Which of the following measures is/are proven to improve performance in the operating room?

• a)
  

  Team training.

  
  
• b)
  

  Surgical skills training leading to improved psychomotor performance.

  
  
• c)
  

  Ergonomic operating-room design improving comfort and procedural efficiency.

  
  
• d)
  

  Checklists reducing mortality.

  
  
• e)
  

  Sterile cockpit communication protocols improving clinical outcome.

The following statements is/are true regarding the ergonomic design of the operating room?

• a)
  

  It can improve cognitive and motor skills.

  
  
• b)
  

  It can enhance perceptual skills.

  
  
• c)
  

  It cannot improve a surgeon’s performance.

  
  
• d)
  

  It can reduce physical complaints.

  
  
• e)
  

  It is an important aspect of occupational health.

Which of the following is/are true about simulation training?

• a)
  

  Simulation provides a risk-free environment for the trainee to practise under minimal level of stress and distraction.

  
  
• b)
  

  Simulation can help trainees to bypass the early learning curve with its inherently higher risk of complications.

  
  
• c)
  

  Simulators are more beneficial to novice groups compared with more skilled surgeons.

  
  
• d)
  

  Intermediate and novice trainees take the same number of sessions to achieve the same standard of simulated surgery.

  
  
• e)
  

  Trainees using simulation by box trainers did not show improved performance when assessed on virtual-reality simulators and vice versa.

In defining the relevant definitions of validity of a simulator used, which of the following statements is/are true?

• a)
  

  Content validity measures the degree of realism of the simulator.

  
  
• b)
  

  Face validity measures the appropriateness of the simulator as a teaching modality.

  
  
• c)
  

  Construct validity assesses whether a simulation method can identify the differences between applicants with different levels of experience.

  
  
• d)
  

  Identifying novices from experts by their performance on a simulator is called construct validity.

  
  
• e)
  

  Consequential validity measures whether the test predicts future performance.

Which of the following is/are true about training curricula?

• a)
  

  Expert feedback is an important part of the training and should be concurrent (i.e. feedback given to trainee at the time of performing the task).

  
  
• b)
  

  Distributed, as opposed to mass practice, results in better acquisition and transfer of skills.

  
  
• c)
  

  The best training programmes are proficiency-based rather than time-based.

  
  
• d)
  

  Training and assessing with varying levels of difficulty of the motor task has a negative effect on the learning process.

  
  
• e)
  

  Formative assessment of training has a better effect on learning than summative assessment.

Open laparoscopic entry (Hasson technique) is associated with which of the following?

• a)
  

  Less bowel injury than closed entry techniques.

  
  
• b)
  

  Differences in bowel injury rates due to the technique alone.

  
  
• c)
  

  Less vascular injury than closed entry techniques.

  
  
• d)
  

  A lower mortality rate than closed entry techniques.

  
  
• e)
  

  Evidence based on meta-analysis.

The rate of visceral injury in laparoscopic gynaecologic surgery is about:

• a)
  

  0.1%.

  
  
• b)
  

  0.3%.

  
  
• c)
  

  0.6%.

  
  
• d)
  

  0.9%.

  
  
• e)
  

  1.2%.

To avoid vascular injury in laparoscopy, it is beneficial to:

• a)
  

  Place the woman in the Trendelenburg position for entry.

  
  
• b)
  

  Direct the Veress needle more perpendicular to the skin for more lean women.

  
  
• c)
  

  Aspiration of the Verress needle to check for vascular placement.

  
  
• d)
  

  Use a downward stabbing motion with the scalpel when making skin incisions.

  
  
• e)
  

  Insert secondary trocars under direct visualisation.

Which of the following is/are true about the Manchester repair?

• a)
  

  It is an abdominal operation.

  
  
• b)
  

  It is an example of a uterine preservation procedure.

  
  
• c)
  

  It is the ‘gold standard’ option for treating uterine prolapse surgically.

  
  
• d)
  

  It has a reported prolapse recurrence risk of up to 20%.

  
  
• e)
  

  A recent modification showed that Manchester repair was associated with less middle-compartment recurrences than vaginal hysterectomy.

Which of the following is/are true about sacrospinous hysteropexy?

• a)
  

  It routinely involves the use of mesh.

  
  
• b)
  

  It is only be carried out unilaterally.

  
  
• c)
  

  Established evidence exists for its superiority to vaginal hysterectomy.

  
  
• d)
  

  It involves the fixation of the uterus to the uterosacral ligament.

  
  
• e)
  

  It was first described in 1968.

Which of the following is/are true about the laparoscopic approach for uterine prolapse?

• a)
  

  It is an established technique for women who want to preserve fertility.

  
  
• b)
  

  It usually involves suspending the uterus to the sacral promontory.

  
  
• c)
  

  The outcomes of pregnancy after laparoscopic uterine suspension are well-established.

  
  
• d)
  

  A recent RCT has proven that recurrence with laparoscopic sacrohysteropexy is significantly more than the gold standard vaginal hysterectomy.

  
  
• e)
  

  A recent RCT showed that it is associated with a quicker return to normal activities compared with abdominal hysteropexy.

Which of the following is/are true about laparoscopic sacrohysteropexy?

• a)
  

  It normally involves attaching mesh to the vagina.

  
  
• b)
  

  A 25% risk of obstructive defecation can occur after laparoscopic sacrohysteropexy.

  
  
• c)
  

  It addresses all the three compartments.

  
  
• d)
  

  The longest follow up is 10 years.

  
  
• e)
  

  The risk of dyspareunia is significantly less then vaginal sacrospinous hysteropexy.

Which of the following is/are true about bowel endometriosis?

• a)
  

  In most cases, the sigmoid is involved.

  
  
• b)
  

  Digestive symptoms are the most frequent.

  
  
• c)
  

  Lesions larger than 3 cm require a radical approach.

  
  
• d)
  

  A stoma is required in all cases of bowel resection.

  
  
• e)
  

  Colonoscopy is mandatory in the preoperative work-up.

Which of the following about the general strategy for endometriosis is/are true?

• a)
  

  Exposure is achieved exclusively with the woman in the Trendelenburg position and with the use of pneumoperitoneum imaging.

  
  
• b)
  

  A low-residue diet facilitates field exposure.

  
  
• c)
  

  A thorough recto-vaginal examination is useful when dealing with deep infiltrating endometriosis.

  
  
• d)
  

  Detaching the sigmoid colon from the abdominal wall permits access to the left ureter and adnexa.

  
  
• e)
  

  Uterine and ovarian suspension can be useful to free the assistant.

What is the gold standard for ovarian endometriosis management?

• a)
  

  Laser vaporization.

  
  
• b)
  

  Ablation.

  
  
• c)
  

  Drainage and lavage.

  
  
• d)
  

  Cystectomy.

  
  
• e)
  

  Drainage, gonadotropin-releasing hormone analogues and second look.

Which of the following is/are true about minimal-invasive surgery?

• a)
  

  Laparoscopic surgery has favourable long-term oncological outcome compared with open or robotic surgery in endometrial and cervical cancer.

  
  
• b)
  

  The main benefit of robotic surgery is an improved ergonomic environment for the surgeon.

  
  
• c)
  

  Robotic surgery has replaced other modes of surgery for cervical cancer in most developed countries.

  
  
• d)
  

  One randomised-controlled trial showed a significantly higher rate of cervical cancer recurrence in open procedures.

  
  
• e)
  

  One of the limitations of single-incision laparoscopic procedures is restricted mobility of the operating surgeon.

Which of the following is/are true about radical ovarian cancer debulking?

• a)
  

  It is an accepted mode of surgical treatment for advanced-stage ovarian, peritoneal and tubal cancers.

  
  
• b)
  

  The current Gynecologic Oncology Group standard of surgical treatment for ovarian cancer is interval debulking for all advanced stage ovarian, peritoneal and tubal cancers.

  
  
• c)
  

  Upper abdominal surgeries carry unacceptable morbidity during radical debulking of ovarian cancer.

  
  
• d)
  

  Optimal debulking to no-residual disease (R = 0) has better prognostic value in primary surgery.

  
  
• e)
  

  Optimal debulking to no-residual disease (R = 0) has better prognostic value in interval surgery.

Which statement(s) is/are true about fertility-sparing procedures?

• a)
  

  All early stage cervical cancer (Stage 1A1–1B2) can be treated successfully with radical trachelectomy without increasing the recurrence rate.

  
  
• b)
  

  Women with early stage ovarian cancer who have undergone fertility sparing-surgery do not need further follow up until their family is complete.

  
  
• c)
  

  Endometrial cancer has better subsequent pregnancy rates than cervical cancer.

  
  
• d)
  

  Endometrial cancer has better subsequent pregnancy rates than ovarian cancer.

  
  
• e)
  

  Pelvic lymph-nodes status is vital for proceeding with radical trachelectomy, as positive lymph-node status has poor prognosis.

Which of the statement(s) is/are true about exenteration procedures?

• a)
  

  They are mainly carried out for palliation of symptoms.

  
  
• b)
  

  They are associated with major morbidity in 15–30% of patients.

  
  
• c)
  

  Exenteration morbidity can significantly affect quality of life.

  
  
• d)
  

  They are only offered to patients with central recurrence of disease.

  
  
• e)
  

  Histological confirmation is always necessary before embarking on definitive diversion procedures.

Women with hydrosalpinges referred to an in-vitro fertilisation (IVF) programme should:

• a)
  

  Always have a salpingectomy before entering the IVF programme.

  
  
• b)
  

  Only have hydrosalpinges removed if previous IVF cycles have failed.

  
  
• c)
  

  Not have the tubal mucosa evaluated before removal.

  
  
• d)
  

  Have a salpingostomy if the prognosis for hydrosalpinges is good.

  
  
• e)
  

  Have thin-walled hydrosalpinges visible on ultrasound removed, as the prognosis for these are poor.

In women with polycystic ovary syndrome who are resistant to clomiphene:

• a)
  

  It is economically more beneficial to refer her to a programme of ovulation induction with gonadotrophins instead of carrying out ovarian drilling.

  
  
• b)
  

  Transvaginal ovarian drilling is less effective than laparoscopic ovarian drilling.

  
  
• c)
  

  Ovarian drilling plus ovulation induction with gonadotrophins are considered second-line treatments.

  
  
• d)
  

  Transvaginal ovarian drilling caries a higher risk of postoperative adhesion formation, as the procedure requires vaginal access.

  
  
• e)
  

  They should be referred directly to an IVF programme.

Multi-centre studies compared with single-centre studies can be:

• a)
  

  More reliable.

  
  
• b)
  

  More valid.

  
  
• c)
  

  Completed through rapid accrual.

  
  
• d)
  

  More generalisable.

  
  
• e)
  

  Less susceptible to bias.

Which of the following is/are true about clinical trials?

• a)
  

  The numbers of multi-centre studies are increasing exponentially in obstetrics and gynaecology.

  
  
• b)
  

  Concealment and randomisation in trials is improving.

  
  
• c)
  

  The quality of surgical trials improves if the patient and clinician are blinded to the intervention.

  
  
• d)
  

  Blinding in surgical trials specifically, can be very difficult.

  
  
• e)
  

  A comparator is always needed in an effectiveness study.

Recruitment into clinical trials can be improved in the following ways:

• a)
  

  If the study is multi-centred.

  
  
• b)
  

  By paying patients to participate.

  
  
• c)
  

  By raising study awareness using social media and information leaflets.

  
  
• d)
  

  By creating an enthusiastic, motivated research team.

  
  
• e)
  

  By participation in research collaboratives and networks.

Which of the following is/are currently the principal indication(s) for single-port surgery (SPAL)?

• a)
  

  Adnexal mass.

  
  
• b)
  

  Hysterectomy.

  
  
• c)
  

  Myomectomy.

  
  
• d)
  

  Endometrial cancer.

  
  
• e)
  

  Ovarian cancer.

Which instrument(s) is/are used to carry out SPAL?

• a)
  

  0 degree camera.

  
  
• b)
  

  Specifically designed trocars for SPAL.

  
  
• c)
  

  Conventional laparoscopic instruments.

  
  
• d)
  

  Robotic instruments.

  
  
• e)
  

  Only disposable instrumentation.

The main obvious advantage(s) of SPL surgery over multi-access laparoscopy is/ are:

• a)
  

  Better cosmetics.

  
  
• b)
  

  Easier removal of the specimen.

  
  
• c)
  

  Less operative time.

  
  
• d)
  

  Absence of ancillary ports.

  
  
• e)
  

  Cheaper.

The following is/are reasons why laparoscopic assisted vaginal hysterectomy has not yet become the universal standard of practice:

• a)
  

  Gynaecologists require a long learning curve to learn the skills of laparoscopic hysterectomy

  
  
• b)
  

  Higher complication rates are related to the operative procedure

  
  
• c)
  

  Higher cost of the procedure

  
  
• d)
  

  Vaginal Hysterectomy has higher complication rates

  
  
• e)
  

  Abdominal Hysterectomy has still remained the default hysterectomy

The following statement(s) is/are true about intraoperative imaging:

• a)
  

  Laparoscopic ultrasound probes are rigid.

  
  
• b)
  

  Conventional B-mode real-time ultrasound is the technique of choice for the detection of all pelvic sentinel lymph nodes (SLN) in gynaecological cancers.

  
  
• c)
  

  Positron emission tomography (PET) and computed tomography fusion imaging (FDG– PET and computed tomography) together with intraoperative gamma probe is more accurate in detecting SLN than operative gross palpation.

  
  
• d)
  

  Intraoperative ultrasound detects more metastatic liver lesions than preoperative computed tomography imaging.

  
  
• e)
  

  Intraoperative ultrasound detects small para-aortic lymph nodes more accurately than computed tomography.

Which of the following statement(s) is/are correct about congenital uterine abnormalities (Müllerian duct anomalies)?

• a)
  

  Hysterosalpingography is a reliable technique for assigning the condition to the correct classification.

  
  
• b)
  

  No imaging technique can replace the gold standard of combined hysteroscopy and laparoscopy before proceeding with surgical management.

  
  
• c)
  

  Three-dimensional ultrasound has equal accuracy compared to hysteroscopy for detecting and making the correct diagnosis in these conditions.

  
  
• d)
  

  Three-dimensional ultrasound compared with magnetic resonance imaging scanning is more cost effective and has higher accuracy at detecting all types of these anomalies.

  
  
• e)
  

  Imaging is used in these conditions to make the diagnosis preoperatively; however there is still some benefit from performing intraoperative imaging even after the correct diagnosis has been established.