Laparoscopy

Laparoscopy

Q. 1

Best gas used for creating pneumoperitonium at laparoscopy is :

 A

 N2

 B

02

 C

CO2

 D

N20 Goniometer is used

Q. 1

Best gas used for creating pneumoperitonium at laparoscopy is :

 A

 N2

 B

02

 C

CO2

 D

N20 Goniometer is used

Ans. C

Explanation:

CO2

CO, is the gas used to create pneumoperitoneum during laparoscopy.

Other option is – N20 : But it is expensive, less soluble in blood and supports combustion.

Also know :

  • Instrument used for creating pneumoperitoneum is veress needle.

Flow Rate of CO, for creating pneumoperitoneum 200 – 2000 ml/min & pressure between 15 – 25 mm of Hg.


Q. 2

Laparoscopy is best avoided in patients with :

 A

Hypertension

 B

Diabetes

 C

Obesity

 D

COPD

Q. 2

Laparoscopy is best avoided in patients with :

 A

Hypertension

 B

Diabetes

 C

Obesity

 D

COPD

Ans. D

Explanation:

COPD


Q. 3

Best tubal function test is-

 A

Laproscopy

 B

Hysterosalpingography

 C

Rubin’s test

 D

X – ray pelvis

Q. 3

Best tubal function test is-

 A

Laproscopy

 B

Hysterosalpingography

 C

Rubin’s test

 D

X – ray pelvis

Ans. A

Explanation:

Laproscopy


Q. 4

Laproscopy detects :

 A

Endometriosis

 B

Ca uterus

 C

Ca cervix

 D

Ca rectum

Q. 4

Laproscopy detects :

 A

Endometriosis

 B

Ca uterus

 C

Ca cervix

 D

Ca rectum

Ans. A

Explanation:

Endometriosis


Q. 5

A female presents with primary amenorrhea and absent vagina, the next investigation to be done is :

 A

LH / FSH assay

 B

Chromosomal analysis

 C

Urianalysis

 D

Laparoscopy

Q. 5

A female presents with primary amenorrhea and absent vagina, the next investigation to be done is :

 A

LH / FSH assay

 B

Chromosomal analysis

 C

Urianalysis

 D

Laparoscopy

Ans. D

Explanation:

Laparoscopy


Q. 6

Salpingitis / Endosalpingitis is best confirmed by:

 A

Hysteroscopy + Laparoscopy

 B

X – ray

 C

Hysterosalpingography

 D

Sonosalpingography

Q. 6

Salpingitis / Endosalpingitis is best confirmed by:

 A

Hysteroscopy + Laparoscopy

 B

X – ray

 C

Hysterosalpingography

 D

Sonosalpingography

Ans. A

Explanation:

Hysteroscopy + Laparoscopy


Q. 7

Best test for diagnosis of tubal patency Is :

 A

Laparoscopy

 B

Hysterosalpingography

 C

Endometrial biopsy

 D

Mantoux test

Q. 7

Best test for diagnosis of tubal patency Is :

 A

Laparoscopy

 B

Hysterosalpingography

 C

Endometrial biopsy

 D

Mantoux test

Ans. A

Explanation:

Laparoscopy


Q. 8

During laparoscopy the preferred site for obtain­ing cultures in a patient with acute pelvic inflammatory disease is :

 A

Endocervix

 B

Pouch of Douglas

 C

Endometrium

 D

Fallopian tubes

Q. 8

During laparoscopy the preferred site for obtain­ing cultures in a patient with acute pelvic inflammatory disease is :

 A

Endocervix

 B

Pouch of Douglas

 C

Endometrium

 D

Fallopian tubes

Ans. D

Explanation:

Ans. is d i.e. Fallopian tube

  • Laparoscopic visualization of the pelvis is the most accurate method of confirming diagnosis of an acute P1D.
  • However, it is not practical to advise diagnostic laparoscopy to all patients of PID,
  • Indications of Laparoscopy in Acute PID :

–   Patients not responding to therapy, in order to confirm the diagnosis.

–   To obtain cultures from cul-de-sac or fallopian tube.

–   To drain pus. if necessary.

Thus, cultures can be obtained from both cul-de-sac and fallopian tube.

Telinde’s Operative Gynae. 9/e, p 679 further says

“Laparoscopy is an excellent means of obtaining cultures directly from the tubes.” My answer to this question is Fallopian tube. You can have your opinion.


Q. 9

Pawaer burr, appearance on laparoscopy is characteristic of :

 A

Endometriosis

 B

Endometroid tumour

 C

Epithelial ovarian tumour

 D

Endometrial cancer

Q. 9

Pawaer burr, appearance on laparoscopy is characteristic of :

 A

Endometriosis

 B

Endometroid tumour

 C

Epithelial ovarian tumour

 D

Endometrial cancer

Ans. A

Explanation:

Endometriosis


Q. 10

Gold standard for diagnosis for PID is:

 A

Clinical triad of Pain, Fever and cervical tenderness

 B

Histologic confirmation of Endometritis

 C

Diagnostic Laproscopy

 D

USG

Q. 10

Gold standard for diagnosis for PID is:

 A

Clinical triad of Pain, Fever and cervical tenderness

 B

Histologic confirmation of Endometritis

 C

Diagnostic Laproscopy

 D

USG

Ans. C

Explanation:

Diagnostic Laproscopy REF: Novak’s Gynecology 13th edition Chapter 15

Traditionally, the diagnosis of PID has been based on a triad of symptoms and signs, including pelvic pain, cervical motion and adnexal tenderness, and the presence of fever.

More elaborate tests may be used in women with severe symptoms because an incorrect diagnosis may cause unnecessary morbidity. These tests include endometrial biopsy to confirm the presence of endometritis, ultrasound or radiologic tests to characterize a tuboovarian abscess (TOA), and laparoscopy to confirm salpingitis visually.

Laparoscopy currently provides the most accurate way to diagnose salpingitis. It should be used when the diagnosis is unclear, particularly in patients with severe peritonitis, to exclude a ruptured abscess or appendicitis.


Q. 11

Best investigation to diagnose ectopic pregnancy is :

 A

Urine pregnancy test

 B

Laparoscopy

 C

USG

 D

Hysteroscopy

Q. 11

Best investigation to diagnose ectopic pregnancy is :

 A

Urine pregnancy test

 B

Laparoscopy

 C

USG

 D

Hysteroscopy

Ans. B

Explanation:

Laparoscopy


Q. 12

During laparoscopy performed for other reasons, a surgeon is startled to see a uniformly black liver. Which of the following is the most likely diagnosis?

 A

Angiosarcoma

 B

Dubin-Johnson syndrome

 C

Hemochromatosis

 D

Malignant melanoma

Q. 12

During laparoscopy performed for other reasons, a surgeon is startled to see a uniformly black liver. Which of the following is the most likely diagnosis?

 A

Angiosarcoma

 B

Dubin-Johnson syndrome

 C

Hemochromatosis

 D

Malignant melanoma

Ans. B

Explanation:

Dubin-Johnson syndrome is a relatively mild, hereditary conjugated hyperbilirubinemia that has the distinctive feature of causing the liver to turn black.
The same black pigment can be seen in microscopic sections.
The origin of the black pigment is not fully understood, but the genetic defect responsible for Dubin-Johnson syndrome has recently been identified, and appears to involve a defect in the canalicular organic anion transporter.
Patients homozygous for Dubin-Johnson syndrome may also have significant amounts of unconjugated bilirubin in the serum, presumably due to deconjugation of conjugated bilirubin in the hepatobiliary system.
 
Angiosarcoma can produce a dark red liver due to increased blood and hemorrhage.

Hemochromatosis can produce a dark red to brown liver.
 

Malignant melanoma can produce black nodules in the liver, but would not be expected to produce a uniformly black liver.
 
Ref: Wyatt C., Kemp W.L., Moos P.J., Burns D.K., Brown T.G. (2008). Chapter 15. Pathology of the Liver, Gallbladder, and Pancreas. In C. Wyatt, W.L. Kemp, P.J. Moos, D.K. Burns, T.G. Brown (Eds), Pathology: The Big Picture.

Q. 13

A patient with abdominal injury presents to the emergency department with signs of peritonitis and shock. His airway and breathing were secured and IV fluids were started with 2 large bore cannulas. The next line of management should be:

 A

FAST

 B

Exploratory Laparotomy under general anesthesia

 C

Insertion of abdominal drain followed by laparotomy

 D

Laproscopy

Q. 13

A patient with abdominal injury presents to the emergency department with signs of peritonitis and shock. His airway and breathing were secured and IV fluids were started with 2 large bore cannulas. The next line of management should be:

 A

FAST

 B

Exploratory Laparotomy under general anesthesia

 C

Insertion of abdominal drain followed by laparotomy

 D

Laproscopy

Ans. B

Explanation:

Patient with abdominal stab injury showing signs of shock and peritonitis require urgent exploratory laparotomy.
 
Ref: Textbook of orthopedics and trauma By GS Kulkarni, Page1331.

 


Q. 14

Which among the following is the best diagnostic method for finding out ovulation?

 A

Ultrasound

 B

Laparoscopy

 C

Endometrial biopsy

 D

Chromotubation

Q. 14

Which among the following is the best diagnostic method for finding out ovulation?

 A

Ultrasound

 B

Laparoscopy

 C

Endometrial biopsy

 D

Chromotubation

Ans. C

Explanation:

The finding of secretory endometrium confirms ovulation.

The use of an endometrial biopsy (EMB) near the end of the luteal phase can provide reassurance of an adequate maturational effect on the endometrial lining.

Within 48 hours of ovulation, the cervical mucus changes under the influence of progesterone to become thick, tacky, and cellular, with loss of the crystalline fernlike pattern on drying.

 
Ref: Ghadir S., Ambartsumyan G., DeCherney A.H. (2013). Chapter 53. Infertility. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.

 


Q. 15

A young female is suggested for doing laparoscopy for finding out the tubal factors for her infertility. Hysterosalpingography was done 6 months before which was appeared normal. Regarding laparoscopy in this patient consider the following:

Assertion: Ideal time for doing laparoscopy in this patient is during proliferative phase

Reason: Recent corpus luteum can be visualized and endometrial biopsy can be taken within same sitting.

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Q. 15

A young female is suggested for doing laparoscopy for finding out the tubal factors for her infertility. Hysterosalpingography was done 6 months before which was appeared normal. Regarding laparoscopy in this patient consider the following:

Assertion: Ideal time for doing laparoscopy in this patient is during proliferative phase

Reason: Recent corpus luteum can be visualized and endometrial biopsy can be taken within same sitting.

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Ans. D

Explanation:

Laparoscopic and dye test are done doing secretory phase of the cycle for finding out the tubal factors of infertility.
 
Ref: Textbook of Gynaecology By D.C.Dutta, 4th Edition, Page 224, 226.

Q. 16

Renu, 28 year old nullipara, complained of dyspareunia and chronic pelvic pain with menstruation. She is married for five years. What is the investigation of choice in this patient?

 A

TVS

 B

Diagnostic laparoscopy

 C

HSG

 D

CT/ MR

Q. 16

Renu, 28 year old nullipara, complained of dyspareunia and chronic pelvic pain with menstruation. She is married for five years. What is the investigation of choice in this patient?

 A

TVS

 B

Diagnostic laparoscopy

 C

HSG

 D

CT/ MR

Ans. B

Explanation:

Chronic pelvic pain with menstruation, dyspareunia, and infertility are characteristics of endometriosis. Diagnostic laparoscopy is the primary method used for diagnosing endometriosis. Laparoscopic findings are variable and may include discrete endometriotic lesions, endometrioma, and adhesion formation.

Imaging of superficial endometriosis or endometriotic adhesions is inadequate in transvaginal sonography (TVS). CT suggested for the diagnosis and evaluation of the extent of bowel endometriosis. MRI has been increasingly used as a noninvasive method for endometriosis diagnosis. HSG has no role in investigation of endometriosis.
 
Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 10. Endometriosis. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.

Q. 17

Which of the following condition is using laparoscopy as the diagnostic tool of investigation?

 A

Endometriosis

 B

Ca uterus

 C

Ca cervix

 D

Ca rectum

Q. 17

Which of the following condition is using laparoscopy as the diagnostic tool of investigation?

 A

Endometriosis

 B

Ca uterus

 C

Ca cervix

 D

Ca rectum

Ans. A

Explanation:

Laparoscopy is the primary method used for diagnosing endometriosis.

Laparoscopic findings are variable and may include discrete endometriotic lesions, endometrioma, and adhesion formation.

The pelvic organs and pelvic peritoneum are typical locations for endometriosis. Lesions are variable colors, which may include red, white, and black.

Laparoscopic visualization of ovarian endometriomas has a sensitivity and specificity of 97 percent and 95 percent, respectively.

Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 10. Endometriosis. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.


Q. 18

Advantage of carbon dioxide in laproscopy are all except

 A

Non-irritant

 B

Non-inflammable

 C

Minimally absorbed

 D

No tissue reaction

Q. 18

Advantage of carbon dioxide in laproscopy are all except

 A

Non-irritant

 B

Non-inflammable

 C

Minimally absorbed

 D

No tissue reaction

Ans. C

Explanation:

Ans. is ‘c’ i.e., Minimally absorbed 


Q. 19

Diagnosis of traumatic rupture of diaphragm

 A

Laparoscopy

 B

Chest X ray

 C

Diagnostic peritoneal lavage

 D

a and b

Q. 19

Diagnosis of traumatic rupture of diaphragm

 A

Laparoscopy

 B

Chest X ray

 C

Diagnostic peritoneal lavage

 D

a and b

Ans. D

Explanation:

Ans is a & b ie. Laparoscopy & Chest x-ray 

Diaphragmatic injuries are relatively rare and result from either blunt trauma or penetrating trauma. Diagnosis and treatment are similar regardless of mechanism.

  • Penetrating injuries of the diaphragm are much more common than blunt injuries( 6:1)
  • Presently, 80-90% of blunt diaphragmatic ruptures result from motor vehicle crashes.
  • Majority (80-90%) of blunt diaphragmatic ruptures have occurred on the left side. The less common right-sided ruptures have more severe associated injuries and result in greater hemodynamic instability. They required greater force of impact, possibly because the liver provides protection and diffuses some of the energy on the right side.

Imaging Studies

  • Chest radiography

– Chest radiography is the single most important diagnostic study and may show elevation of the hemidiaphragm, a bowel pattern in the chest, or a nasogastric (NG) tube passing into the abdomen and then curling up into the chest. Additionally, a hemothorax, while not specific for diaphragmatic injuries, may be the only chest radiographic finding. The chest radiograph does not allow direct visualization of the diaphragmatic injury/defect but rather the associated herniation or other injuries. The initial chest radiograph is nondiagnostic in approximately 10-40% of patients. Repeated chest radiograph may be helpful.

  • Ultrasonography is used commonly in trauma and may visualize large disruptions or herniation; however, it may miss small tears from penetrating injuries.
  • New-generation helical CT scanning is helpful but not 100% sensitive because of its poor visualization of the diaphragm. A diagnosis can be made if herniation of abdominal contents is visualized
  • MRI may aid in the diagnosis because it can accurately visualize the diaphragm’s anatomy. MR1 may be used in a patient in stable condition who has an equivocal diagnosis and no need for laparotomy (some penetrating injuries) or for late diagnosis.
  • Laparoscopy is a useful but invasive technique for detecting occult diaphragmatic injuries in patients who have no other indications for formal laparotomy.

Management  (Ref: CSDT 13/e)

  • Once the diagnosis is made, a transabdominal surgical approach should be used in cases of acute rupture. Laparoscopic repair may be used in selective cases.

Chronic injuries with herniation is associated with adhesions of the herniated viscera to the thoracic structures. It is approached via thoracotomy, with the addition of a separate laparotomy when indicated .


Q. 20

The intra-abdominal pressure during laparoscopy should be set between –

 A

5-8 mm of Hg

 B

10-15 mm of Hg

 C

20-25 mm of Hg

 D

30-35 mm of Hg

Q. 20

The intra-abdominal pressure during laparoscopy should be set between –

 A

5-8 mm of Hg

 B

10-15 mm of Hg

 C

20-25 mm of Hg

 D

30-35 mm of Hg

Ans. B

Explanation:

Ans. is (b) i.e. 10-15mm of Hg 

The infra-abdominal pressure during laproscopic surgery is monitored by insufflator. The pressure is set between 12­15 mm of Hg. because at higher pressures there is risk of hypercarbia, acidosis and adverse hemodynamic and pulmonary effects.


Q. 21

Shoulder pain post laparoscopy is due to:

 A

Subphrenic abscess

 B

CO2 retention

 C

Positioning of the patient

 D

Compression of the lung

Q. 21

Shoulder pain post laparoscopy is due to:

 A

Subphrenic abscess

 B

CO2 retention

 C

Positioning of the patient

 D

Compression of the lung

Ans. B

Explanation:

Ans is b ie CO2 retention 

Shoulder pain is although a minor complication is exceedingly common and is due to the presence of a significant amount of residual carbon dioxide in the peritoneal cavity, trapped under the diaphragm and causing irritation of the diaphragm and thus referred pain to the shoulder through the phrenic nerve.


Q. 22

Laparoscopy is the diagnostic procedure of choice for:

March 2008

 A

Ca uterus

 B

Ca cervix

 C

Ca rectum

 D

Endometriosis

Q. 22

Laparoscopy is the diagnostic procedure of choice for:

March 2008

 A

Ca uterus

 B

Ca cervix

 C

Ca rectum

 D

Endometriosis

Ans. D

Explanation:

Ans. D: Endometriosis

Indications for gynaecological laparoscopy include the following:

  • Ovarian cysts and tumours.
  • Removal of fibroids (Myomectomy).or destroying them (Myolysis)
  • Infertility, lysis of adhesions.
  • Infertility, checking the condition and patency of the fallopian tubes.
  • Reproductive or tubal surgery
  • Endometriosis
  • Intraperitonal Haemorrhage
  • Polycystic Ovaries
  • Pelvic infection (Pelvic Inflammatory disease)
  • Egg collection for assisted reproduction
  • Sterilization (laparoscopic Sterilization)
  • Severe period pain
  • Diagnosis and treatment of some uterine anomalies
  • Pelvic floor and vaginal prolapse
  • Urinary incontinence

Q. 23

Anorchia best diagnosed by:

 A

USG

 B

SPECT

 C

CT

 D

Laparoscopy

Q. 23

Anorchia best diagnosed by:

 A

USG

 B

SPECT

 C

CT

 D

Laparoscopy

Ans. D

Explanation:

Ans. Laparoscopy


Q. 24

A young female presents witTVSh cyclical pain, dysmenorrheal and complain of infertility. Which of the following would be investigation of choice in her

 A

TVS

 B

Diagnostic laparoscopy

 C

Aspirate from pouch of Douglas

 D

Hormonal assessment

Q. 24

A young female presents witTVSh cyclical pain, dysmenorrheal and complain of infertility. Which of the following would be investigation of choice in her

 A

TVS

 B

Diagnostic laparoscopy

 C

Aspirate from pouch of Douglas

 D

Hormonal assessment

Ans. B

Explanation:

Ans. b. Diagnostic laparoscopy

  • Clinical features of infertility, dysparenuia and cyclic pain are highly suggestive of endometriosis. Laparoscopy is gold standard for diagnosis of endometriosis


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