Welcome to your Core Surgical Skills(platinum)-EMQ

The repair of perineal and vaginal tears is a key clinical competency.The options show various anatomical structures  and landmarks  important during perineal tear repair.

Option List :

A. The pubococcygeus
B. Iliococcygeus
C. Internal anal sphincter
D. Ischiorectal fossa
E. Ischiocavernosus
F. Ischiococcygeus
G. Ischiorectal fossa
H. Pubococcygeus
I. Transverse perineal muscle
J. The external anal sphincter
K. Bulbospongiosus

1. This perineal muscle Has subcutaneous, superficial and deep parts:

2. This muscle Is the most medial part of the levator ani:

3. Supplied by the pudendal nerves that join the muscle at 3 and 9 o'clock:

4. Originates from the ischial tuberosities and inserted in the perineal body:

5. Arises from perineal body and inserted in corpora cavernosa of clitoris:

The following labels in images are muscles of the perineum. Choose correct label for the description of muscle mentioned in question . Each option can be chosen once or more or none at all.
Option List :

A. Label B
B. Label A
C. Label D
D. Label E
E. Label C
F. Label A&C
G. Label D&E
H. Label A&B
I. Label B&C
J. Label A&E
K. None of  the above

6. This is muscle just below the surface of the perineum, present in both men and women.

7. The paired muscle of the pelvic floor which covers the vestibular bulb.

8. The pyramidal fibromuscular mass in the middle line of the perineum  mainly supports the pelvic floor.

For each image provided  below, choose the most likely explanation of principles and problems with diathermy . Each option may be used once, more than once, or not at all.

Option List :

A. Continuous low voltage current
B. Current flows between tips of instruments
C. Use split pad technology
D. Current flows  from active probe through the patients body and return via patient return plate
E. Interrupted high voltage current
F. Interrupted low voltage current
G. Capacitative coupling
H. Direct coupling
I. Use lowest voltage possible
K. Faulty application of return electrode
L. Continuous high voltage current

9. Ms, sweetie , 44year old has undergone laparoscopic Abdominal hysterectomy for multiple fibroid uterus . On 7th post op day she came with distention of abdomen , vague abdominal pain and vomiting .she was admitted and evaluated -diagnosed to have sigmoid colon necrosis . On further detailed introspection , it was noted that during surgery , metal trocar with plastic insert was used. The type of injury is known as

10. Surgeon is doing laparoscopicsalphingectomy for ruptured left tubal ectopic pregnancy , there is a arterial bleeder which needs to be coagulated , type of current used Is

11. Ms,Leslie , 32 year old is undergoing laser loop excision f transformation zone for CIN 3,for excising transformation zone , current used is

12. You have been asked to conduct  A teaching  session on principles  of diathermy .one of junior colleagues asks you what is mono polar circuit.

13. 52 year old Ms.Alphonsa underwent  vaginal  hysterectomy  for   Uterovaginal  prolapse . She has a previous history of left  Hip joint replacement 4 years back At the time of shifting  patient from operation  theatre scrub noticed deep burn  at  left hip joint

For each image  provided  below, choose the most appropriatename of the instrument used during various gynaecology all surgeries  .Each option may be used once, more than once, or not at all.

Option List :

A. Morrison clamp
B. Gwilliams clamps
C. Babcock s forceps
D. Zeppelin clamps
E. Morris clamps
F. Ballantine clamp
G. Kocher’s clamp
H. Littlwood forceps
I. lahey's forceps
J. Heaney clamps
K. Maingotforceps

14. Instruments used to hold LineAlba during cesarean section

15. Instrument used to hold parametrium during werthimes   Hysterectomy

16. The instrument used to dissect the ureteric tunnel during radical hysterectomy

17. The instrument used to stabilize cyst capsule during open cystectomy

For each option provided  below, choose the possible complication of  different surgical procedures which you need to explain to obtain valid , informed consent Each option may be used once, more than once, or not at all.

Option List :

A. Infection
B. Haemorrhage
C. Death
D. Third and fourth degree perineal tear
E. Cephalhematoma
F. Uterine perforation
G. Postpartum Haemorrhage
H. Need for repeat evacuation
I. Bleeding for 2 weeks
J. Retinal Haemorrhage
K. Neonatal jaundice

18. Mrs, Adams , is 38 weeks pregnant  here for planning her delivery .her second pregnancy  ,first one was Emergency cesarean section does at full dilatation for fetal distress.she is asking what is the commonest problem she can encounter if she chooses to have a repeat cesarean section

19. Ms. Rebecca / 24 year old In her pregnancy m now 38 weeks admitted in active labour, she has been fully dilated for 3hours 30minutes under epidural analgesia, station is +3 , left occipital anterior , absent membranes , ,when discussed for operative delivery m she is keen on ventouse delivery , wants to know very common complication to her

20. Ms. Katie m /34year old is in her 2nd pregnancy , she has been pushing for 2hours, one epidural analgesia ,on examination - fully dilated, persistent occipito posterior , station at +2 membranes-absent ,caput +, mounding 1+
After counseling for forceps delivery , she wants to know very common complication to the baby

21. Betsy / 15 to year old is here for surgical termination Of pregnancy  for social reasons . Before signing consent form , she wants to understand uncommon risk to her during procedure

For each case described below, choose the most likely management from the above list of options. Each option may be used once, more than once or not at all.

Option List :
A. Laparoscopy/laparotomy and repair
B. Observation,anti biotics
C. Intravenous augmention and mentronidazole
D. Bladder drainage for 10 days and follow up cystogram
E. Enoxparin 40mg/ day
F. Return to theatre for explorative laparotomy
G. Admission to HDU,MDT,stabilise patient
H. Bladder training, bladder care and documentation
I. ultrasound guided drainage

22. Katie, 22 year old is undergoing, surgical termination of pregnancy. This is her second pregnancy, first one was cesareansection.During procedure, perforation suspectedand patient suddenly became tachycardic and hypertensive

23. ST5,performingcesarean section -elective cesarean for 2 previous cesarean section. While opening up fold of peritoneum, a 0.5 cm incision is made on the dome of the bladder, which is adherent to the anterior abdominal wall. It was repaired by 2 layers by consultant .

24. Ms.Aparna Joseph has undergone laparotomy &left ovarian cystectomy 4 hrs back. She has severe abdomen pain. Pain score is 8/ 10 in spite of patient controlled analgesia.Her pulse is 120 bpm.Blood pressure is 70/50mm of Hg.

25. A 51 year-old woman underwent a vaginal hysterectomy and pelvic floor repair. She had an uneventful recovery and was discharged on day 3. She returns as an admission 15 days later with pelvic pain, spiking temperatures and on examination the pouch of Douglas feels probably full and tender.