MODULE-CORE SURGICAL SKILLS – SBA

1. Safety measures to prevent laparoscopic electrosurgical complications include all of the following except:

2. In electro surgical procedures,  tissue is heated by electric current.

Temperature at which coagulation occurs is

3. An electrosurgical unit (ESU) consists of a generator and a handpiece with one or more electrodes. The device is controlled using a switch on the a foot switch.

Pedal used for cutting is

4. All are true regarding safe Electrocautery procedures except

5. You are asked to see a 21-year-old para 1 in the early pregnancy assessment unit. She is 9 weeks into her second pregnancy and presents with cramping abdominal pain and vaginal bleeding. Pelvic ultrasound scan shows a picture of incomplete miscarriage. She opts for surgical management of the miscarriage, and you consent her for surgical evacuation.
What is the risk of uterine perforation at the time of surgical evacuation?

6. A 55-year-old  woman  is  due to  come in  for  total abdominal hysterectomy  and  bilateral salpingo-oophorectomy  for  a large  mucinous  ovarian  cyst.  She  takes  sequential HRT  for menopausal symptoms.

What  is  the approximate overall risk  of  serious  complications from  abdominal hysterectomy?

7. You  see a 48-year-old  woman  opting  for  a hysterectomy  for  management  of  her  heavy menstrual bleeding.  While obtaining  her  consent  for  the  operation  you  explain  to  her that  haemorrhage requiring  transfusion  is  a ‘common’  procedural risk.  What  is  the numerical ratio  for  a complication  when  it  is  quoted  as  ‘common’?

8. You have been asked by your consultant to write a patient information lea et on caesarean section. You decide to include information on serious and frequently occurring risks.
What is the incidence of ureteric injury at the time of caesarean section?

9. Which is correct regarding entry technique in laparoscopic surgery?

10. Most common laparoscopic injury reported to National patient insurance Association.

11. Ms. X 50 years old woman is here to discuss consent for Abdominal hysterectomy due to abnormal uterine bleeding, she tried all conservative measures(Mirena, tranexamic acid, ablation ) She is on clopidogrel. If the benefits of stopping clopidogrel outweigh the risks, how long should clopidogrel be stopped prior to surgery?

12. You see a 30 years old pregnant women a for elective repeat cesarean section. While obtaining her consent for the operation you explain to her that persistent wound and abdominal discomfort in the first few months after surgery, is common risk.
What is the numerical ratio for a complication when it is quoted as ‘common’?

13. This instrument is used commonly in cesarean section. What is the name of this instrument ?

14. Mrs. Marsha is diagnosed as Stage 1A endometrial cancer. Her BMI is 40kg/m2, she was posted for TAH with BSO via midline laparotomy. In OT, scrub nurse is asking to prepare suture for abdominal closures, she is worried about burst abdomen as a complication. Which Suture material would you ask her to keep ready for mass closure?

15. 37-year-old P2L2 has been posted for diagnostic laparoscopy for chronic pelvic pain. She has undergone a midline vertical laparotomy for ruptured ectopic pregnancy. The decision of doing a closed-entry technique at the palmer’s point has been made. Which of the following is the correct anatomical description of Palmer’s point?

16. During the insertion of the primary trocar, the intra-abdominal pressure following the veress needle insertion is maintained between 22-25 mm Hg. All are true regarding this, except

17. The incidence of periumbilical adhesion with previous laparoscopy is

18. Your consultant is doing a diagnostic laparoscopy for a 30 year old woman who has presented to you with chronic pelvic vein. Your consultant has asked you to identify the marked structure. Identify the structure.

19. The overall risk of serious complication during a diagnostic hysteroscopy is

20. The first-choice anti-septic unless contraindicated for the surgical site that is next to the mucous membrane is

21. 35-year-old P1L1, is planned for a resection of a sub-mucous fibroid. Hysteroscopy reveals, 

What is the ideal distension medium for the resection of the fibroid using a bipolar resectoscope?

22. The preferred transverse incision is Joel-Cohen incision because it has

23. All are true regarding bipolar devices and the energy, except

24. The following are good practice points while using a monopolar device, except:

25. 38 year old multiparous woman is undergoing diagnostic laparoscopy for chronic pelvic pain. What is the chance that the bowel injury might be missed at the time of laparoscopy?

26. A 35-year-old female, who is a para 3, had firstly a vaginal delivery and two Caesarean sections – first was done in view of foetal distress and the second was elective caesarean. She has presented with chronic pelvic pain three months after her last lower uterine segment Caesarean section (LSCS).What is the incidence of nerve entrapment after LSCS?

27. All regarding Smead–Jones closure is true except,

28. 38 year old multiparous woman is undergoing diagnostic laparoscopy for chronic pelvic pain. What is the chance that the bowel injury might be missed at the time of laparoscopy?

29. Identify this!!!

30. A healthy 39-year-old woman with no significant past medical history attends a preoperative assessment clinic.She is due to undergo a total abdominal hysterectomy for heavy menstrual bleeding following a local anaesthetic endometrial ablation that was unsuccessful.She is fit and well.

What preoperative investigation is required?

31. An ST5 trainee performs an elective Caesarean section for a primigravida with a breech presentation. The patient’s BMI is 23. She has had no previous abdominal surgery. A straight transverse abdominal incision is made 3 cm below the level of the anterior superior iliac spines. The subcutaneous tissue and rectus sheath are opened in the midline and extended laterally with blunt finger dissection. Blunt dissection is used to separate the rectus muscles and enter the peritoneum.
Which transverse abdominal incision is described above?

32. Cesarean sections is the one of the commonest surgical procedure in UK according to NICE ,which skin incision preferred for Cesarean Section ?

33. Antibiotic prophylaxis is not recommended in the following surgical interventions in obstetrics and gynaecology. Please select the best answer.

34. An 60 year-old woman with hypertension and type 2 diabetes attends for hysterectomy and bilateral salpingoopherectomy following investigation for postmenopausal bleeding.

On examination, her pulse was 93 beats a minute, respiratory rate was 20 breaths per minute and her blood pressure 140/90 mmHg. She has moderate bilateral ankle edema which she reports started after starting the “blood pressure tablets”.

What antihypertensive agent is most likely to be the cause of her symptoms?

35. A 34 year-old woman has had an emergency laparotomy and salpingectomy for ruptured tubal ectopic pregnancy. Her BMI is 50.She smokes 15 cigarettes a day and is a poorly controlled diabetic on metformin.
Her HbA1C is 11%
What is the most appropriate step to reduce the incidence of scar dehiscence?

36. The most common site of Urinary Bladder injury during laparoscopic surgery is

37. 36 year old woman underwent hysteroscopic resection of sub mucous fibroid (3 x3 cms) using a resectoscope with glycine. After the procedure, the patient developed confusion, nausea, vomiting, headache. The diagnosis is

38. Palmers point is

39. All are true regarding laparoscopic entry except:

40. The distention media that is recommended for the use during the resection of the fibroid with a monopolar resectoscope is

41. The distension media that is preferred for office hysteroscopy is

42. 46 year old woman is planned for Burschcolposuspension for urodynamic stress incontinence. Which of the incision is the preferred method?

43. A 28 year old lady has undergone a hysteroscopic resection of fibroid for a 4 cm fibroid. She is anxious to conceive and is under fertility treatment.  Which of the following anti adhesive agents should be used to prevent intrauterine adhesions? 

44. A 56 year old multiparous woman presented with postmenopausal bleeding. She was found to have an endometrial thickness of  8 mm on pelvic USG.  She is posted for an outpatient hysteroscopy.  What size of hysteroscope should be used for her procedure? 

45. A 21 year old woman is posted for diagnostic laparoscopy for chronic pelvic pain. She was told that she has higher risk of laparoscopic injuries as her BMI is 18. Her highest risk of complication is: 

46. A 70 year old lady is undergoing hysteroscopy with a 30° hysteroscope. She has a retroverted uterus. What should be the position of the cervical os on view for appropriate hydrodilatation?

47. A 45 year old woman is posted for outpatient hysteroscopy and endometrial polyp resection.  Please choose the best distention medium that will reduce her risk of having vasovagal attack.

48. A 55-year-old woman is due to come in for total abdominal hysterectomy and bilateral salpingo-oophorectomy for a large mucinous ovarian cyst. She takes sequential HRT for menopausal symptoms.What is the approximate overall risk of serious complications from abdominal hysterectomy?

49. A 64 year old lady is having ovarian debulking surgery.  The disadvantages of her having a midline incision is as follows:

50.Ms. XY, 48 years old, para 3, is due to undergo a NovaSure endometrial ablation in theatre for heavy menstrual bleeding. A WHO surgical safety checklist is in progress. Which of the following is not a component to the sign out?