1. Indications : Hysterectomy MCQ
The most common indication for Hysterectomy
a) Uterine leiomyomata
b) Dysfunctional Uterine Bleeding
c) Uterine prolapse
Correct Answer: a) Uterine leiomyomata are the most common reason for hysterectomy, accounting for approximately 30% of indication for this procedure. Approximately 20% to 30% of hysterectomies are performed with DUB as the primary indication. Hysterectomy is not indicated unless the bleeding recurrent, severe and unresponsive to hormonal therapy and D&C on several occaasions. (Ref: Telind’s Text book)
2. OC Pills : Hysterectomy MCQ
Woman taking oral contraceptive pills. When do we need to stop OC’s before elective hysterectomy, to prevent thrombosis?
a) 30 days before
b) Complete the current cycle and can do surgery after withdrawal
c) At least 7 days before
d) 30 days after completion of current cycle
e) No need to stop
Correct Answer: e) No need to stop. Practice of stopping OC’s 2-4 weeks prior to surgery have been discontinued as it is not supported by current prospective controlled studies and places the patient at risk for unwanted pregnancy as well as menstrual irregularities. So routine discontinuation of OC’s is not recommended, but instead mechanical venous support such as elastic stockings or intermittant pneumatic compression be used at the time of surgery. (Ref: Telind’s Text book)
3. Complications : Hysterectomy MCQ
40-year-old woman has developed haematuria, pain and reduced urine output on D3 following abdominal hysterectomy. Urine shows RBCs but no nitrites. An X-ray of the pelvis was unremarkable. What is the most likely diagnosis?
a) Bladder injury
b) Intra-abdominal bleeding
c) Ureteric stone
d) Ureteric trauma
e) Urinary tract infection
Correct Answer: d) Ureteric trauma. While intra-abdominal bleeding may be associated with these signs, it is more likely to present at an earlier stage, as would significant bladder injury. The unremarkable pelvic X-ray makes ureteric stone unlikely, while the absence of nitrites makes urinary tract infection unlikely.
4. Structures removed : Hysterectomy MCQ
While performing abdominal hysterectomy for fibroid in a 40-yr old woman (without any high risk), which of the following structures should be removed, if followup is reliable?
a) Body of uterus
c) Fallopian tubes
d) Both Ovary
e) One ovary
Correct Answer: a) Body of uterus and can add c) Fallopian tubes plus b) Cervix also. Till date there is no clear evidence for retaining the cevix. In the present case as follow-up is reliable you can discuss retaining the cervix with the patient.
1) J Cancer Res Clin Oncol. 2014: Prophylactic bilateral salpingectomy (PBS) to reduce ovarian cancer risk incorporated in standard premenopausal hysterectomy.
2) Cochrane review: When hysterectomy is required for non-cancerous conditions, either the uterus alone (subtotal hysterectomy) or the uterus and the cervix (total hysterectomy) are removed. It has been suggested that not removing the cervix (subtotal hysterectomy) would reduce the chances of sexual difficulties or problems with passing urine or stools. This review has found no evidence of a difference between these two different operations for these outcomes. Surgery is faster with subtotal hysterectomy and there is less blood loss during or just after surgery, although these benefits are not large. With subtotal hysterectomy, women are less likely to experience fever during or just after surgery but are more likely to have long term ongoing menstrual bleeding when compared with total hysterectomy.
5. Vaginal Hysterectomy Complication : Hysterectomy MCQ
65-year-old woman underwent vaginal hysterectomy. Postoperatively you have noticed parasthesia of the lateral side of the leg, foot and foot drop. The compression of which nerve is likely to be responsible?
a) Common peroneal nerve
b) Femoral nerve
c) Great saphenous nerve
d) Obturator nerve
e) Pudendal nerve
Correct Answer: a) Common peroneal nerve. The injury is thought to be secondary to compression of the nerve between the lateral head of the fibula and the bar holding the legs. When the stirrups are used, special attention must be paid in order to avoid compression. Injury to the femoral nerve will cause hypoesthesia in the anterior and anteromedial area on the thigh below the inguinal ligament.
6. Instrument : Hysterectomy MCQ
Identify the instrument used in Gynecology.
a) Auvard’s speculum
b) Cusco’s speculum
c) Right angle retractor
d) Jackson speculum
e) Sims single blade speculum
Correct Answer: d) Jackson speculum. It is commonly used instrument these days for NDVH, as it has single blade so the other blade (like Sim’s speculum) does not obstruct the introduction of speculum. Also length of the blade is longer than Sims speculum, provides more space and retraction for Vaginal Hysterectomy specially NDVH and Sacrospinous fixation.Prev Next
"Authored By Dr.Niraj Mahajan"
MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.Read more [+]