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MRCOG PART 2 SBAs and EMQs

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SBA 10

SBA 10 Posted by PAUL A.

Question 1

Using the Pelvic Organ Prolapse Quantification (POP-Q) system, post-hysterectomy vaginal vault prolapse is defined as

a)     Descent of point A

b)     Descent of point B

c)     Descent of point C                                                

d)     Descent of point D

e)     Descent of points A and D

 

Question 2

A 47 year old woman has a total abdominal hysterectomy because of a large fibroid uterus. The risk of her suffering post-hysterectomy vault prolapse is

a)     1-2%                         

b)     2-5%

c)     6-9%

d)     10-12%

e)     15-18%

 

Question 3

A 47 year old mother of 4 children has a vaginal hysterectomy because of symptomatic uterine prolapse. The risk of her suffering post-hysterectomy vault prolapse is

a)     1-2%                        

b)     2-5%

c)     6-9%

d)     10-12%                                                       

e)     15-18%

 

Question 4

A healthy 67 year old woman is referred to the gynaecology clinic because of prolapse symptoms. She had a vaginal hysterectomy 20 years ago because of uterine prolapse. She suffers from occasional constipation but has no other urinary or bowel symptoms. Clinical examination confirms vaginal vault prolapse and there is no urinary leakage on straining. Following counselling, she agrees to undergo prolapse surgery.

 

a)     Recommend urodynamic studies with prolapse reduced

b)     No indication for urodynamic studies                      

c)     Recommend urodynamic studies without prolapse reduction

d)     Recommend urodynamic studies with + without prolapse reduction

e)     Recommend prophylactic surgery for stress urinary incontinence

 

Question 5

McCall culdoplasty involves

 

a)     Excision of redundant vaginal wall at the vault

b)     Approximating the cardinal ligaments and attaching them to the vaginal vault

c)     Attaching the round ligaments to the posterior vaginal wall

d)     Closure of the vagina in elderly women who are not sexually active

e) Approximation of the utero-sacral ligaments with obliteration of the pouch of Douglas    

 

Question6

With respect to the surgical treatment or prevention of post-hysterectomy vaginal vault prolapse, the Moschcowitz procedure involves

a)    Closure of the parietal pelvic peritoneum

b)    Attachment of the utero-sacral ligaments to the vaginal vault

c)    Attachment of the transverse cervical ligaments to the vaginal vault

d)    Obliteration of the pouch of Douglas using concentric purse-string sutures                     

e)    Obliteration of the utero-vesical pouch using concentric purse-string sutures        

 

Question7

A healthy 79 year old woman is undergoing vaginal hysterectomy because of symptomatic uterine prolapse. She is sexually active. Which procedure should be used to reduce the risk of vault prolapse?

a)    Moschcowitz culdoplasty

b)    McCall culdoplasty              

c)    Sacro-spinous fixation

d)    Colpocliesis

e)    Closure of the pelvic peritoneum  

 

Question 8

A healthy 47 year old woman is due to undergo abdominal hysterectomy because of a large fibroid uterus. She is up-to-date with her smears and the last test was negative. She enquires about the benefits and disadvantages of sub-total hysterectomy. Sub-total hysterectomy is associated with

 

a)     A lower risk of post-hysterectomy vault prolapse

b)     A lower risk of urinary incontinence

c)     A higher risk of vaginal prolapse                                  

d)     No significant difference in long-term outcomes

e)     A higher risk of fecal incontinence

 

Question 9

A healthy 79 year old woman attends the gynaecology clinic because of a 3 year history of prolapse symptoms. She had a vaginal hysterectomy for uterine prolapse 20 years ago. There are no urinary symptoms and she is sexually active. Clinical examination confirms stage II vaginal vault prolapse.

 

a)     Ring pessary

b)     Hodge pessary

c)     Gellhorn pessary

d)     Pelvic floor muscle training                           

e)     Vaginal cone

 

Question 10

A healthy 82 year old woman has been referred to the gynaecology clinic because of prolapse symptoms. She had an abdominal hysterectomy 40 years ago because of heavy menstrual bleeding. She is not sexually active. Clinical examination confirms stage IV vaginal vault prolapse. The woman does not wish to have surgery.

 

a)     Ring pessaries are ineffective in women with vault prolapse

b)     Gellhorn pessaries are ineffective in women with vault prolapse

c)     Ring pessaries are more effective than Gellhorn pessaries in women with vault prolapse

d)     Gellhorn pessaries are more effective than ring pessaries in women with vault prolapse

e)     Ring and Gellhorn pessaries are effective in women with vault prolapse                                

 

Question 11

A 76 year old woman is referred to the gynaecology clinic with prolapse symptoms. She had a vaginal hysterectomy 30 years ago because of uterine prolapse. She has no urinary or bowel symptoms and is sexually active. Clinical examination confirms vaginal vault prolapse. With respect to the choice of operative procedure

 

a)     A vaginal approach should be recommended if the vaginal length is short

b)     Both vaginal and abdominal approached are equally appropriate in women with short vaginal length

c)     An abdominal approach should be recommended if the vaginal length is short                                   

d)     A vaginal approach should not be used if the woman is sexually active

e)     A vaginal approach should be recommended if culdoplasty was performed at the time of hysterectomy

 

Question 12

A 76 year old woman is referred to the gynaecology clinic with prolapse symptoms. She had a vaginal hysterectomy 30 years ago because of uterine prolapse. She has no urinary or bowel symptoms and is sexually active. Clinical examination confirms vaginal vault prolapse. With respect to the choice of operative procedure

 

a)     Open abdominal sacro-colpopexy is associated with lower recurrence rates compared to vaginal sacro-spinous fixation                           

b)     Open abdominal sacro-colpopexy is associated with higher rates of dyspareunia compared to vaginal sacro-spinous fixation

c)     Open abdominal sacro-colpopexy is associated with higher rates of post-operative stress urinary incontinence compared to vaginal sacro-spinous fixation

d)     Open abdominal sacro-colpopexy is associated with higher re-operation rates compared to vaginal sacro-spinous fixation

e)     Open abdominal sacro-colpopexy is associated with lower patient satisfaction compared to vaginal sacro-spinous fixation

 

Question 13

A healthy 66 year old woman is referred to the gynaecology clinic with prolapse symptoms. She had a vaginal hysterectomy 15 years ago because of uterine prolapse. She has no urinary or bowel symptoms and is sexually active. Clinical examination confirms vaginal vault prolapse. Following counselling, the woman is undergoing open abdominal sacro-colpopexy. During the operation, the vaginal vault is attached to

 

a)     The sacro-spinous ligament

b)     The anterior longitudinal ligament                            

c)     The posterior longitudinal ligament

d)     The sacro-tuberous ligament

e)     The inter-spinous ligament

 

Question 14

A healthy 66 year old woman is referred to the gynaecology clinic with prolapse symptoms. She had a vaginal hysterectomy 15 years ago because of uterine prolapse. She has no urinary or bowel symptoms and is sexually active. Clinical examination confirms vaginal vault prolapse. Following counselling, the woman is undergoing open abdominal sacro-colpopexy. During the operation, the vaginal vault is suspended using

 

a)     Absorbable sutures

b)     Non-absorbable sutures

c)     Absorbable mesh

d)     Non-absorbable mesh                    

e)     Delayed absorbable sutures

 

Question 15

A healthy 76 year old woman is referred to the gynaecology clinic with prolapse symptoms. She had a vaginal hysterectomy 15 years ago because of uterine prolapse. She has no urinary or bowel symptoms and is sexually active. Clinical examination confirms stage IV vaginal vault prolapse. Following counselling, the woman is undergoing vaginal sacro-spinous fixation. During the operation, the vaginal vault anchored to

 

a)     The left sacro-spinous ligament

b)     The left and right sacro-spinous ligaments

c)     The right sacro-spinous ligament                                

d)     The inter-spinous ligament of the sacrum

e)     The anterior longitudinal ligament of the sacrum

 

Question 16

A healthy 76 year old woman is referred to the gynaecology clinic with prolapse symptoms. She had a vaginal hysterectomy 15 years ago because of uterine prolapse. She has no urinary or bowel symptoms and is sexually active. Clinical examination confirms stage IV vaginal vault prolapse. Following counselling, the woman is undergoing vaginal sacro-spinous fixation. During the operation, the vaginal vault anchored using

 

a)     Absorbable sutures

b)     Non-absorbable sutures

c)     Absorbable or non-absorbable sutures                                                      

d)     Absorbable mesh

e)     Non-absorbable mesh

 

Question 17

A healthy 78 year old woman has undergone vaginal sacro-spinous fixation because of vaginal vault prolapse. At her follow-up appointment 6 weeks later, she complains of right buttock pain. She should be informed that

a)     Buttock pain on the right is unlikely to be related to the operation

b)     1 in 2 women with right buttock pain will need further surgery to remove sutures

c)     Buttock pain usually resolves in 6-12 months in most women

d)     Buttock pain usually resolves in 2-3 months in most women                        

C,a,d,b,e,b,b,d,d,e,c,a,d,e,b,c,d Posted by sujatha K.
C, A, D, B, E, B, B, D, D, E, C, A, D, E, B, C, D
Posted by PAUL A.

Answers

 

1)   C

2)   A

3)   D

4)   B

5)   E

6)   D

7)   B

8)   C

9)   D

10)                   E

11)                   C

12)                   A

13)                   B

14)                   D

15)                   C

16)                   C

17)                   D