Gynaecological surgery via vaginal route: Multiple choice questions for Vol. 25, No. 2






  • 1.

    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



  • 2.

    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



  • 3.

    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



  • 4.

    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



  • 5.

    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



  • 6.

    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



  • 7.

    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



  • 8.

    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



  • 9.

    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



  • 10.

    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



  • 11.

    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



  • 12.

    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



  • 13.

    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



  • 14.

    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



  • 15.

    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



  • 16.

    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



  • 17.

    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



  • 18.

    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



  • 19.

    The prognosis of cervix cancer depends on:



    • a)

      Tumour size


    • b)

      Lymphovascular invasion


    • c)

      Depth of invasion


    • d)

      Nodal metastasis


    • e)

      Histologic type



  • 20.

    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



  • 21.

    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



  • 22.

    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



  • 23.

    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



  • 24.

    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



  • 25.

    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



  • 26.

    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



  • 27.

    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



  • 28.

    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



  • 29.

    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



  • 30.

    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



Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Nov 9, 2017 | Posted by in OBSTETRICS | Comments Off on Gynaecological surgery via vaginal route: Multiple choice questions for Vol. 25, No. 2

Full access? Get Clinical Tree

Get Clinical Tree app for offline access