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MRCOG PART 2 SBAs and EMQs

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Week 5 - Surgery

Week 5 - Surgery Posted by PAUL A.

Question 1

To minimise the risk of visceral injury during laparoscopy

 

A.     The abdominal wall incision should be vertical at the base of the umbilicus                        

B.     The patient should be at a 15-30 degrees head down tilt during insertion of primary port

C.     The intra-abdominal pressure should be 15-25 mmHg before insertion of the primary port

D.    5 Litres of CO2 should be insufflated into the abdomen before insertion of the primary port

E.     A test to confirm intra-peritoneal placement of the Veress needle is not recommended

 

Question 2

To undertake laparoscopic entry using the Hasson technique, you will require

A.     One pair of Littlewood forceps and one artery forceps

B.     Two pairs of Littlewood forceps and two artery forceps

C.     Two pairs of Littlewood forceps, two artery forceps and a Langenbeck retractor

D.     Two pairs of Littlewood forceps, two artery forceps and two Langenbeck retractors   

E.     Two pairs of Littlewood forceps. Two artery forceps, two Langenbeck retractors and a Veress needle

 

Question 3

When performing laparoscopy using the Hasson technique, Littlewood forceps should be used to

A.     Pick up the parietal peritoneum

B.     Evert the umbilicus                           

C.     Pick up the visceral peritoneum

D.     Pick up the sub-cutaneous fat

E.     Pick up the rectus sheath

 

Question 4

Gas leakage can be a problem during laparoscopy performed using the Hasson technique. This can be minimised by

A.     Reducing intra-abdominal pressure

B.     Tying a suture around the primary trocar                              

C.     Tying a suture around the secondary trocar

D.     Using a wider trocar

E.     Using a narrower trocar

 

 

Question 5

Following intra-abdominal surgery, adhesions are least likely to be found in

A.     The pelvis

B.     The right lower quadrant

C.     The right upper quadrant

D.     The left lower quadrant

E.     The left upper quadrant                                   

 

Question 6

When performing laparoscopy using Palmer’s point and the closed entry technique

A.     An NG tube should be passed to empty the stomach                          

B.     The woman should be placed at 15 degrees left lateral tilt

C.     The woman should be placed at 15 degrees head-down tilt

D.     The skin incision should be made 2 cm below the costal margin in the mid-axillary line

E.     A  10 mm trocar is typically inserted at Palmer’s point

 

Question 8

Your gynaecology unit has decided to introduce an enhanced recovery care pathway for women undergoing major surgery.

A.    Women should be admitted the day before the operation to prepare them for surgery

B.    Women should not eat or drink from mid-night the day before surgery

C.   Women may drink clear fluids up to 2 hours before surgery              

D.   If surgical injury to the rectum is a possible complication, mechanical bowel preparation should be recommended

E.    Women should be allowed to eat and drink up to 2 hours before surgery

 

Question 9

To facilitate post-operative recovery in women undergoing major gynaecological surgery

A.     Early post-operative feeding is associated with increased nausea and vomiting

B.     At least 3 L intravenous fluids should be prescribed for the first 24 hours after surgery

C.     Regular intra-muscular opiates should be offered to ensure adequate analgesia and facilitate mobilisation

D.     The bladder catheter should not be removed until at least 24 hours after surgery

E.     Early post-operative feeding is associated with reduced nausea                                   

 

Question 10

A 34 year old woman had an emergency caesarean section for non-progressive labour at 7 cm dilatation. Labour had been induced at 37 weeks gestation because of dichorionic twin pregnancy. Five hours post-delivery, she continues to have heavy vaginal bleeding despite uterotonic drugs. It is now 01:00 h and the consultant has instructed you to transfer the woman to the operating theatre for insertion of a B-Lynch suture. The position of the woman on the operating table should be

 

A.     Supine

B.     Lloyd-Davies                       

C.     Lithotomy

D.     Trendelenburg

E.     Sims

 

Question 11

When inserting a B-Lynch suture using the classical technique, the bite on the lower lip of the uterine incision is placed

A.     3 cm from the cervix

B.     3 cm from the uterine artery

C.     3 cm from the lateral border of the uterus

D.     3 cm below the incision                                    

E.     3 cm from the mid-line

 

Question 12

A 34 year old woman had an emergency caesarean section for non-progressive labour at 7 cm dilatation. Labour had been induced at 37 weeks gestation because of dichorionic twin pregnancy. Five hours post-delivery, she continues to have heavy vaginal bleeding despite uterotonic drugs. It is now 01:00 h and the woman has been transferred to the operating theatre for insertion of a B-Lynch suture. Following laparotomy

A.     The uterine incision does not necessarily need to be re-opened

B.     Bi-manual compression should first be used to control bleeding                                 

C.     The B-Lynch suture is knotted on the posterior surface of the uterus

D.     If the uterine incision is re-opened, it should be closed before the B-Lynch suture is knotted

E.     The B-Lynch suture should compress the uterine fundus 1-2 cm from the corneal border

 

Question13

 

You are performing a caesarean section because of breech presentation at 39 weeks gestation. The recommended abdominal incision is

 

A.    Pfannestiel

 

B.    Joel Cohen                  

 

C.    Joel Cohen or Pfannestiel

 

D.    Low transverse

 

E.    Maylard

 

Question 14

 

You are performing a caesarean section because of breech presentation at 39 weeks gestation. During a two layer closure of the lower segment incision, the first layer should incorporate

A.    Full thickness of the myometrium including the endometrium

B.    Full thickness of the myometrium excluding the endometrium

C.    The inner half of the myometrium including the endometrium

D.    The inner half of the myometrium excluding the endometrium                

E.    The outer half of the myometrium

 

 

Question15

 

You are performing a caesarean section because of breech presentation at 39 weeks gestation. The lower segment incision is typically made

A.    2-3 cm above the cervix

B.    2-3 cm above the internal os

C.    2-3 cm below the attachment of the utero-vesical fold      

D.    At the level of the attachment of the utero-vesical fold

E.    2-3 cm above the attachment of the utero-vesical fold

 

Question 16

You are assisting the consultant during an elective caesarean section list. One of the cases is an EXIT procedure at 37 weeks gestation.

A.     The procedure would be undertaken under local anaesthesia

B.     The woman has a difficult airway

C.     The baby probably has spina bifida

D.     The baby probably has an airway problem                            

E.     The general surgeons should be available to open and close the abdomen

 

Question 17

Uterine balloon tamponade is an effective management strategy in women with post-partum haemorrhage. The Bakri balloon

A.     Should not be used in women with placenta previa

B.     Should be left in-situ for 24-48 hours

C.     Can be inserted trans-abdominally or through the vagina                               

D.     Should be filled with 200-300 ml of saline maximum

E.     Should be replaced if it is located within the lower segment of the uterus on ultrasound scanning

 

Question 18

Which one is a recognised risk factor for obstetric anal sphincter injury?

A.     Induced labour

B.     BMI over 30

C.     BMI below 18

D.     Asian ethnic background                                 

E.     African ethnic background

 

Question 19

When performing a medio-lateral episiotomy, the perineum should be incised to ensure that

A.     The incision is at least 15 degrees away from the midline after repair

B.     The incision is at least 45 degrees away from the midline after repair

C.     The incision is at least 45 degrees away from the midline when the perineum is distended

D.     The incision is 45-60 degrees away from the midline when the perineum is distended   

E.     The incision is 30-45 degrees away from the midline after repair

 

Question 20

Which one has been shown to reduce the risk of obstetric anal sphincter injury?

A.     Application of warm compression to the perineum during the second stage        

B.     Perineal massage during the second stage

C.     Perineal massage during the antenatal period

D.     Medio-lateral episiotomy 45-60 degrees away from the midline

E.     Lubrication of the perineum with aqueous lubricant

Posted by PAUL A.

Answers

 

1)   A

2)   D

3)   B

4)   B

5)   E

6)   A

7)   X

8)   C

9)   E

10)                  B

11)                  D

12)                  B

13)                  B

14)                  D

15)                  C

16)                  D

17)                  C

18)                  D

19)                  D

20)                  A