Section 5 Aspects of Gynecologic Surgery > Chapter 38.

Anatomy
1. The anterior abdominal wall is innervated by?
a. intercostal nerves (T7-11)
b. subcostal nerve (T12)
c. iliohypogastric
d. ilioinguinal nerves (L1)
e. A,B,C and D are true
Jawaban E, The anterior abdominal wall is innervated by the abdominal extensions of
the intercostal nerves (T7-11), the subcostal nerve (T12), and the iliohypogastric and
the ilioinguinal nerves (L1). The T10 dermatome approximates the level of the
umbilicus.
2. Separate innervation of the levator ani muscle and the striated urethral and anal
sphincters in women can lead?
a. Develop pelvic organ prolapse and others develop urinary or fecal incontinence
b. Loose arrangements of collagen, elastin, and adipose tissue
c. Increase urogenital hiatus size
d. vaginal axis becomes more vertical
e. stretching of the connective tissue pelvic ligaments
Jawaban A, Separate innervation of the levator ani muscle and the striated urethral
and anal sphincters may explain why some women develop pelvic organ prolapse and
others develop urinary or fecal incontinence (Heit, 1996).
3. The portion of the corpus that extends above the level of entry of the fallopian tubes
into the endometrial cavity is known as?
a. Cervix
b. Fundus
c. Anus
d. Pelvic
e. Portio
Jawaban B. The uterus is a fibromuscular hollow organ situated between the bladder
and the rectum. The uterus is divided structurally and functionally into two portions:
an upper muscular body, the corpus, and a lower fibrous cervix (Fig. 38-10). The
portion of the corpus that extends above the level of entry of the fallopian tubes into
the endometrial cavity is known as the fundus.
4. Vaskularisasi dari korpus uteri berasal dari?
a. Arteri uterina dan arteri uterina
b. Arteri vaginalis

c. Arteri hemoroidalis
d. Arteri karotis
e. Vena uterina
Jawaban A. The blood supply to the uterine corpus arises from the ascending branch
of the uterine artery and from the medial or uterine branch of the ovarian artery (Fig.
38-15; see also Fig. 38-13). The uterine artery may originate directly from the internal
iliac artery as an independent branch, or it may have a common origin with the
internal pudendal or vaginal artery.
5. Yang termasuk adneksa adalah?
a. Uterus
b. Vagina
c. Cervix
d. Tuba falopii dan ovarium
e. Rektum
Jawaban D. The ovaries and fallopian tubes constitute the uterine adnexa. The size
and hormonal activity of the ovaries depend on age, time of the menstrual cycle, and
exogenous hormonal suppression. During reproductive years, the ovaries measure 2.5
to 5 cm in length, 1.5 to 3 cm in thickness, and 0.7 to 1.5 cm in width.
6. Pada laki-laki, klitoris homolog dengan?
a. Skrotum
b. Testis
c. Penis
d. Anus
e. Perineum
Jawaban C. This is the female erectile structure homologous to the penis. It consists of
a glans, a body, and two crura. The glans contains many nerve endings and is covered
by a mucous membrane. The body measures approximately 2 cm and is connected to
the pubic ramus by the crura.

Section 5 Aspects of Gynecologic Surgery > Chapter 39. Perioperative Considerations

1. Cardiovascular disease is the leading cause of death. Which is a risk factor for
Cardiac Complications?
a. Valvular Heart Disease
b. Heart Failure
c. Arrhythmias
d. Hypertension
e. A,B,C and D are true
Jawaban E. Cardiovascular disease is the leading cause of death in most industrialized
countries and contributes significantly to perioperative mortality in patients
undergoing cardiac and noncardiac surgery.
2. what is the purpose of Postoperative Considerations?
a. Support of each organ system while normal function is gradually reestablished
b. Prevent moderate to severe pain
c. controll analgesia
d. A and B are true
e. Not all of the above
Jawaban A. Postoperative orders provide instruction regarding support of each organ
system while normal function is gradually reestablished. Although orders are
customized for each woman, goals are common among all surgical patients
resuscitation, pain control, and resumption of daily activities.
3. After intra-abdominal surgery, activity first returns in the stomach and is noted
typically within?
a. 1 hour
b. 24 hours
c. 1 week
d. 0 hour
e. 2 days
Jawaban B. Normal gastrointestinal function requires synchronized motility
throughout the system, mucosal transport of nutrients, and evacuatory reflexes
(Nunley, 2004). However, following intra-abdominal surgery, dysfunction of enteric
neural activity typically disrupts normal propulsion. Activity first returns in the
stomach and is noted typically within 24 hours. The small intestine also exhibits
contractile activity within 24 hours of surgery, but normal function may be delayed for
3 to 4 days (Condon, 1986; Dauchel, 1976). Rhythmic colonic motility resumes last,
at approximately 4 days following intra-abdominal surgery (Huge, 2000). Passage of

flatus characteristically marks this return of function, and stool passage typically
follows in 1 to 2 days.
4. Untuk menghindari ileus pasien pasca operasi abdomen, kapan sebaiknya pasien
makan?
a. Sesegera mungkin
b. Sehari setelah operasi
c. Setelah tidak terasa sakit
d. Setelah pasien meminta makan
e. Setelah pasien pulang
Jawaban A. Postoperative feeding has been found to be most effective when started
immediately postoperatively. Early feeding has been shown to improve wound
healing, stimulate gut motility, decrease intestinal stasis, increase splanchnic blood
flow, and stimulate reflexes that elicit secretion of gastrointestinal hormones that can
shorten postoperative ileus (Anderson, 2003; Braga, 2002; Correia, 2004; Lewis,
2001). The decision to initiation "early feeding" with liquids or with solid food has
been studied prospectively (Jeffery, 1996). In patients who were given solid food as
the first postoperative meal, the number of calories and protein consumed on the first
postoperative day were higher. In addition, the number of patients requiring diet
changes to NPO was not statistically different (7.5 percent in the regular diet group
and 8.1 percent in the clear diet group). The improved tolerance and better palatability
of solids make this a reasonable option.
5. Tujuan utama pemberian nutrisi pasca operasi adalah?
a. Meningkatkan fungsi imunitas
b. Meningkatkan proses penyembuhan luka
c. Meminimalisir gangguan metabolik
d. BSSD
e. A,B dan C benar
Jawaban E. The primary goals of postoperative nutrition are to improve immune
function and promote wound healing while minimizing metabolic disturbances.
Despite the additional stress in the immediate postoperative period, underfeeding is
accepted for a brief period of time (Seidner, 2006). Table 39-16 offers a summary of
the basic metabolic needs in the immediate postoperative period. However, extended
protein-calorie restriction in a surgical patient can lead to impaired wound healing,
diminished cardiac and pulmonary function, bacterial overgrowth within the
gastrointestinal tract, and other complications that increase hospital stays and patient

morbidity (Elwyn, 1975; Kinney, 1986; Seidner, 2006). If substantial oral caloric
intake is delayed for 7 to 10 days, nutritional support is warranted.
6. Sebaiknya, perban luka operasi diganti berapa lama?
a. Setelah luka sembuh
b. Setiap hari
c. Saat pasien akan pulang
d. Saat kontrol kepoli
e. 7 hari setelah operasi
Jawaban B. Ideally, wound dressings are removed daily and replaced with properly
hydrated materials. In very necrotic wounds, allowing gauze to dry and pulling tissue
adherent to the gauze with each change is acceptable. More frequent changes should
be avoided because they lead to aggressive dbridement of vital tissues and slow
wound healing. Table 39-17 lists products used in modern wound care.

Section 5 Aspects of Gynecologic Surgery > Chapter 40. Intraoperative

Considerations

1. The cervix, vagina, and uterus are richly supplied by nerves of the uterovaginal
plexus, also known as ?
a. Frankenhuser plexus
b. Kiesselbach plexus
c. Brachialis plexus
d. Lateral plexus
e. Longitudinal plexus
Jawaban A. The cervix, vagina, and uterus are richly supplied by nerves of the
uterovaginal plexus. (see Fig. 38-23B). Also known as Frankenhuser plexus, this
plexus lies within the connective tissue lateral to the uterosacral ligaments. For
this reason, paracervical injections are most effective if placed immediately lateral
to the insertion of the uterosacral ligaments into the uterus
2. The most commonly anesthesia methos during first-trimester pregnancy evacuation
is?
a.
b.
c.
d.
e.

Paracervical block
Thoracal block
Total block
Local anesthesia
TIVA

Jawabanm A. Paracervical block is used most commonly during first-trimester

pregnancy evacuation but also has been used prior to cervical ablative or excisional
procedures, transvaginal sonographically guided oocyte retrieval, and in-office
hysteroscopy.
3. The femoral nerve perforates the psoas muscle early in its course to provide motor

function?
a. Iliac muscles
b. Sartorius muscles
c. Quadriceps muscles
d. Not all of the above

e. A,B and C are true

Jawaban E. The femoral nerve perforates the psoas muscle early in its course to
provide motor function to the iliac, sartorius, and quadriceps muscles and sensory
function to the anteromedial thigh and medial leg (Fig. 40-4). Before exiting the
pelvis, this nerve passes medially beneath the inguinal ligament to enter the femoral
triangle lateral to the femoral artery and vein. This nerve can be compressed anywhere
along its course but is particularly susceptible within the body of the psoas muscle and
at the inguinal ligament.
4. Kerusakan saraf sering terjadi selama pembedahan abdomen secara tranversal,

terutama mengenai saraf ?

a. Ilioinguinal
b. Iliohypogastric
c. Cabang saraf genitofemoralis
d. BSSD
e. A,B dan C benar
Jawaban E. Nerve injury during transverse abdominal entry is common. It typically
involves the ilioinguinal and iliohypogastric nerves or less frequently, branches of the
genitofemoral nerve. The ilioinguinal and iliohypogastric nerves emerge through the
internal oblique muscle approximately 2 to 3 cm inferomedial to the anterosuperior
iliac spine.
5. Berapa persen kehilangan darah yang tidak menimbulkan gangguan pada tekanan

darah?
a. <15 %
b. 15-30%
c. 30-40%

d. 40-50%
e. >50%
Jawaban A. Total blood volume for an adult approximates 70 mL/kg, and thus a 50-kg
woman's calculated blood volume is 3,500 mL. Of this volume, 15 percent can be lost
by most patients with no changes in arterial pressure or heart rate. A 15-percent blood
loss can be roughly calculated by multiplication of a patient's weight in kilograms by
10. Thus, for a 50-kg woman, a 15-percent loss approximates 500 mL.
6. Berapa banyak kenaikan Hb dan Ht saat diberikan tranvusi 180-200 cc PRC?

a. 10g/dl Hb dan 3% Ht
b. 10g/L Hb dan 3% Ht
c. 1 g/L Hb dan 2% Ht
d. 10 g/dl Hb dan 2% Ht
e. A,B,C dan D benar
Jawaban B. Terdapat pada Section 5 Aspects of Gynecologic Surgery > Chapter 40.
Intraoperative Considerations > Table 40-7 Characteristics of Blood Components

f.

Section 6 Atlas of Gynecologic Surgery > Chapter 41. Surgeries for Benign
Gynecologic Conditions
1. Initial step of abdominal surgery is?
a. Skin and Subcutaneous Layer
b. Anesthesia and Patient Positioning
c. Fascia
d. Peritoneum
e. Operative Field
Jawaban B. Terdapat dalam Surgical Steps, pada Section 6 Atlas of Gynecologic
Surgery > Chapter 41. Surgeries for Benign Gynecologic Conditions
2. Type of operation transverse abdominal incisions used for gynecologic procedures is?
a. Pfannenstiel incisions.
b. Midline incisions
c. Paramedian incisions
d. Gynecologic procedure
e. Patient Positioning
Jawaban A. The Pfannenstiel, Cherney, and Maylard incisions are transverse
abdominal incisions used for gynecologic procedures. Of these, the Pfannenstiel
incision is the most commonly used incision for laparotomy in the United States. As
discussed in Chapter 38, because the incision follows Langer lines of skin tension,
excellent cosmetic results can be achieved. Additionally, decreased rates of
postoperative pain, fascial wound dehiscence, and incisional hernia are noted.
3. The indications for hymenectomy may include?
a. Amenorrhea
b. Pain
c. Abdominal mass
d. Urinary and defecation dysfunction

e. A,B,C and D are true

Jawaban E. Imperforate hymen results from failure of the hymen to canalize during
the perinatal period. Most imperforate hymens are diagnosed after they have become
symptomatic, usually during adolescence. Accordingly, the indications for
hymenectomy may include complaints of amenorrhea, pain, abdominal mass, and
urinary and defecation dysfunction. The diagnostic evaluation of these symptoms
prior to surgery is discussed in Chapter 18, Description and Patient Presentation.
4. Setelah berapa panjangkah labia minora dilakukan labia minora reduced ?
a. 0,5 cm
b. 1 cm
c. 5 cm
d. 14,5 cm
e. 20 cm
5. Septum tranversal pada vagina diakibatkan oleh?
a. Penyakit sistemik
b. Penyakit degeneratif
c. Kegagalan regresi vaginal plate saat masa embrionik
d. Kegagalan kanalisasi hyemen saat masa embrionik
e. Kegagalan penutupan neural tube
Jawaban C. Failure of the vaginal plate to regress completely during embryologic
development can result in formation of transverse septums at various levels of the
vagina (see Fig. 18-5). Some septums may have small perforations that allow
prolonged menstrual blood egress, whereas others may have no openings and lead to
accumulations and distention in the upper reproductive tract. Some may be managed

conservatively with observation, whereas those associated with pain, infertility, or

hematometra require excision (see Chap. 18, Diagnosis and Treatment).
6. Tahapan setelah dilakukan tindakan anastesi dan posisi pada operasi Laparoscopic
Salpingo-Oophorectomy adalah?
a. Pelvic Inspection and Washings
b. Ligation of the ovarian vessels
c. Opening of the broad ligament
d. Utero-ovarian Ligament Coagulation
e. Trocar and Laparoscope Insertion
Jawaban E. Terdapat dalam pembahasan Section 6 Atlas of Gynecologic Surgery >
Chapter 41. Surgeries for Benign Gynecologic Conditions > Laparoscopic SalpingoOophorectomy > Surgical Steps.

Section 6 Atlas of Gynecologic Surgery > Chapter 42. Surgeries for Female Pelvic
Reconstruction
1. The most commonly performed operation worldwide for stress urinary incontinence
is?
a.
b.
c.
d.
e.

Tension-free vaginal tape

Burch Colposuspension
Urethroscopy
Uretroplasty
Vaginoplasty

Jawaban A. The tension-free vaginal tape procedure (TVT) is the most commonly
performed operation worldwide for stress urinary incontinence. The procedure is one
of the most widely studied anti-incontinence operations, and 5-year cure rates
approximate 85 percent. The TVT procedure also has become the prototype for a host
of other anti-incontinence operations (SPARC Sling System, American Medical
Systems, TOT [transobturator tape], TVT-O [tension-free vaginal tape]). These are all
based on the concept that midurethral support is vital to continence.
2. what is their choice for patients with prior failed anti-incontinence operations ?
a. Antibiotic injection
b. Pubovaginal Sling
c. Nerve cauterisation
d. Vaginoplasty
e. Uretroplasty
Jawaban B. Pubovaginal sling is a standard procedure for stress urinary
incontinence (SUI). Traditionally, it has been used for SUI stemming from
intrinsic sphincteric deficiency, which is characterized by a nonmobile urethra, a
low maximum urethral closing pressure, or low Valsalva leak point pressure (see
Chap. 23, Pubovaginal Slings). In addition, this procedure also may be indicated
for patients with prior failed anti-incontinence operations. It is generally not
employed in a woman having her first anti-incontinence operation.
3. The bulking agent is injected under constant pressure, and the submucosal lining
begins to rise to bulk the proximal and midurethra until coaptation of the mucosa has
developed. This is the procedure of?
a. Pubovaginal Sling
b. Tension-free vaginal tape
c. Urethral Bulking Injections
d. Vaginoplasty
e. Burch Colposuspension

Jawaban C. Section 6 Atlas of Gynecologic Surgery > Chapter 42. Surgeries for
Female Pelvic Reconstruction > Urethral Bulking Injections > Surgical Steps
4. Operasi untuk penanganan vesico-vaginal fistula adalah?
a. Dapat dilakukan melalui vagina
b. Dapat dilakukan perabdominal
c. Menggunakan Latzko Technique
d. A dan B benar
e. A,B dan C benar
Jawaban E. Vesicovaginal fistulas may be repaired either vaginally or abdominally
(see Chap. 26, Route of Surgical Repair). A vaginal approach is preferred for most
fistulas seen in the United States, which are posthysterectomy apical fistulas. This
approach is selected because of its comparable success rates, lower morbidity, and
faster patient recovery. The most commonly performed vaginal procedure is the
Latzko technique, which is a partial colpocleisis that obliterates the upper vagina for 2
to 3 cm around the fistula.
5. Martius Bulbocavernosus Fat Pad Flap adalah?
a. Vascular graft
b. Penanganan komplikasi fistula vesico-vaginal
c. Penanganan komplikasi pada fistula recto-vaginal
d. Penanganan pada inkontinensia urin
e. A,B dan C benar
Jawaban E. The Martius bulbocavernosus fat pad flap is a vascular graft. It is used
commonly in complex rectovaginal or vesicovaginal fistula repairs complicated by
avascular or fibrotic tissue. Specifically, previously irradiated vaginal tissues often
require this graft.
6. Berikut ini benar mengenai Sacral neuromodulation?
a. Stimulasi elektrik pada plexus pelvic dan pudendal nerves
b. Pencegahan partus tak maju pada kehamilan berikutnya
c. Pencegaan partus macet pada kehamilan berikutnya
d. Penanganan hemiparese
e. Salah-satu terapi karsinoma ovarii
Jawaban A. Sacral neuromodulation is a technique that delivers electrical stimulation
to the pelvic plexus and pudendal nerves. This device is a Food and Drug
Administration (FDA)approved treatment for urinary urgency, frequency, urge
incontinence, and for nonobstructive urinary retention. Although not FDA approved
for pelvic pain and interstitial cystitis, it is sometimes used for these indications if
they are associated with urgency, frequency, or retention.

Section 6 Atlas of Gynecologic Surgery > Chapter 43. Surgeries for Gynecologic
Malignancies
1. This is true about modified Radical Abdominal Hysterectomy (Type II)?
a. Below levator ani muscles resection
b. Complete Levator ani muscles resection
c. Complete vulvoperineal tissues resection
d. Above levator ani muscles resection
e. Limited vulvoperineal tissues resection
Jawaban A. Section 6 Atlas of Gynecologic Surgery > Chapter 43. Surgeries for
Gynecologic Malignancies > Table 43-3.1 Differences among Type I (Supralevator),
Type II (Infralevator), and Type III (with Vulvectomy) Pelvic Exenterations
2. The reasons of Vaginal Reconstruction is?
a. congenital absence of the vagina
b. postirradiation stenosis
c. total vaginectomy
d. A and B are true
e. A,B and C are true
Jawaban E. Patients undergoing exenterative surgery are typical candidates for
creation of a new vagina. Other less common indications include congenital
absence of the vagina, postirradiation stenosis, and total vaginectomy. There are
innumerable ways to perform the procedure, and the type of reconstruction
typically is determined by both the surgeon's personal experience and the woman's
clinical circumstances.
3. The best choice for vaginal reconstruction at the time of pelvic exenteration in Vaginal
Reconstruction is?
a. Rectus abdominis muscle flaps
b. Gracilis myocutaneous Flap
c. Pudendal Thigh Fasciocutaneous Flap
d. Omental
e. M. Sphincter ani

Jawaban A. Rectus abdominis muscle flaps are perhaps the best choice for vaginal
reconstruction at the time of pelvic exenteration. Ideally, they fill pelvic dead space,
reduce the risk of fistulas, and provide fulfilling sexual activity (Goldberg, 2006).
However, the donor site may be difficult to close primarily or lead to a postoperative
hernia or dehiscence. The operating time is also increased because two surgical teams
are not possible. Flap necrosis, fistula, and vaginal stricture or stenosis are other
frequent complications (Soper, 2005).

4. Lymphocyst formation setelah operasi Pelvic Lymphadenectomy, dikenal dengan?

a. Hydrocoele
b. Lymphocoele
c. Flap of lymphocyts
d. Lymphatic formation
e. Kista
Jawaban B. Surgical blunt dissection techniques decrease the risk of inadvertent
vessel or nerve injury but may increase the chance of postoperative lymphocyst
formation. Also known as lymphocoele, these cysts usually are asymptomatic,
transient collections of lymph with a thick fibrotic wall. Symptomatic or large
lymphocysts usually will respond to percutaneous aspiration with or without drainage
catheter placement (Mann, 1989). Sclerosis is uncommonly required. Laparotomy
with marsupialization should be considered a last option (Liu, 2005). Omentoplasty
may reduce the incidence of these complications but is not usually performed
(Fujiwara, 2003).
5. Komplikasi yang paling sering pada operasi Para-Aortic Lymphadenectomy adalah?
a. Perdarahan
b. Ileus

c. Inkontinensia urin
d. Infertilitas
e. A dan B benar
Jawaban E. Para-aortic lymphadenectomy is not performed routinely worldwide
because of the procedure's difficulty and potential for complications (Fujita, 2005). Of
these, acute hemorrhage and postoperative ileus are associated most commonly. Other
complications should be infrequent. However, in an obese woman, visibility in the
area of dissection is decreased, and thus, the complexity of performing this delicate
procedure is increased. The operative time is also lengthened considerably.
6. Komplikasi yang sering terjadi setelah Diaphragmatic Surgery pada pasien kanker
ovarium adalah?
a. Empyema, subphrenic abscess, pleural effusions, dan pneumothorax.
b. Ileus dan hematemesis
c. Anemia gravis
d. Metastase sel kanker ke otak
e. Emboli paru
Jawaban A. Patients with presumed advanced ovarian cancer should be informed of
the possible need for extensive upper abdominal surgery to achieve optimal
cytoreduction. Pulmonary complications are most common after diaphragmatic
surgical techniques and include atelectasis, empyema, subphrenic abscess, pleural
effusions, and pneumothorax.