The following has/have been proven for the benefits of vaginal hysterectomy (VH) versus abdominal hysterectomy (AH):

• a)
  

  Speedier return to normal activities

  
  
• b)
  

  Fewer febrile episodes

  
  
• c)
  

  Reduced cost

  
  
• d)
  

  Reduced incidence of DVT post-operatively

  
  
• e)
  

  Less post-operative analgesic requirement

The following is/are absolute contraindications to vaginal hysterectomy:

• a)
  

  Nulliparity

  
  
• b)
  

  History of Caesarean section or pelvic surgery

  
  
• c)
  

  No uterine descent during examination under anaesthesia

  
  
• d)
  

  Uterine size greater than that of a 12-week pregnancy

  
  
• e)
  

  Endometrial cancer

Which of the following statements is/are true:

• a)
  

  There is no evidence of benefits of laparoscopic hysterectomy over vaginal hysterectomy

  
  
• b)
  

  Vaginal hysterectomy has less bladder and ureter trauma and takes less time to complete than laparoscopic hysterectomy

  
  
• c)
  

  Vaginal hysterectomy is more economical than laparoscopic hysterectomy

  
  
• d)
  

  Hospital stay is similar for vaginal hysterectomy and laparoscopic hysterectomy

  
  
• e)
  

  The postoperative recovery period is similar for vaginal hysterectomy and laparoscopic hysterectomy

Subtotal hysterectomy (STAH) should be recommended over total hysterectomy (TAH) because:

• a)
  

  It reduces the chance of vault prolapse

  
  
• b)
  

  It provides a better sex life

  
  
• c)
  

  It maintains better vaginal lubrication

  
  
• d)
  

  There is less urinary tract injury

  
  
• e)
  

  There is a shorter operating time

Regarding subtotal hysterectomy:

• a)
  

  The procedure is likely to have a less deleterious effect on a woman’s sexual function than after total abdominal hysterectomy

  
  
• b)
  

  The rate of urinary incontinence is less than after total abdominal hysterectomy

  
  
• c)
  

  The risk of subsequent cancer of the cervical stump is much greater than vaginal carcinoma where cervical screening takes place

  
  
• d)
  

  Postoperative recovery is the same after subtotal hysterectomy compared with total abdominal hysterectomy

  
  
• e)
  

  It was the first hysterectomy carried out

Vaginal subtotal hysterectomy (by the Döderlein–Kronig method):

• a)
  

  Generally gives better access than a standard Heaney vaginal hysterectomy

  
  
• b)
  

  Is the vaginal hysterectomy of choice for a uterus larger than that of a pregnancy of 14 weeks gestation

  
  
• c)
  

  As with any vaginal hysterectomy, the essential aspects of a safe operation are good uterine mobility, adequate vaginal access, and experienced assistants

  
  
• d)
  

  Is carried out through an anterior colpotomy

  
  
• e)
  

  Voiding before transfer to theatre and catheterisation only at the end of the procedure provides a simple check for bladder injury

Vaginal myomectomy by colpotomy:

• a)
  

  Permits a more thorough myomectomy than a laparoscopic procedure where multiple fibroids are present

  
  
• b)
  

  Is ideal where fundal fibroids are present

  
  
• c)
  

  Is likely to give a stronger uterine scar than laparoscopic myomectomy

  
  
• d)
  

  Operating time is roughly the same as with abdominal myomectomy

  
  
• e)
  

  Operating time is less than by a purely laparoscopic approach on the best evidence available

Pelvic organ prolapse is unique among hernias because:

• a)
  

  Of the size of the opening that allows the prolapse to develop

  
  
• b)
  

  It develops through a break in damaged connective tissues

  
  
• c)
  

  It may reach a large size

  
  
• d)
  

  It may be chronic

  
  
• e)
  

  It may be associated with ulceration

Evidence-based data are difficult to generate in the analysis of pelvic organ prolapse surgery because of:

• a)
  

  Complexity of surgical technique

  
  
• b)
  

  Variation of surgical technique

  
  
• c)
  

  Rapid change in operative techniques

  
  
• d)
  

  Rapid change of materials used in repair

  
  
• e)
  

  Difficulty in standardizing technique

Pelvic organ prolapse surgery should consider the following factors when success of treatment is evaluated

• a)
  

  Urinary, bowel, and sexual function

  
  
• b)
  

  Preferred surgical technique of the doctor

  
  
• c)
  

  Degree of anatomical restoration

  
  
• d)
  

  Difficulty of the surgery

  
  
• e)
  

  Cost of the procedure

Which of the following materials can be used to strengthen a prolapse repair:

• a)
  

  Xenograft

  
  
• b)
  

  Autograft

  
  
• c)
  

  Allograft

  
  
• d)
  

  Thermoplastic polymer

  
  
• e)
  

  Artificial collagen

Which of the following is/are accepted treatment(s) for early endometrial carcinoma?

• a)
  

  Extrafascial hysterectomy with bilateral salpingooophorectomy and pelvic periaortic lymph nodes removal

  
  
• b)
  

  Neoadjuvant chemotherapy followed by extrafascial hysterectomy with bilateral salpingooophorectomy

  
  
• c)
  

  Extrafascial hysterectomy with bilateral salpingooophorectomy followed by adjuvant radiation treatment

  
  
• d)
  

  Radical radiation treatment

  
  
• e)
  

  Chemotherapy alone

Among the following group(s) of patients with early endometrial cancer, which is/are those in whom vaginal hysterectomy is an appropriate alternative technique?

• a)
  

  Elderly patients and patients with coexisting morbidities at high surgical risk

  
  
• b)
  

  Patients with vaginal prolapse requiring vaginoplasty

  
  
• c)
  

  Patients at no risk for nodal metastases

  
  
• d)
  

  Elderly patients with stage II endometrial cancer

  
  
• e)
  

  Younger women with stage II endometrial cancer

Regarding the use of vaginal hysterectomy as a treatment for endometrial cancer, the following is/are true:

• a)
  

  Its use in Western Europe is remarkably consistent

  
  
• b)
  

  The incidence of use in Western Europe appears to be similar to in the USA

  
  
• c)
  

  The majority of gynaecological oncologists in Europe feel its use is completely inappropriate

  
  
• d)
  

  The majority of gynaecological oncologists in the USA feel its use is completely inappropriate

  
  
• e)
  

  >90% of American oncologists recognized it may be utilized for specific clinical conditions

In cancer of the cervix, sentinel-node mapping with ultra staging has shown the following advantages:

• a)
  

  The technique is possible by laparoscopy

  
  
• b)
  

  If the sentinel node is negative on frozen section, complete pelvic lymphadenectomy can be avoided

  
  
• c)
  

  If the sentinel node is positive on frozen section, para-aortic node dissection is indicated

  
  
• d)
  

  If the sentinel node is negative on frozen section, ultra staging helps find micro metastases

  
  
• e)
  

  The sentinel nodes are always in the pelvis

In any surgical procedure, knowing the anatomy is very important. When carrying out vaginal radical hysterectomy:

• a)
  

  It is important to remove at least 2 cm of vaginal mucosa in all cases

  
  
• b)
  

  Tumour size can determine vaginal cuff margins

  
  
• c)
  

  The ureter is seen above the uterine artery

  
  
• d)
  

  The ureter is seen under the uterine artery

  
  
• e)
  

  After opening the vesico-uterine space, the ureter is easily palpable under the pubic bone

Compared with a Wertheim radical hysterectomy, studies have shown a significant difference in favour of laparoscopically assisted vaginal radical hysterectomy (LAVRH) in relation to the following:

• a)
  

  Fewer intra-operative complications

  
  
• b)
  

  Less blood loss and transfusions

  
  
• c)
  

  A shorter hospital stay

  
  
• d)
  

  A shorter operating time

  
  
• e)
  

  Recurrence rate

Cervical cancer staging according to FIGO requires the following:

• a)
  

  Magnetic resonance imaging

  
  
• b)
  

  Computed tomography

  
  
• c)
  

  Clinical examination

  
  
• d)
  

  Histologic diagnosis of invasive cancer

  
  
• e)
  

  Lymph-node dissection

The prognosis of cervix cancer depends on:

• a)
  

  Tumour size

  
  
• b)
  

  Lymphovascular invasion

  
  
• c)
  

  Depth of invasion

  
  
• d)
  

  Nodal metastasis

  
  
• e)
  

  Histologic type

The following is/are true for women pregnant after trachelectomy

• a)
  

  The majority have become pregnant after IVF

  
  
• b)
  

  They should follow strict rules and bed rest from the second trimester

  
  
• c)
  

  Delivery should be by Caesarean Section

  
  
• d)
  

  Removal of cerclage at 38 weeks gestation is recommended

  
  
• e)
  

  They are prone to premature rupture of membranes

Regarding pre-malignant and malignant disease of the cervix, vaginal hysterectomy is:

• a)
  

  Generally the preferred route of uterine removal

  
  
• b)
  

  Indicated for cervix cancer stage IB1

  
  
• c)
  

  Not sufficient treatment of CIN III

  
  
• d)
  

  A minimally invasive procedure

  
  
• e)
  

  Requires a trained surgeon

The following statement(s) regarding stress urinary incontinence is/are true:

• a)
  

  The prevalence of stress urinary incontinence (SUI) increases with age

  
  
• b)
  

  SUI is only seen in postmenopausal women

  
  
• c)
  

  Obesity and smoking are some of the factors that increase the risk of developing SUI

  
  
• d)
  

  SUI is a potentially life-threatening condition

  
  
• e)
  

  SUI results from urethral hypermobility, intrinsic sphincter deficiency, or both

The following statement(s) is/are true about the surgical management of SUI:

• a)
  

  Anterior colporrhaphy is still recommended

  
  
• b)
  

  Retropubic needle suspension technique is the operation of choice because it gives good long-term cure rates

  
  
• c)
  

  Mid-urethral sling procedures can be considered as ‘gold standard’ operations

  
  
• d)
  

  Tension-free vaginal tape operation does not have any potentially serious complications

  
  
• e)
  

  Trans-obturator tape operation is as effective as tension-free vaginal tape procedure

The risk of recurrence of pelvic organ prolapse (POP) after primary surgery is increased in the following situation(s):

• a)
  

  Osteoporosis

  
  
• b)
  

  Body mass index less than 18.5

  
  
• c)
  

  Family history of POP

  
  
• d)
  

  POP-Q grade 3 or 4

  
  
• e)
  

  Smoker

The risk of vaginal mesh erosion can be decreased by:

• a)
  

  Trimming the redundant vaginal skin (colpectomy)

  
  
• b)
  

  Spreading the mesh to avoid any fold

  
  
• c)
  

  Systematic vaginal estriol tablets

  
  
• d)
  

  Leaving the fascia attached to the vaginal mucosa and inserting the implant deeply between organ and fascia

  
  
• e)
  

  Using a lighter mesh with bigger pore size

A woman presents at the 2-month follow up with part of the mesh (1 cm ² ) exposed at the median part of the longitudinal anterior scar. She has no discharge or pain. Which of the following would be part of her management?

• a)
  

  You decide not to treat and follow up in a month’s time

  
  
• b)
  

  You prescribe estriol tablets

  
  
• c)
  

  You give her antibiotics to avoid infection

  
  
• d)
  

  You schedule her for mesh excision and closure of the defect under local anaesthesia

  
  
• e)
  

  You pull slightly on the exposed part to see if it is mobile and, if it is, you trim it

A woman presents with perineal pain persisting 6 months after a posterior repair with a translevatoric sacrospinous ligament sling. There is no erosion or retraction. Which of the following would be part of her management?

• a)
  

  You think of a persisting haematoma and prescribe pain killers

  
  
• b)
  

  You check the woman for pudendal nerve entrapment

  
  
• c)
  

  You prescribe perineal electromyography and infiltration of the pudendal nerve

  
  
• d)
  

  You prescribe anti-inflammatory drugs to ease the pain

  
  
• e)
  

  You schedule the woman for mesh removal and nerve decompression by vaginal or laparoscopic approach

The following statements are true about the anatomical structures supporting the uterus and vagina:

• a)
  

  The main support for the pelvic floor is provided by the round ligaments

  
  
• b)
  

  The parametrium is composed mainly of the uterosacral and cardinal ligaments

  
  
• c)
  

  The genital hiatus is created by the fibres of the levator ani muscle converging anteriorly in front of the vagina and urethra

  
  
• d)
  

  Damage to the perineal body predisposes to rectocele formation

  
  
• e)
  

  The uterus is the driving force weakening the pelvic floor support structures

The following statements are features of pelvic organ prolapse:

• a)
  

  The life-time risk of a woman undergoing surgery for pelvic organ prolapse is 1 in 50

  
  
• b)
  

  It is more common in women of low parity

  
  
• c)
  

  Is a consequence of weakness of the pelvic floor support structures

  
  
• d)
  

  It can occur in young women with congenital connective tissue weakness

  
  
• e)
  

  Vaginal hysterectomy and colporrhaphy is suitable for correction of all types of pelvic organ prolapse

When considering treatment of uterovaginal prolapse in young women:

• a)
  

  Vaginal pessary insertion is the preferred long-term treatment

  
  
• b)
  

  The evidence in favour of pelvic floor exercise is considered robust

  
  
• c)
  

  Vaginal hysterectomy is the treatment of choice

  
  
• d)
  

  Posterior vaginal colporrhaphy could lead to dyspareunia

  
  
• e)
  

  An intra-peritoneal approach is used for sacrospinous ligament fixation