Postoperative Care ( Platinum ) – SBA

1. Ms. Tina 28 year old is a primigravida who has been pushing actively for 2 hours now.,she is only on entonox,after counselling her for operative delivary. She agrees for pudental nerve during vaginal delivary. Which of the following branch of the pudental nerve that will be blocked by this procedure?

2. You are asked to review a ms.Rachel, primiparous 2. woman following a  rotational difficultforcepsdelivery. She presents with left lateral calf paresthesia, sensory loss between her first and second toes and foot drop with inversion.
Which nerve compression is the likely cause of her symptoms?

3. Nerve injuries are the commonest complication of gynecological surgery It happens in what percentages of cases

4. Nerve injuries are the commonest complication of gynecological surgery. which type of injury is most severe form?

5. Ms. sweetie,26 year old patient is has undergone second stage cesarean section after a failed difficult forceps delivery for persistent . She complains of numbness to the anterior and medial thigh on the right side. On examination  knee reflex  absent on the right side, what nerve is likely to have been injured ?

6. MS,Tiara, 45 year old patient is reviewed in clinic 6 months post hysterectomy.Hysterectomy done for multiple fibroid uterusShe is having Pain in perineum and perirectal areas. Her relation ship is affected with her partner as She a sexual intercourse painful since the operation.
She also complains of urgency and hesitancy .What type of neuralgia is this likely to represent?

7. Mrs.Maha ,34 year old went for emergency cesarean section .she developed  massive Postpartum hemorrhage , which ended in cesarean hysterectomy . Total duration of surgery was  4hours  . during surgery, her arm abducted more than 90degrees .post op she  developed ERB’S palsy,
which part of the brachial plexus was got damaged.

8. Mrs. Razanza ,  60year old presented with mass per vagina .on examination she has
Grade 3 prolapse on POPQ. After counseling she has decided for vaginal hysterectomy . At the end of hysterectomy, vault descends to introitus. To prevent vault prolapse,consultant decodes to proceed for Sacrospinous fixation.what measures need to be taken to prevent pudendal nerve injury ?

9. Mrs.x , 24 year old had prolonged second stage , postnatal period she developed footdrop.Which nerve is commonly injured?

10. Mrs. X a 48-year-old woman presents 1 week after a difficult , prolonged total abdominal hysterectomy. Her BMI is 32 Kg/m2 , she has persistent weakness of hip flexion and paraesthesia over the anterior and medial aspects of her left thigh. Damage to which nerve is the most likely cause?

11. During the postoperative period, all are true except

12. 22 year old woman underwent elective repeat caesarean section at 39+ weeks and had received morphine as intrathecal opioid. She should be monitored hourly for RR, sedation, and pain scores for atleast __?

13. Your hospital has recently had an increase in postoperative infections. As a result, you are formulating a new guideline that includes information on skin preparation and hair removal prior to surgery. What is the most appropriate method of hair removal prior to surgery?

14. Rebecca , 46 year old and then again in the gynaecology ward. Her respiratory rate is suppressed; she is drowsy and has pinpoint pupils.What medication would you give to reverse this potential morphine overdose?

15. 63-year-old Mrs. Briganza had undergone vaginal hysterectomy for prolapse. She is readmitted after 10days ith a vault haematoma. She subsequently develops severe sepsis.
An arterial blood gas was performed, which showed the following:
• pH 7.15 (7.35–7.45)
• pO2 10.1 kPa (10–13)
• pCO2 4.6 kPa (4.5–6.0)
• BE 17 mmol/L (22–28).
What is the most appropriate definition of her clinical condition?

16. 44-year-old Rachel had undergone radical hysterectomy and bilateral pelvic lymphadenectomy for cancer of endometrium.Suddenly on day 3 post op she develops worsening shortness of breath and tachycardia.
Following initial investigations, a computed tomography (CT)-pulmonary angiogram demonstrates a segmental defect.

What is the most appropriate next step in management?

17. A 58-year-old woman underwent a total abdominal hysterectomy and bilateral salpingoophorectomy under general anaesthetic for a complex endometrial hyperplasia. She developed pyrexia of 38°C, 18 hours after surgery. There were no other symptoms.
Which of the following is the most likely cause of her pyrexia?

18. 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 ask for herconsentfor surgical evacuation.
What is the risk of uterine perforation at the time of surgical evacuation?

19. You have been asked by your consultant to write a patient information leaflet 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?

20. All are true regarding enhanced recovery principles except

21. Mrs. Briganza54 year old menorrhagia posted for Total Abdominal hysterectomy with bilateral salpingo-oophorectomy. Your hospital has introduced Enhanced Recovery (ER) in gynaecology.
What is the key management in Enhanced recovery ?

22. The incidence of periumbilical adhesion with previous laparoscopy is

23. The most appropriate statement regarding Ogilvie syndrome is

24. 48-year-old woman underwent abdominal hysterectomy for huge broad ligament fibroid. Intraoperative period uneventful except that there were concerns regarding the course of the ureter due to the fibroid. Following surgery there was a delayed recovery with oliguria despite adequate fluid intake.
Which is the most appropriate investigation?

25. Mrs. Maha, 34 years old, went for emergency cesarean section. She developed massive postpartum haemorrhage, which ended in cesarean hysterectomy. Total duration of surgery was 4hours. During surgery, her arm abducted more than 90 degrees. Post op she developed ERB’S palsy. Which part of the brachial plexus was damaged?