Williams Gynecology, Second Edition (Schorge,Williams Gynecology), 2nd Edition

CHAPTER 44
Surgeries for Gynecologic Malignacies

44–1. What is the most common complication from a radical abdominal hysterectomy and lymph node dissection?

a. Lymphocele

b. Constipation

c. Urinary retention

d. Intraoperative hemorrhage

44–2. Which of the following is FALSE regarding type II radical hysterectomy?

a. Postoperative bladder dysfunction is uncommon.

b. The uterine vessels are ligated at their origin.

c. The most common indication is stage IA2 cervical cancer.

d. Less vaginal tissue is removed compared with a type III radical hysterectomy.

44–3. Which of the following is NOT an advantage of laparoscopic radical hysterectomy compared with an abdominal approach?

a. Less blood loss

b. Shorter procedure

c. Shorter hospital stay

d. Less postoperative pain

44–4. What steps can be taken during laparoscopy to minimize complications?

a. Placement of Foley catheter

b. Placement of nasogastric or orogastric tube

c. Positioning of the patient flat, not in Trendelenburg position

d. All of the above

44–5. What is the first step of a radical hysterectomy?

a. Opening the paravesical and pararectal spaces

b. Dividing the utero-ovarian ligaments if ovarian preservation is planned

c. Dissecting the ureters from the peritoneum to the level of the uterine arteries

d. Opening the rectovaginal septum and dissecting the rectum off the posterior vagina

44–6. What is the most common indication for performing a total pelvic exenteration?

a. Recurrent vulvar cancer

b. Stage IVA cervical cancer

c. Recurrent endometrial cancer

d. Centrally recurrent cervical cancer

44–7. What is the most common reason for aborting an exenteration?

a. Sidewall involvement

b. Peritoneal metastases

c. Parametrial involvement

d. Para-aortic lymph node metastases

44–8. What is the most common complication of an incontinent urinary conduit?

a. Infection

b. Anastomotic leak

c. Ureteral stricture

d. Electrolyte abnormalities

44–9. Which of the following statements regarding continent urinary conduits is FALSE?

a. Obese women are ideal candidates for this surgery.

b. Approximately 10 percent of patients will require surgical revision.

c. A Miami pouch includes portions of the ileum, ascending colon, and transverse colon.

d. Complications are common, and include pyelonephritis, urinary strictures, and difficulty with catheterization.

44–10. Which of the following flaps cannot be performed in a patient with a history of a Maylard incision?

a. Rhomboid flap

b. Gracilis myocutaneous flap

c. Rectus abdominis myocutaneous flap

d. Pudendal thigh fasciocutaneous flap

44–11. What is the structure identified by the arrow?

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a. Obturator vein

b. Obturator nerve

c. Obturator artery

d. Genitofemoral nerve

44–12. Which of the following are the correct boundaries for a paraaortic lymphadenectomy for endometrioid adeno-carcinoma of the uterus?

a. Bifurcation of aorta, renal vein

b. Mid-common iliac artery, renal vein

c. Bifurcation of aorta, inferior mesenteric artery

d. Mid-common iliac artery, inferior mesenteric artery

44–13. Which of the following is the LEAST common complication from para-aortic lymphadenectomy?

a. Ileus

b. Lymphocyst

c. Ureteral injury

d. Intraoperative hemorrhage

44–14. Which of the following is NOT an indication for omentectomy?

a. Clinical stage I ovarian cancer

b. Advanced ovarian cancer with omental involvement

c. Papillary serous endometrial cancer clinically confined to the uterus

d. Grade I endometrioid adenocarcinoma of the uterus clinically confined to the uterus

44–15. The organ to the right was removed with the omentum during cancer debulking surgery. Which of the following vaccines should be administered postoperatively?

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Photograph contributed by Dr. Jennifer Prats.

a. Pneumococcal

b. Meningococcal

c. Haemophilus influenzae

d. All of the above

44–16. Which of the following statements regarding diaphragm resection for ovarian cancer is FALSE?

a. Chest tubes are typically required.

b. The use of grafts for repair is uncommon.

c. Pleural effusion is a common complication.

d. In the setting of optimal debulking, it improves survival rates.

44–17. When is a loop colostomy NOT recommended?

a. Colonic perforation during chemotherapy for ovarian cancer

b. Large bowel obstruction in the setting of recurrent cervical cancer

c. Protection of a low rectal anastomosis after ovarian cancer debulking

d. Rectovaginal fistula after chemoradiation for cervical cancer, with no evidence of disease

44–18. Which of the following bowel segments is NOT directly supplied by a branch of the superior mesenteric artery?

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Reproduced, with permission, from McKinley M, O’Loughlin VD (eds): Vessels and circulation. In Human Anatomy. New York, McGraw-Hill, 2006, Figure 23-15.

a. Cecum

b. Ascending colon

c. Transverse colon

d. Descending colon

44–19. A 45-year-old woman has a history of stage IIB cervical cancer for which she completed chemoradiation therapy 12 months ago. She is admitted with a diagnosis of recurrent small bowel obstruction. Her computed tomography scan is shown below. Where is the most likely site of obstruction?

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a. Jejunum

b. Distal ileum

c. Gastric outlet

d. Proximal ileum

44–20. Which of the following is a risk factor for anastomotic leak of a rectosigmoid anastomosis?

a. Low anastomosis

b. Albumin level less than 3 g/dL

c. History of pelvic radiation

d. All of the above

44–21. A 55-year-old woman with a history of cervical cancer and chemoradiation treatment undergoes an intestinal bypass for a nonresectable small bowel obstruction. She initially does well but then develops recurrent nausea, vomiting, and diarrhea. She continues to pass flatus. Which of the following is NOT part of this condition?

a. Steatorrhea

b. Bacterial overgrowth

c. Small bowel obstruction

d. Vitamin B12 malabsorption

44–22. In which of the following patients is an appendectomy during gynecologic surgery NOT indicated?

a. A 25-year-old who undergoes a right salpingo-oophorectomy for a serous cystadenoma

b. A 25-year-old who undergoes a right salpingo-oophorectomy for a mucinous low malignant potential tumor

c. A 60-year-old with stage IIIC ovarian cancer undergoing cytoreductive surgery and with tumor involving the appendix

d. A 40-year-old woman who is found to have extensive mucin in her abdomen and bilateral mucinous tumors of the ovaries

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44–23. Which of the following statements regarding radical partial vulvectomy is FALSE?

a. Local recurrence rate is approximately 10 percent.

b. It is ideal for women with unilateral well-circumscribed lesions.

c. The distal urethra may be removed without an increase risk in urinary incontinence.

d. Survival is worse compared with patients undergoing complete radical vulvectomy, even if negative margins are achieved.

44–24. During inguinofemoral lymphadenectomy, which of the following may lower postoperative rates of chronic lymphedema?

a. Sparing the saphenous vein

b. Sparing the cribriform fascia

c. Sartorius muscle transposition

d. Jackson-Pratt drain placed prior to incision closure

44–25. During inguinofemoral lymphadenectomy, if the lymph nodes in the groin are grossly positive below the cribriform fascia, what is the most appropriate management?

a. Do not resect them, and give postoperative chemoradiation

b. Incise the cribriform fascia, and remove the lymph nodes

c. Incise the cribriform fascia, remove the involved lymph nodes, repair the defect in the cribriform fascia, and consider a transposition of the sartorius muscle

d. Incise the cribriform fascia, remove the involved lymph nodes, repair the defect in the cribriform fascia, transpose the sartorius muscle, and give postoperative chemoradiation

Chapter 44 ANSWER KEY

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