EBCOG Part 1 2 Weeks Crash Course General Gynaecology,Urogynaecology,Reproductive Medicine Day 3 EMQ

Below is a list of options for the management of urinary incontinence. Following it are three clinical scenarios. For each scenario, choose the most appropriate treatment option. Each option in the list can be chosen once, more than once or not at all.
A. TVT
B. TOT
C. Colposuspension
D. Anterior colporrhaphy
E. Artifical urinary sphincter
F. Intraurethral NASHA/DX copolymer injection
G. Sacral neuromodulation
H. Urinary diversion
I. Botulinum A Toxin
J. Augmentation cystoplasty
K. Rectus fascia pubovaginal sling
L. Needle suspension

1) An 83-year-old woman in poor medical health with urodynamic stress incontinence and normal voiding parameters

2.A 44-year-old woman with urge incontinence and severe detrusor overactivity on urodynamics unresponsive to conservative therapy and anticholinergic medications

3.A 56-year-old woman with urodynamic stress incontinence and no previous surgery; her family is complete and there is no prolapse on examination

A. Paravaginal repair
B. Posterior vaginal wall repair
C. Uterosacral ligament suspension
D. Sacrospinous vault fixation
E. Pelvic floor exercises
F. Colpocleisis
G. Abdominal sacropexy
H. Posterior vaginal wall repair with mesh
I. Traditional anterior repair
J. Shelf pessary
K. Ring pessary

Match each of the following case scenarios with the most
appropriate treatment from the list above. Each option may beused once, more than once or not at all.

4) A 46-year-old woman presents with ‘something coming down’ for the past 6 months. She has previously had a vaginal hysterectomy for heavy menstrual bleeding. She is sexually active and denies any bladder or bowel symptoms. On examination she has stage 3 apical prolapse and stage 1 anterior prolapse.

5)A  65-year-old woman presents with ‘something coming down’ and difficulty emptying her bowels. She has had a vaginal hysterectomy and posterior repair 2 yearsago and was well for the first 6 months post-operation. She does not report any urinary symptoms. She is not sexually active. Examination reveals a stage 2 posterior prolapse, stage 1 apical descent and a well-supported anterior wall.

6) A healthy 62-year-old sexually active women presents with a sensation of a bulge ‘down below’ and difficulty sometimes initiating urinary voiding. On examination she has stage 2 anterior compartment prolapse. The vault is well supported, as is the posterior vaginal wall. She is having to spend increasing amounts of time caring for her elderly mother and is keen on a definitive treatment as soon as possible.

7) An elderly, but basically healthy, widow of 77 years presents once again to her gynaecologist with symptoms suggestive of prolapse. She has struggled for many years with this problem, and indeed has undergone a number of surgeries, including vaginal hysterectomy, totreat prolapse in all three compartments. The problem has recurred and examination shows a recurrence of stage 2–3 prolapse. Pessaries have previously been poorly tolerated.

Below is a list of options for the management of urinary incontinence. Following it are three clinical scenarios. For each scenario, choose the most appropriate treatment option. Each option in the list can be chosen once, more than once or not at all.

A. TVT
B. TOT/TVT-O
C. Colposuspension
D. Anterior colporrhaphy
E. Artificial urinary sphincter
F. Urethral bulking agent
G. Rectus fascia pubovaginal sling
H. Needle suspension
I. Mini sling
J. None of the above


8) An 83-year-old woman in poor medical health with urodynamic stress incontinence and normal voiding parameters.

9) A 44-year-old woman with urge incontinence and severe detrusor overactivity on urodynamics unresponsive to conservative therapy and anticholinergic medications.

10) A 56-year-old woman with urodynamic stress incontinence and no previous surgery; her family is complete and there is no prolapse on examination.

A. Tolterodine
B. Chlorpromazine
C. Cyclizine
D. Codeine
E. Furosemide
F. Doxazosin
G. Zopiclone
H. Oxybutynin
I. Amitriptyline
J. Temazepam
K. Imipramine


11) An alpha blocker

A. Midstream urine sample for microbiology
B. Pelvic floor exercises
C. Multichannel cystometry
D. Weight loss
E. Duloxetine
F. Oxybutynin
G. Tolterodine
H. Solifenacin
I. Pre-operative counselling in a clinic setting
J. Case discussion in multidisciplinary setting
K. Joint management with urology
L. Botulinum toxin
M. Midurethral retropubic tape
N. Midurethral transobturator tape
O. Open colposuspension
P. Laparoscopic colposuspension

12.A 76-year old with a BMI of 40 presents with symptoms of incontinence which is affecting her daily life. She is on treatment for heart failure, unstable angina and COPD. Pelvic examination reveals a small cystocele and minimal uterine descent with leakage on coughing. She has already been referred for physiotherapy which has made little difference to her symptoms.

13.A 35-year old woman presents with leaking on exercise.She is a fitness instructor and routinely does two sessions a week. She gives a history of straining while voiding. There are no symptoms of urgency or increased frequency. Examination is essentially unremarkable. She wants a definitive solution to her problem in order to improve her quality of life. She has done 3 months of pelvic floor physiotherapy. Uroflowmetry shows max flow rate of 12 ml/second and average flow rate of 8 ml/second.

14) A 45-year-old lady presents with symptoms of leaking urine on walking, light running and every time she laughs or sneezes. She does not have any voidingproblems. There are no other medical co-morbidities. Bladder diary shows a daily intake of around 1.5 litres. Examination is unremarkable. She has already tried supervised pelvic floor exercises

A. Dimethyl sulfoxide
B. Botulinum toxin
C. NSAIDs
D. Physical therapy
E. Sacral neuromodulation
F. Cystoplasty
G. Sodium pentosanpolysulfate
H. Hydroxyzine
I. Amitriptyline
J. Opioid analgesia




15.The only oral drug licensed by the FDA for treatment of symptoms associated with painful bladder syndrome

16) A drug administered by instilling in the bladder every week for 6e8 weeks

17) Aims to increase the bladder’s capacity, but should only be used when other options have been exhausted

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.


18.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.

19) 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.

20) 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.

21) A 38-year-old woman presents with urinary leakage on cou ghing 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.