MRCOG Part 2 – Postoperative Care – SBAs

A 48-year-old woman underwent a total abdominal hysterectomy and bilateral salpingo-oophrectomy for a 30-week fibroid uterus that was causing significant pressure symptoms and hydronephrosis on the left side. The surgery was further complicated by the presence of adhesions and endometriosis. One day post operatively, she is complaining of a distended abdomen and flank pain. A CT urogram is organised which shows that the left ureter has been transected in its upper third. What is the most appropriate technique for repair?

You are asked to complete a venous thromboembolism risk assessment pre-operatively for a 65 year old woman about to have an abdominal hysterectomy for endometrial cancer. She is known to have a history of idiopathic thrombocytopaenia.  At her pre-operative assessment, her platelet count is found to be 85.  What is the most appropriate management?

You are asked to complete a venous thromboembolism risk assessment pre-operatively for a 55 year old woman about to have an vaginal hysterectomy and pelvic floor repair for pelvic organ prolapse. Her BMI is 28 and she is currently taking HRT. What is the most appropriate management?

You are in pre-operative assessment clinic and you review a patient booked for a vaginal hysterectomy and pelvic floor repair. She asks about whether the hospital offers enhanced recovery as she has read about it on the Internet.  Which of the following statements about enhanced recovery is incorrect?

You are asked to review a patient on the ward who had an open myomectomy yesterday with an estimated blood loss of 1000ml. She has a wound drain inserted and it has drained approximately 300ml of serosanguinous fluid.  Her observations are otherwise normal and her post-operative haemoglobin is 104.  What is the most appropriate management?

You are asked to review a 70 year old patient on the Gynaecology Ward who had a vaginal hysterectomy yesterday with an estimated blood loss of 250ml. Her pre-operative haemoglobin was 109. On examination, the woman is complaining of severe abdominal pain but there is no evidence of peritonism. Her pulse is 120, her blood pressure is 80/50.  She is afebrile and her respiratory rate and oxygen saturations are normal.  What is the most appropriate investigation?

You are asked to review a 70 year old patient on the Gynaecology Ward who had a vaginal hysterectomy two days ago with an estimated blood loss of 250ml. Her pre-operative haemoglobin was 109. The woman is complaining of feeling generally unwell and short of breath.  There is no abdominal tenderness but there is reduced air entry at the right lung base. Her pulse is 120, her blood pressure is 80/50, her temperature is 39.5°C, her respiratory rate is 25 and her oxygen saturations are 94% on 10L of oxygen.  What is the next most appropriate investigation?

You are asked to review a 45 year old woman on the Gynaecology Ward who had an abdominal hysterectomy for large uterine fibroids yesterday. The nurses are concerned that there has been reduced urine output post-operatively despite 3 litres of intravenous fluids over the last 12 hours.  On examination, the patient is complaining of severe left sided back pain and there is minimal blood stained urine in the urinary catheter.  Observations are all within normal limits.  What is the next most appropriate management?

You are asked to review a 45 year old woman on the Gynaecology Ward who had an abdominal hysterectomy for large uterine fibroids yesterday. The nurses are concerned that there has been reduced urine output post-operatively.  On examination, the patient is complaining of severe left sided back pain and there is minimal blood stained urine in the urinary catheter.  Observations are all within normal limits.  What is the next most appropriate investigation?

A 26 year old woman is readmitted to hospital five days after laparoscopic adhesiolysis and salpingectomy for hydrosalpinx. She complains of worsening abdominal pain and vomiting and is pyrexial.  What is the most important investigation?

A 70 year old woman attends the pre-operative assessment clinic for a planned hysterectomy for a diagnosis of endometrial cancer.She is taking warfarin for atrial fibrillation following a stroke 2 months ago.  What is the most appropriate pre-operative management for her anticoagulation?

You are asked to complete a venous thromboembolism risk assessment pre-operatively for a woman about to have an abdominal hysterectomy. Which of the following is not a risk factor for venous thromboembolism?