SAGES Web Quiz #25 -- Problems in the Pelvis

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1. A 52 year old 350 pound woman has been evaluated and felt to be a good candidate for a laparoscopic gastric bypass. At the time of insertion of the laparoscope, this is seen in the right pelvis.

This is the
a) cecum
b) appendix
c) ovary
d) ileum
e) fallopian tube
f) Don't Know

2. The problem is:
a) mucocoele of the appendix
b) ovarian carcinoma
c) tubal pregnancy
d) acute appendicitis
e) cecal diverticulum
f) Don't Know

3. Best course of action at this point
a) abandon the bypass and do a TAHBSO via open incision
b) complete the bypass and do a right oophorectomy
c) complete the bypass and do an appendectomy
d) abandon the bypass and do a right hemicolectomy
e) complete the bypass and biopsy the lesion (no frozen)
f) Don't Know

4. A thirty-one year old woman presents to the emergency room with a six hour history of crampy lower abdominal pain. Minimal associated nausea. No fever. No dysuria. Last menstrual period eight weeks ago, but she has a history of irregularity. Labs show Hct of 34, WBC of 9000, normal electrolytes and urinalysis. Pregnancy test reported negative.

You can clearly see, in this photo:

a) pelvic inflammatory disease
b) diverticulitis
c) uterine carcinoma
d) endometriosis
e) hemopelvis
f) Don't Know

5. This slide clearly shows a major disruption of the right tube, consistent with a ruptured tubal pregnancy. The pregnancy test is rechecked and found to be falsely negative. The woman clearly has a ruptured tubal pregnancy.

An appropriate course of action would be:
a) close
b) do a TAHBSO through an open incision
c) do a right oophorectomy
d) do a D&C followed by vaginal hysterectomy
e) Don't Know

6. An 82 year old man is seen in the emergency room with a three day history of lower abdominal pain. When questioned more carefully, he says the pain came on and has been constantly present, though worsening, in an area just below McBurney's point in the right lower quadrant on exam. He is markedly tender there, but has no rebound and not very tender elsewhere. He has a 38.2 fever, and WBC is at 11,000.

You should:
a) admit to the hospital and observe (keep NPO)
b) administer laxatives and observe
c) perform appendectomy through Rocky-Davis incision
d) perform diagnostic laparoscopy

7. This is:

a) foreign body protruding from the wall of the ileum
b) Crohn's disease
c) ruptured abdominal aortic aneurysm
d) acute appendicitis
e) Don't Know

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