EBCOG Part-1 High Yield Questions Core Surgical Skills

Options list
A. Azygos artery of the vagina
B. Descending cervical artery, branch of the uterine artery
C. Descending cervical artery, branch of the internal iliac artery
D. Inferior epigastric artery, branch of the external iliac artery
E. Inferior epigastric artery, branch of the internal iliac artery
F. Inferior gluteal artery
G. Internal pudendal artery
H. Ovarian artery, branch of the abdominal aorta
I. Ovarian artery, branch of the internal iliac artery
J. Superior epigastric artery, branch of the internal thoracic artery
K. Superior gluteal artery
L. Superior vesical artery
M. Vaginal artery, branch of the descending cervical artery
N. Vaginal artery, branch of the internal iliac artery
Each of the following clinical scenarios relates to a pelvic surgical operative procedure. For each operative step, select the single most applicable option from the above list. Each option may be used once, more than once or not at all.

1. A 29-year-old woman has just undergone a knife cone biopsy of her cervix. Both angles of the cervix are bleeding profusely. A suture needs to be inserted to arrest this bleeding. Which blood vessel is the main contributor to this bleeding?

2. A 56-year-old woman is undergoing an abdominal hysterectomy for uterine fibroids. The surgeon attempts to open the vaginal vault to introduce a clamp on the vaginal angles and makes a stab wound in the midline on the vaginal vault just below and anterior to the cervix. The woman bleeds from the vaginal vault. Which vessel is the main source of this bleeding?

3. During a teaching session, the trainer is demonstrating the anatomy of pelvic blood vessels and demonstrates an artery that passes in between the piriformis and ischiococcygeus muscles and then round the sacrospinous ligament. There is another artery passing through the same space posteriorly. Which artery is this?

4. During a laparoscopic salpingectomy for ectopic pregnancy, the surgeon is about to introduce a lateral laparoscopic port on the left abdominal flank. The surgeon is trying to determine the correct position to make the incision and is looking for the course of a blood vessel. Which blood vessel is this?

5. A surgeon is demonstrating the anatomy of a pelvic blood vessel to a trainee. The surgeon traces the course of the internal iliac artery and identifies the largest branch. Which artery is this?

Options list
A. Up to 1 woman in 10
B. Up to 1 woman in 100
C. Up to 5 women in 100
D. Up to 1 woman in 1000
E. Up to 2 women in 1000
F. Up to 5 women in 1000
G. Up to 4–8 women in 1000
H. Up to 7–8 women in 1000
I. Up to 1 woman in 12,000
J. Up to 1 woman in 100,000
K. Up to 3–8 women in 100,000
L. Up to 10 women in 100,000
M. Up to 100 women in 100,000
N. Up to 1000 women in 100,000
O. Up to 10,000 women in 100,000
Instructions: For each condition described below, choose the single most likely quoted risk from the list of options above. Each option may be used once, more than once, or not at all.

6. A 24-year-old woman complains of pelvic pain for the last 8 months. She has been booked for diagnostic laparoscopy. A specialist registrar is obtaining consent for the surgery and informing about the risk of serious complications in this procedure.

7. A 40-year-old woman is booked for an elective caesarean section for breech presentation. She goes into labour before the planned operation date at 38 weeks of gestation. She is concerned about the possibility of losing her womb during caesarean section.

8. A 34-year-old woman, para 1, presents to the labour ward at 40 weeks of gestation with regular contractions every 3 minutes. Abdominal examination reveals ballotable head and vaginal examination reveals early labour. Thirty minutes later she has a spontaneous rupture of membranes and cord prolapse. She is pushed to theatre for crash caesarean section. She wants to know her risk of bladder injury.

9. A 20-year-old woman presents to the early assessment unit at 9 weeks of gestation with mild vaginal bleeding. An ultrasound scan reveals a missed miscarriage. The doctors discuss with her these options: (1) conservative, (2) medical and (3) surgical management. The woman prefers to have surgical management for missed miscarriage but is concerned about the risk of uterine perforation.

10. A 28-year-old woman is admitted to the day surgery unit for diagnostic laparoscopy. She has been suffering from dysmenorrhoea which has outlasted her periods for the last 2 years. An ultrasound scan reveals normal ovaries and an endometrial polyp. She is scared that she may die while asleep.

Options list
A. Bladder perforation
B. Bowel injury
C. Bradycardia
D. Inferior epigastric vessel injury
E. Omental injury
F. Port site hernia
G. Post-operative pain
H. Surgical emphysema
I. Thromboembolism
J. Unrecognised visceral injury
K. Uterine perforation
L. Vessel injury
For each of the following cases, select the single most likely complication from the list above. Each option may be used once, more than once or not at all.

11. A 30-year-old woman with a body mass index of 32 was admitted for laparoscopicmanagement of her endometriosis. She had Grade III endometriosis requiring extensive peritoneal excision from the left pelvic side wall and right para-rectal space. She has been readmitted 48 hours after surgery with shortness of breath anda tachycardia.

12. A 24-year-old woman with a body mass index of 18 was admitted to the daysurgery unit for a diagnostic laparoscopy to investigate pelvic pain. She has no significant past medical history. After the primary laparoscopic port was placed, the operating surgeon was explaining to a medical student the vasculature of the anterior abdominal wall. The anaesthetist urgently asked for the abdomen to bedeflated.

13. A 40-year-old woman with a body mass index of 28 was admitted for laparoscopicdivision of adhesions following her caesarean section. In view of her previous surgery an open entry technique was used at the umbilicus. During entry of the abdominal cavity yellow, frothy fluid was noted and the operative surgeryrequested assistance from a senior colleague.

14. A 28-year-old woman with a body mass index of 26 was admitted for hysteroscopy,dilatation and curettage and diagnostic laparoscopy. Laparoscopic entry is uneventful but 150 mL of fresh blood is noted in the pelvis. On closer inspectionthere is a bleeding point on the uterine fundus.

15. A 25-year-old woman with a body mass index of 29 is admitted to the day surgeryunit for a diagnostic laparoscopy and dye test. After insertion of the lateral operative port in the left iliac fossa, brisk bleeding is noted.

Options list
A. Laparoscopic salpingectomy
B. Laparoscopic salpingotomy
C. Intramuscular methotrexate
D. Immediate laparotomy
E. Conservative management
F. Cornual resection
G. Hysterectomy
H. Hysteroscopic aspiration
I. Ultrasound guided aspiration +injection of methotrexate in the sac
J. Suction evacuation
For each case described below, choose the single most likely management option from the above list of options. Each option may be used once, more than once, or not at all,

16. A 23-year-old primigravid woman presents after 7 weeks of amenorrhea with rightsided lower abdominal pain and bleeding per vagina. Her-hCG is 2850 IU/L.A transvaginal scan shows a small sac like structure in utero and a heterogeneous doughnut-like structure in the right adnexa measuring 1.8 x 2 cm. There is no evidence of any cardiac activity within this mass, and no evidence of fluid in pouchDouglas. The woman is not very keen on a repeat B-hCG and wants treatmentstraight away. You suspect a right-sided ectopic pregnancy.

17. A 27-year-old woman presents soon after missing her periods. She gives a historyof previous two ectopic pregnancies, first treated with right salpingostomy with a subsequent ectopic on the left side treated by methotrexate. She is very worried about the status of her present pregnancy and would prefer an early intervention if this is another ectopic pregnancy. She does feel slight left sided lower abdominal discomfort, but has no bleeding per vaginum. Clinically, she is haemodynamically stable and there is no tenderness or guarding in her abdomen. Her B-hCG measured today is 1050 IU/L and a transvaginal scan shows a suspicious area near the left cornua, with no clear evidence of an intra-or extra-uterine pregnancy.

Options list
A. CT Urogram
B. X-ray abdomen
C. Full blood count
D. Urea and electrolytes
E. Laparoscopy
F. Laparotomy
G. Ultrasound
H. MRI
I. Bladder scan
J. Urinary self-retaining catheter
For each case described below, choose the single most likely initial treatment option from the above list of options. Each option may be used once, more than once, or not at all.

18. A 45-year-old woman undergoes a total laparoscopic hysterectomy with bilateralsalpingo-oophorectomy. The right ureter is noted to be hitched up and was carefully dissected at the time of hysterectomy. Postoperatively, she complains of abdominal pain mainly on the right and in her right flank.

Options list
A. Bleeding
B. Infection
C. Haematoma
D. Bladder injury
E. Ureteric injury
F. Pulmonary embolism
G. Hernia
H. Bowel injury
I. Scar dehiscence
J. Pulmonary oedema
K. Uterine perforation
For each patient described below, choose the single most likely diagnosis from the above list of options. Each option may be used once, more than once, or not at all.

19. A 32-year-old woman has undergone laparoscopy for endometriosis. She wasfound to have dense adhesions along with multiple endometriotic lesions. Lesions were resected and adhesiolysis performed using sharp and thermal dissection. She was discharged from hospital the next day following a smooth recovery. She presented to emergency 2 days later complaining of severe generalised abdominalpain, vomiting, fever and she looks generally unwell.

20. A 32-year-old nulliparous woman is undergoing a hysteroscopic resection ofa partial uterine septum as a part of subfertility treatment. Examination under anaesthesia reveals a normal size, irregular shaped retroverted uterus. There was some resistance at the initial access through the cervix, but the resection was performed under direct vision and a good intrauterine view was obtained. Some time after the resection is started, the anaesthetist tells you that the patient is hypotensive.