Deck 5: Gynecologic and Obstetric Surgery

Question 1

Select the congenital anomaly that best reflects indications for fetal surgery.

A)Imperforate anus
B)Tracheoesophageal fistula
C)Congenital diaphragmatic hernia
D)Nonobstructive uropathy

Answer 1

C
Conditions treated by fetal surgery include congenital diaphragmatic hernia, congenital cystic adenomatoid malformation, bronchopulmonary sequestration, obstructive uropathy, sacrococcygeal teratomas , twin-to-twin transfusion syndrome, thoracic lesions, twin reversed arterial perfusion syndrome, monochorionic twins, discordant twins, and myelomeningocele . Fetal surgery may be accomplished by way of laparotomy and hysterotomy or, in some instances, with endoscopic techniques.

Question 2

Sally Hargraves is a 72-year-old patient with multicentric carcinoma in situ (CIS) of the vulva, without evidence of leukoplakia and pruritus. She has a history of prior papillomavirus infection. Select the most appropriate surgical option.

A)Radical vulvectomy with inguinal lymph node dissection
B)Skinning vulvectomy
C)CO2 laser surface ablation of the vulvar lesions
D)Simple vulvectomy

Answer 2

D
Simple vulvectomy is removal of the labia majora and labia minora, possibly (but not preferably) the glans clitoris, and occasionally tissue from the perianal area. A simple vulvectomy is usually performed to treat carcinoma in situ of the vulva when it is multicentric. Occasionally, a vulvectomy is necessary for the treatment of either leukoplakia or intractable pruritus, especially when a skinning procedure is impractical or has failed.

Question 3

Miranda Cox returned to her gynecologist's office for a second Pap smear when her routine exam showed dysplastic cells in her cervical cytology test. Miranda has a family history of cervical cancer and had laser ablation within the last 2 years for vulvar condylomata. She can expect her gynecologist to perform another Pap smear and:

A)colposcopy with endocervical biopsy.
B)hysteroscopy with cervical biopsy and frozen section.
C)colposcopy with cervical skinning procedure performed using a local anesthetic.
D)second-look vaginal exam with cervical Pap smear.

Answer 3

A
A colposcopy, with colpomicroscopy, is often performed in the physician's office. This examination is indicated for the patient with an abnormal Papanicolaou (Pap) smear suggestive of dysplasia. It identifies cellular abnormalities that may involve the vulva, vagina, or cervix and helps identify areas of dysplasia and carcinoma in situ. Endocervical curette samples may be obtained during the colposcopic procedure to rule out invasive carcinoma or to detect early adenocarcinoma.

Question 4

From the list below, select the statement that is true about fallopian tube cancer.

A)Fallopian tube cancer metastasizes to the ovaries and cervix.
B)Fallopian tube cancer is fast-growing in women with genital herpes.
C)Fallopian tube cancer is very rare, with an incidence of less than 1%.
D)Fallopian tube cancer is seen primarily as a metastasis from the small intestine.

Question 5

Ova travel through the fallopian tubes toward the uterus by which type of action?

A)Peristalsis
B)Gravity
C)Brownian motion
D)Intra-abdominal pressure

Question 6

When catheterizing the female patient, the urethra must be located. The correct order of the external organs of the vulva listed anterior to posterior is:

A)mons pubis, labia majora, labia minora, urethra, clitoris, vaginal opening.
B)labia majora, labia minora, clitoris, urethra, vaginal opening, mons pubis.
C)mons pubis, labia majora, labia minora, clitoris, urethra, vaginal opening.
D)labia majora, labia minora, urethra, mons pubis, clitoris, vaginal opening.

Question 7

During the skin preparation for a gynecologic procedure that requires both an abdominal and a vaginal prep, the circulator must ensure that cross-contamination does not occur. Select two principles of aseptic technique that support cross-contamination prevention.

A)Tuck sterile towels under the patient's buttocks and both sides of the abdomen.
B)Insert the urinary catheter to drainage before beginning the prep.
C)Prep the abdomen before beginning the vaginal prep.
D)Use two separate prep trays (one for the abdomen, one for the vagina).

Question 8

What classification of drugs are GYN/obstetric-related medications that require monitoring of blood pressure, assessment for continued bleeding, and monitoring of fundal response to the drug?

A)Oxytocics
B)Tocolytics
C)Antimetabolites
D)Cytotoxics

Question 9

The surgical team gently abducted Matilda's arms into position on padded armboards at less than 90 degrees with palms facing up. Extra padding was placed under her elbows and an armboard strap was secured over her forearm. The armboards were locked into place to prevent inadvertent abduction. This important maneuver is designed as a risk reduction strategy to prevent:

A)axillary tension.
B)brachial plexus injury.
C)celiac plexus injury.
D)elbow torsion with displacement.

Question 10

Marla Moriarity, a 32-year-old recently unemployed and uninsured college professor, is diagnosed with an early ectopic pregnancy. Her obstetrician has given her the option of surgical or medical therapy. She is well-informed about the details of each medical and surgical option, but her primary concern about her condition is that her decision will be based upon her strong cultural belief system that will not sanction the destruction of the fetus. Marla's treatment decision will most likely be:

A)the medical therapy of IM methotrexate for 5 to 7 days.
B)laparoscopic injection of methotrexate to the extrauterine gestational sac.
C)emergency laparotomy for a ruptured ectopic pregnancy.
D)salpingectomy.

Question 11

Matilda Gunderson, a 55-year-old woman with uterine cancer, is scheduled for an open panhysterectomy. She is positioned in low lithotomy with her legs symmetrically arranged in padded cradle stirrups. After the incision is made and primary dissection accomplished, she will be positioned in Trendelenburg position to facilitate exposure of the lower pelvis and displacement of the small bowel from the operative area. Matilda is at risk for compromise and injury related to prolonged Trendelenburg tilt, which promotes:

A)decreased pulmonary compliance and functional residual capacity.
B)increased popliteal congestion and peripheral vascular collapse.
C)shearing force injury from sliding toward the head of the OR bed.
D)avascular ischemic changes to the lower leg and feet from gravitational devascularization.

Question 12

Margie Donaldson's examination has revealed a family history of endometrial cancer. She has never been pregnant and has been taking hormone replacement therapy for 4 years. Her physician has scheduled her for a surgical procedure to obtain visual and pathologic information and provide treatment as indicated. Margie was sure that she would have to have a D&C (dilatation and curettage). Margie's surgery, on the operative schedule, would most probably be written as:

A)D&C with endocervical biopsies.
B)hysteroscopy with endometrial ablation.
C)D&C with endometrial biopsies, frozen section, possible LAVH.
D)D&E with endometrial washings, frozen section, total abdominal hysterectomy.

Question 13

An example of perineal glands that secrete mucus is:

A)Skene's glands.
B)Bartholin's glands.
C)perineal glands.
D)labial glands.