EBCOG P1 – 3 Month – Urogynaecology – Urinary incontinence-Urogynaecology-Day 1 EMQ

A. CA bladder
B. Mixed urinary incontinence
C. Neurogenic bladder
D. Overactive bladder
E. Overflow incontinence
F. Painful bladder syndrome
G. Urethral caruncle
H. Urethral diverticulum
I. Urethral prolapse
J. Urinary stress incontinence
K. UTI
L. Urogenital atrophy
M. Vesico-vaginal fistula

For each of the following clinical scenario, choose the single diagnosis most suitable from the list provided. Each option may be used once, more than once or not at all.

 1. A 61-yr old woman presents with recurrent dysuria and frequency worsening over the past three-six months. She smokes 20-25 cigarettes per day. She has seen her GP for the same symptoms and Repeated MSUs at her GP had no demonstrable infection on urine culture. Urinalysis demonstrates ++ haematuria. Repeat MSU for microscopy, culture, and sensitivity was negative. The most probable diagnosis

2. A 28-yr old woman underwent anterior colporrhaphy 10 days back for cystocele. She presented to the gynaecology clinic with feeling constantly damp vaginally and is having to wear pads continuously.

3. A 61-yr old postmenopausal multiparous woman presents with a 7 months history of dysuria and vulval pain. On examination, a pink exophytic lesion is observed at the urethral meatus.

4. A 48-yr old multiparous woman who has had all four vaginal delivery presents with a 2 yr worsening history of leakage of urine on coughing, sneezing, and during exercise. On examination a moderate cystocele and rectocele is observed.

5. A 56-yr old woman presents with a 8 month history of urinary frequency, urgency, and pelvic pain. Urine dip stick and microscopy negative and urodynamic study have been normal.

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
6. A 36-yr old woman presents with urinary incontinence. She has some associated urinary frequency and some suprapubic pain.

7. 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.

8. 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.

9. 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.

10. A 59-yr old para 6 woman presents with urinary incontinence and a mass in her anterior vagina. She has tried pelvic floor exercise but they have not helped her symptoms.

A. Amitriptyline
B. Anterior colporrhaphy
C. Artificial urinary sphincter
D. Augmentation cystoplasty
E. Botulinum A toxin
F. Cimetidine
G. Colposuspension (Bursh)
H. Intraurethral NASHA/DX copolymer injection
I. Needle suspension
J. Rectus fascia pubovaginal sling
K. Sacral neuromodulation
L. TOT
M. TVT
N. Urinary diversion

11. An 83-yr old woman in poor medical health with urodynamic stress incontinence and normal voiding parameters.

12. A 44-yr old woman with urge incontinence and severe detrusor overactivity on urodynamic assessment. This is unresponsive to conservative therapy and anticholinergic medication.