EBCOG P1 – 3 Month – Urogynaecology – LUT – Day 4 EMQ

A. bladder diary
B. blood culture
C. post-void residual urine test
D. cystoscopy and bladder biopsy
E. referral under 2-week rule
F. symptom questionnaire
G. ultrasound of the renal tract
H. urinalysis
I. urine culture and sensitivity
J. urine cytology
K. urine staining and culture for fungus
L. urodynamics
For each of the following questions, choose an appropriate investigation option from the list
A–L. Each response may be chosen once, more than once or not at all.
Questions:
1.A 30-year-old woman presents to the gynaecology outpatient department (OPD) with a 6-month history of urinary urgency – frequency but no urge incontinence or nocturia. The GP letter states that the urinalysis done last fortnight reported negative.

2 .A 72-year-old woman presents to the GP with presence of blood in her urine over the  last 2 months. She has no fever or any other systemic symptoms. Routine urinalysis  shows blood 3+. She feels quite well and has been brought to the GP reluctantly by her  persuasive daughter. The patient apologises for being an encumbrance.

3.A 41-year-old woman presents with a long history of probable recurrent urinary tract  infections and has been treated with presumptive antibiotics when she lived abroad.  She has severe pain in the bladder area and also urinary urgency but no leaks. She also  reports occasional haematuria that resolves spontaneously. Serial urine cultures have  always been negative, including for fungus and atypical bacteria.

4.A 38-year-old woman presents with urinary leakage on coughing and sneezing. She has  completed her family. She has had two normal deliveries. She also admits that she has  difficulty holding on due to urinary urgency and frequents the toilet at least seven times  a day but not at night. Anticholinergics have not been helpful so far.

For each of the following clinical scenarios, choose the best initial investigation. Each option may be used once, more than once, or not at all.
A. Bladder diary
B. Cystoscopy
C. Hysteroscopy
D. Intravenous pyelogram
E. Laparoscopy
F. Laparoscopy and cystoscopy
G. Midstream urine
H. MRI of pelvis
I. Nerve studies
J. USG
K. Urine dipstick
L. Urodynamic
5. A 36-yr old woman presents with urinary incontinence. She has some associated urinary frequency and some suprapubic pain.

6.A 47-yr old personal trainer presents with urinary leaking when weight training at the gym. She also needs to wear a sanitary towel due to some urge incontinence. Her GP has tried oxybutynin but to no avail. Her urine dipstick is normal.

7.A 35-yr old woman presents with a five-month history of suprapubic pain when passing urine. Urine dipstick persistently shows microscopic haematuria. Her urine cultures have not grown any organism.

8.A 40-yr old woman with menorrhagia attends the urogynaecology clinic with difficulty voiding. On examination she has a 16 weeks-sized mass in her abdomen.

Which of the following contributing factors to postpartum voiding dysfunction is most likely for each of the patients below?
A. Trauma to pudendal nerve
B. Trauma to pelvic floor
C. Regional anaesthesia
D. Over-distension injury
E. Urinary tract infection
F. Fluid shifts to intravascular space
G. Incarcerated uterus
H. Pelvic haematoma

9. A 31-year old woman has a spontaneous onset of labour and progresses well until the second stage when her contractions lessen. After 2 hrs in second stage, she achieves a spontaneous vaginal delivery after syntocinon augmentation. 8 h after delivery, she has not passed urine.

10.A 30-year old woman has an uncomplicated labour until 8 cm dilation. But at 8cm, the CTG becomes pathological and she urgent Caesarean section under spinal anaesthesia. The next morning the urinary catheter was removed, but 6 hours later has no sensation of needing to void.