Laproscopy

Laproscopy

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

Gas commonly used in laparoscopy is :

 A

Air

 B

Pure 02

 C

N20

 D

CO2

Q. 3

Gas commonly used in laparoscopy is :

 A

Air

 B

Pure 02

 C

N20

 D

CO2

Ans. D

Explanation:

CO2


Q. 4

Best tubal function test is-

 A

Laproscopy

 B

Hysterosalpingography

 C

Rubin’s test

 D

X – ray pelvis

Q. 4

Best tubal function test is-

 A

Laproscopy

 B

Hysterosalpingography

 C

Rubin’s test

 D

X – ray pelvis

Ans. A

Explanation:

Laproscopy


Q. 5

The intra – abdominal pressure 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. 5

The intra – abdominal pressure 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:

10 – 15 mm of Hg


Q. 6

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. 6

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. 7

Salpingitis / Endosalpingitis is best confirmed by:

 A

Hysteroscopy + Laparoscopy

 B

X – ray

 C

Hysterosalpingography

 D

Sonosalpingography

Q. 7

Salpingitis / Endosalpingitis is best confirmed by:

 A

Hysteroscopy + Laparoscopy

 B

X – ray

 C

Hysterosalpingography

 D

Sonosalpingography

Ans. A

Explanation:

Hysteroscopy + Laparoscopy


Q. 8

Best test for diagnosis of tubal patency Is :

 A

Laparoscopy

 B

Hysterosalpingography

 C

Endometrial biopsy

 D

Mantoux test

Q. 8

Best test for diagnosis of tubal patency Is :

 A

Laparoscopy

 B

Hysterosalpingography

 C

Endometrial biopsy

 D

Mantoux test

Ans. A

Explanation:

Laparoscopy


Q. 9

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. 9

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. 10

Gas most commonly used in laparoscopy is

 A

CO2

 B

SO2

 C

N2

 D

O2

Q. 10

Gas most commonly used in laparoscopy is

 A

CO2

 B

SO2

 C

N2

 D

O2

Ans. A

Explanation:

Ans. is a i.e. CO2

CO2 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 CO2 for creating pneumoperitoneum 200 — 2000 ml/min and pressure between 15 — 25 mm of Hg.

Q. 11

Insufflation pressure during laparoscopy is?

 A 5-10 mm Hg
 B

11-15 mm Hg

 C 15-20 mm Hg
 D

20-25 mm Hg

Q. 11

Insufflation pressure during laparoscopy is?

 A 5-10 mm Hg
 B

11-15 mm Hg

 C 15-20 mm Hg
 D

20-25 mm Hg

Ans. B

Explanation:

11-15 mm Hg REF: Maingot’s 10th ed p. 243

The intrabdominal pressure during laparoscopy is monitored by insufflator and it is set between 12-15 mm Hg.


Q. 12

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. 12

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. 13

Shoulder pain post laparoscopy is due to:

 A

Subphrenic abscess

 B

CO2 retention

 C

Positioning of the patient

 D

Compression of the lung

Q. 13

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:

CO2 retention [Ref: http://humupd.oxfordjournals.org/cgi/reprint/3/5/505 J

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. 14

Best investigation to diagnose ectopic pregnancy is :

 A

Urine pregnancy test

 B

Laparoscopy

 C

USG

 D

Hysteroscopy

Q. 14

Best investigation to diagnose ectopic pregnancy is :

 A

Urine pregnancy test

 B

Laparoscopy

 C

USG

 D

Hysteroscopy

Ans. B

Explanation:

Laparoscopy


Q. 15

A lady presented in the emergency department with a stab injury to the left side of the abdomen. She was hemodynamically stable and a contrast enhanced CT scan revealed a laceration in spleen. Laparoscopy was planned however the patient’s p02 suddenly dropped as soon as the pneumoperitoneum was created. What is the most likely cause?

 A

Gaseous Embolism through splenic vessels

 B

Injury to the left lobe of the diaphragm

 C

Inferior vena cava compression

 D

Injury to colon

Q. 15

A lady presented in the emergency department with a stab injury to the left side of the abdomen. She was hemodynamically stable and a contrast enhanced CT scan revealed a laceration in spleen. Laparoscopy was planned however the patient’s p02 suddenly dropped as soon as the pneumoperitoneum was created. What is the most likely cause?

 A

Gaseous Embolism through splenic vessels

 B

Injury to the left lobe of the diaphragm

 C

Inferior vena cava compression

 D

Injury to colon

Ans. A

Explanation:

Pneumoperitoneum can lead to various complications, Gas embolism one of them which is highly dangerous and potentially lethal one.
The clinical presentaion of gas embolism during laproscopy, is sudden cardiovascular collapse and hypoxia.
As this patient already has the splenic artery laceration it is clear possiblity the gas that used in pneumoperitonium can gush into the blood vessel causing gas embolism.
 
Ref: Laproscopic Surgery By Jorge Cueto-Garcia, Moises Jacobs, Michel Gagner, Page 25

 


Q. 16

A 45 year old female presents with symptoms of acute Cholecystitis. On USG there is a solitary gallstone of size 1.5cm. Symptoms are controlled with medical management. Which of the following is the next most appropriate step in the management of this patient?

 A

Regular follow up

 B

IV Antibiotics

 C

Laparoscopy cholecystectomy immediately

 D

Open cholecystectomy immediately

Q. 16

A 45 year old female presents with symptoms of acute Cholecystitis. On USG there is a solitary gallstone of size 1.5cm. Symptoms are controlled with medical management. Which of the following is the next most appropriate step in the management of this patient?

 A

Regular follow up

 B

IV Antibiotics

 C

Laparoscopy cholecystectomy immediately

 D

Open cholecystectomy immediately

Ans. C

Explanation:

Cholecystectomy is the definite line of treatment for patients with acute cholecystitis.

Early cholecystectomy performed within 2-3 days of presentation is preferred over interval or delayed cholecystectomy.

 
Ref: Bailey and Love’s Short Practice of Surgery, 25th Edition, Page 1121; Sabiston Textbook of Surgery, 18th Edition, Pages 1558-59; Schwartz Principles of Surgery, 8th Edition, Page 1199; Harrison’s Internal Medicine, 17th Edition, Page 1195; Mastery of Surgery By Josef E. Fischer, Volume 1, Page 1117

Q. 17

Pressure needed for abdominal insufflation in laparoscopy is:

 A

10 mm Hg

 B

20 mm Hg

 C

30 mm Hg

 D

40 mm Hg

Q. 17

Pressure needed for abdominal insufflation in laparoscopy is:

 A

10 mm Hg

 B

20 mm Hg

 C

30 mm Hg

 D

40 mm Hg

Ans. A

Explanation:

Laparoscopic surgery can be performed under local anesthesia, but general anesthesia is preferable. Under local anesthesia, N2O is used as the insufflating agent, and insufflation is stopped after 2 L of gas is insufflated or when a pressure of 10 mmHg is reached.

Ref: Schwartz’s principle of surgery 9th edition, chapter 14.

 


Q. 18

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. 18

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. 19

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. 19

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. 20

Gas most suited for laproscopy is –

 A

Air

 B

Nitrogen

 C

CO

 D

Carbon dioxide

Q. 20

Gas most suited for laproscopy is –

 A

Air

 B

Nitrogen

 C

CO

 D

Carbon dioxide

Ans. D

Explanation:

Ans. is `d’ i.e., Carbon dioxide 


Q. 21

Advantage of carbon dioxide in laproscopy are all except

 A

Non-irritant

 B

Non-inflammable

 C

Minimally absorbed

 D

No tissue reaction

Q. 21

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. 22

A lady presented in the emergency department with a stab injury to the left side of the abdomen. She was hemodynamically stable and a contrast enhanced CT scan revealed a laceration in spleen. Laparoscopy was planned. The patient’s p02 suddenly dropped as soon as the pneumoperitoneum was created. What is the most likely cause:

 A

Inferior venacava compression

 B

Injury to the left lobe of the diaphragm

 C

Injury to the colon

 D

Gaseous embolism through splenic vessels

Q. 22

A lady presented in the emergency department with a stab injury to the left side of the abdomen. She was hemodynamically stable and a contrast enhanced CT scan revealed a laceration in spleen. Laparoscopy was planned. The patient’s p02 suddenly dropped as soon as the pneumoperitoneum was created. What is the most likely cause:

 A

Inferior venacava compression

 B

Injury to the left lobe of the diaphragm

 C

Injury to the colon

 D

Gaseous embolism through splenic vessels

Ans. D

Explanation:

Ans is ‘d’ i.e. Gaseous embolism through splenic vessels 

The sudden drop in p02 during insufflation of gas for creating pneumoperitoneum suggests gas embolism from entry of the gas into the circulation through exposed vessels in the splenic tear. Gas embolism may also occur due to inadvertent insertion of the trocar into a vessel or an abdominal organ.


Q. 23

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. 23

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. 24

Shoulder pain post laparoscopy is due to:

 A

Subphrenic abscess

 B

CO2 retention

 C

Positioning of the patient

 D

Compression of the lung

Q. 24

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. 25

Gold standard investigation in diagnosing PID is:

March 2005

 A

Anti chlamydial Ab

 B

Laparoscopy

 C

USG

 D

Blood leucocyte count

Q. 25

Gold standard investigation in diagnosing PID is:

March 2005

 A

Anti chlamydial Ab

 B

Laparoscopy

 C

USG

 D

Blood leucocyte count

Ans. B

Explanation:

Ans. B: Laparoscopy

Investigations in a case of PID:

  • Physical examination
  • Pregnancy test (to rule out anectopic pregnancy)
  • White blood cell test (to rule out appendicitis)
  • Genital culture (to look for gonorrhea and chlamydia).
  • An endometrial biopsy (tissue sample removed from the endometrium)
  • Sonogram (if abscesses are suspected)
  • Culdocentesis (fluid sample taken from uterine sac)
  • Laparoscopy are done.

Laparoscopy is considered the “gold standard” for diagnosis of PID, because it allows visualization of the pelvic organs. The procedure involves inserting a tiny, flexible lighted tube through a small incision just below the navel.

This procedure is recommended when results of the preliminary tests (physical exam, blood tests and cultures) are unclear.


Q. 26

Gas commonly used in laparoscopy is:  

March 2004

 A

CO2

 B

SO2

 C

N2

 D

O2

Q. 26

Gas commonly used in laparoscopy is:  

March 2004

 A

CO2

 B

SO2

 C

N2

 D

O2

Ans. A

Explanation:

Ans. A i.e. CO2


Q. 27

Laparoscopy is the diagnostic procedure of choice for:

March 2008

 A

Ca uterus

 B

Ca cervix

 C

Ca rectum

 D

Endometriosis

Q. 27

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. 28

Gold standard IOC for female infertility is:

September 2011

 A

Laparoscopy

 B

Transvaginal USG

 C

Hysteroscopy

 D

Laparoscopy and hysteroscopy

Q. 28

Gold standard IOC for female infertility is:

September 2011

 A

Laparoscopy

 B

Transvaginal USG

 C

Hysteroscopy

 D

Laparoscopy and hysteroscopy

Ans. D

Explanation:

Ans. D: Laparoscopy and hysteroscopy

Laparoscopy is combined with hysteroscopy as a comprehensive one-stop infertility work-up, to detect cause of infertility and treat the cause in one go


Q. 29

Anorchia best diagnosed by:

 A

USG

 B

SPECT

 C

CT

 D

Laparoscopy

Q. 29

Anorchia best diagnosed by:

 A

USG

 B

SPECT

 C

CT

 D

Laparoscopy

Ans. D

Explanation:

Ans. Laparoscopy


Q. 30

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. 30

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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