injury. He diagnosed a transection injury distally, below the pelvic brim, 5 cm from the ureterovesicular junction. What is the best management for this injury?

31. A 60 years old woman presented with compliant of  vaginal vault prolapse. H/O vaginal hysterectomy 5 years back for 3^rddegree prolapsed.  There was some difficulty dissecting the bladder and opening the vesicovaginal pouch. At the end of the surgery, there was clear urine in the drainage catheter. Two weeks later, the patient presented with complaint of continuous leaking of urine vaginally. On examination and the methylene blue test, you noticed a vesicovaginal  fistula of <5 mm diameter. What is your first-line management?

32.   You have performed TAH+BSO on a 43years old obese patient  6 days back. Now she has presented with surgical site infection. What will you tell her about the most common cause of SSI?

33. You have operated a morbidly obese patient 2 days back, she complains of deep tissue pain in the buttocks with dark urine. What is your provisional diagnosis?

34.  You have booked a 42 years old obese patientfor TAH+BSO (BMI 40). She is healthy with no medical disorders or other comorbidity. What is the most important specific risk-screening question in pre-operative assessment you should ask?

35. You plan laparoscopic sterilization for a 42 years old P5 who has completed her family.  Her BMI is 45 kg/m2 . She was keen on going home the same day. What is your advice?

36. While performing  a surgical termination of pregnancy you think you have perforated the uterus before completion of procedure. How will you handle the situation?

37. While performing a  laparoscopic sterilization procedure, if you discover a suspicious right ovarian cyst. What should you do?

38. During performing a total abdominal hysterectomy for a  large right broad ligament fibroid, how best should you avoid ureteric injury?

39. You are demonstrating a laparoscopic myomectomy procedure to your minimal access surgery module trainee. What is the most serious complication?

40. You are demonstrating laparoscopic hysterectomy (LH) to one of your trainees. What is the most common surgical complication with this procedure compared to abdominal hysterectomy (AH)?

41. You are demonstrating laparoscopic hysterectomy (LH) . What is the most common surgical complication with this procedure compared to vaginal hysterectomy (VH)?

42.  While reviewing the outpatient cases, your junior colleague wants to discuss the management of ovarian cyst in a woman who is 35 years old. What is the cyst size at which laparoscopic management should be a cost-effective procedure?

43. What is the most common cause of failure to obtain a good view of the cavity while performing an outpatient hysteroscopy in a patient of postmenopausal bleeding?

44. A 28 years old woman presented at 36 weeks of gestation for plan of delivery. She had a hysteroscopic resection of a uterine septum because of recurrent pregnancy loss 3 years back. All her antenatal visits have been normal. What is your plan for her delivery?

 45.  A 28 years old woman  has presented with secondary infertility. She has H/O previous two Caesarean section and one episode of previous pelvic inflammatory disease (PID). You are going to perform a diagnostic laproscopy. Which one of the following anti-adhesion agents would you like to use to prevent adhesion formation?

46.  A 24 years old primigravida woman presented for a dating scan, which showed a 6 cm right ovarian cyst.  A follow-up scan at 15 weeks confirms an increase in size up to 14 cm, with radiological and laboratory features suggestive of benign disease. The pregnancy is otherwise progressing normally. Which one of the following options is the most appropriate management?

47. A 32 years old patient with a subserosal fibroid (6 x 7 cm) is counselled for a laparoscopic myomectomy using a morcellator. What is the most common complication?

48.  Which one would is recommended for outpatient hysteroscopy?

49. You are performing a diagnostic laparoscopy on a 32yrs old patient. You observe that blood was dripping into the pelvis soon after inserting the lateral secondary trocar, quickly filling the operative field. Which blood vessel is more likely to be injured?

50.   A 26 years old woman is admitted for diagnostic laparoscopy for assessment of chronic pelvic pain. What is the estimated risk of death associated with this procedure?

51.   A 42 years old woman presented with  complaint of cyclical cramping with or without menses. She had an endometrial ablation and tubal sterilization two years previously. Review of the operative findings showed an uncomplicated procedure. MRI imaging during times of symptomatic cramping showed blood trapped in the uterine cornua and swollen tubes. The diagnosis of post-ablation tubal sterilization syndrome was made (PATSS). What is the incidence of PATSS after endometrial ablation?

52. A 65 years old woman presented with 3 episodes  of postmenupausal bleeding in form of spotting. She was not sexually active before her menopause. She suffers from depressive anxiety disorders. An ultrasound scan shows a thickened irregular endometrium of 10 mm. What is the most suitable management?

53. You are seeing a  44 years old woman in outpatient department. She has presented for hysteroscopic removal of a 2-cm endometrial polyp. You want to use electrosurgery during hysteroscopy for removal of the polyp. Which distention media should be used?