EBCOG Part 1 High Yield Questions – Urogynaecology

A. Endometriosis
B. Pelvic inflammatory disease
C. Ovarian cyst
D. Irritable bowel syndrome
E. Adhesions
F. Ureteric stones
G. Interstitial cystitis
H. Appendicitis
I. Constipation
J. Psychological
K. Musculoskeletal
L. Adenomyosis
M. Nerve entrapment

For each case described below, choose the single most likely diagnosis from the above list of options. Each option may be used once, more than once, or not at all.

1. A 28 year-old mother of two is referred to you by her general practitioner with a complaint of lower backache. She has had this pain for the last 8 months, after the first birthday of her last child. The pain is present all the time but she feels it increase more around her periods. She has used combined oral contraceptives for years but now her husband has had a vasectomy. She has no significant past medical or surgical history. On further inquiry she complains of getting constipated around her periods which is manageable with laxatives. She also complains of deep dyspareunia on some occasions, especially on the days when her backache is worsened. She has received physiotherapy for her backache without much benefit.

2. A 45-year-old woman presents with a long-standing history of lower abdominal and pelvic pain. On exploring her history, you do not find any relevant information apart from the fact that she has been known to have a moderate uterine prolapse.

A. Abdominal X-ray
B. Bladder scan
C. Complete a bladder diary
D. CT of pelvis
E. Cystoscopy
F. Digital assessment of pelvic floor contraction
G. Filling and voiding cystometry
H. MRI of pelvis
I. No investigation required
J. Pad testing
K. Pelvic ultrasound scan
L. Perform a quality-of-life assessment
M. Repeat midstream urine
N. Ultrasound scan of renal tract
O. Urinary catheterisation
P. Urine dipstick test
Q. Video urodynamics

For each of the following clinical scenarios, what is the most appropriate investigation that needs to be performed before any therapy is commenced? Each option may be used once, more than once or not at all.

3. A 40-year-old woman attends the gynaecology clinic with a history of leakage of urine on coughing or sneezing following the birth of her last child 2 years ago. A urine dipstick is negative. A decision is made to commence a course of supervised pelvic floor muscle training.

4. A 55-year-old woman who previously had insertion of a tension- free vaginal tape for the treatment of stress incontinence attends with new symptoms of urinary leakage with physical exertion or coughing. She is requesting further surgery.

5. A 60-year-old woman has an initial appointment at the gynaecology clinic. Her presenting symptoms are urinary leakage, urgency and nocturia.

A. Botulinum toxin A
B. Botulinum toxin B
C. Darifenacin
D. Desmopressin
E. Dimethyl sulfoxide
F. Duloxetine
G. Flavoxate
H. Imipramine
I. Mirabegron
J. Oestriol cream
K. Oxybutynin
L. Propantheline
M. Propiverine
N. Solifenacin
O. Tibolone
P. Tolterodine
Q. Transdermal oestrogen
R. Trospium

For each of the following clinical scenarios, choose the single most appropriate phar- macological therapy from the list above. Each option may be used once, more than once or not at all.

6. A 60-year-old woman returns to the urogynaecology clinic for a review. She initially presented with symptoms of urinary leakage and urgency. She has completed a course of bladder training with no effect. She has myasthenia gravis but is otherwise well.

7. A 55-year-old woman initially presented with urinary leakage on coughing and sneezing. She completed a course of pelvic floor muscle training with little effect. She wishes to avoid surgical intervention.

8.A 62-year-old woman who is otherwise fit and well presents with urgency, urinary leakage and nocturia. The urgency and leakage are improved with transdermal oxybutynin, but the nocturia remains troublesome with her needing to go to the toilet four or five times per night.

A. Berger’s disease (IgA nephropathy)
B. Bladder calculus
C. Bladder endometriosis
D. Cystocele
E. Foreign body
F. Haemophilia A
G. Idiopathic haematuria
H. Paroxysmal nocturnal haemoglobinuria
I. Polycystic kidney disease
J. Poststreptococcal glomerulonephritis
K. Renal calculus
L. Sickle-cell disease
M. Transitional cell carcinoma
N. Urethrocele
O. Urinary tract infection (UTI)
P. Von Willebrand’s disease

For each of the following clinical scenarios, choose the single most likely cause of haematuria. Each option may be used once, more than once or not at all.

9. A 25-year-old woman presents to her GP with urinary frequency and dysuria. Her urine dipstick results are:

10. Two days after an upper respiratory tract infection, a 20-year-old woman presents to her GP with episodes of frank haematuria. Renal function tests are normal.

11.A 45-year-old woman presents with acute loin pain and haematuria. She is found to be hypertensive with abnormal renal function tests.

A. Anterior and posterior colporrhaphy
B. Anterior colporrhaphy
C. Artificial urinary sphincter
D. Augmentation cystoplasty
E. Colpocleisis
F. Fenton’s procedure
G. Intramural bulking agents
H. Laparoscopic colposuspension
I. Marshall–Marchetti–Krantz procedure
J. Open colposuspension
K. Posterior colporrhaphy
L. Tension-free vaginal tape
M. Transobturator tape
N. Urinary diversion
O. Vaginal hysterectomy

For each of the following clinical scenarios, choose the single most appropriate surgi- cal intervention from the list of options above. Each option may be used once, more than once or not at all.

12. A woman attends the urogynaecology clinic with symptoms of stress incontinence that have not responded to conservative measures. She is keen for surgical intervention but wishes to avoid synthetic meshes and tapes as she has read adverse reports in the media.

13. A 45-year-old woman presents with urinary frequency and urgency and a diagnosis of idiopathic detrusor overactivity is made. This has not responded to conservative measures and she is ready to proceed with surgical intervention.

14. A 90-year-old woman with hypertension and type 2 diabetes presents with worsening uterovaginal prolapse that is not being controlled with shelf pessaries.

A. Atrophic vaginitis
B. Bladder calculus
C. Bladder diverticulum
D. Bladder endometriosis
E. Bladder pain syndrome
F. Fibromyalgia
G. Pelvic inflammatory disease (PID)
H. Peritoneal adhesions
I. Sjögren’s syndrome
J. Systemic lupus erythematosus
K. Transitional cell carcinoma
L. Urethral diverticulum
M. Urinary tract infection (UTI)
N. Vesicovaginal fistula

For each of the following clinical scenarios, choose the single most likely diagnosis from the list of options above. Each option may be used once, more than once or not at all.

15. A 40-year-old woman with no significant past medical history presents with a 10-month history of pelvic pain mainly located to the suprapubic area. She has urinary urgency and frequency but no leakage. The symptoms persist through her cycle. She suffers with constipation but not diarrhoea.

16. A 48-year-old woman presents to clinic with complex symptoms. She has urinary urgency and frequency but also dysuria and postmicturition dribble. A full gynaecological history also reveals dyspareunia. An initial pelvic examination is unremarkable.

A. Arrange CT of kidneys, ureters and bladder (CT KUB)
B. Arrange MRI scan
C. Complete bladder diary
D. Consider antibiotics while awaiting midstream urine culture results
E. Measure postvoid residual volume by bladder scan
F. Measure postvoid residual volume by catheterisation
G. Perform cystoscopy
H. Perform digital pelvic examination
I. Perform pad test
J. Perform urodynamic testing
K. Prescribe antibiotics while awaiting midstream urine culture results
L. Refer to urologist
M. Send urine for culture and sensitivity

From the list of management options above, choose the single most appropriate man- agement for each of the following clinical scenarios. Each option may be used once, more than once or not at all.

17. A woman attends a general gynaecology clinic and has routine urinalysis by dipstick. She has no symptoms, but the urine tests positive for both leucocytes and nitrites.

18. A woman is referred to a urogynaecologist with recurrent UTIs. A urine dipstick in the clinic is negative.

19. A 53-year-old woman is referred to the urogynaecology clinic with urinary incontinence. She has routine urine dipstick testing and is found to have microscopic haematuria.

A. Bulbospongiosus muscle
B. Conjoint longitudinal coat
C. External anal sphincter
D. Iliococcygeus
E. Internal anal sphincter
F. Ischial tuberosities
G. Ischiocavernosus muscle
H. Ischiococcygeus muscle
I. Ischiopubic rami
J. Levator ani
K. Levator hiatus
L. Puborectalis muscle
M. Pubovaginalis muscle
N. Sacrotuberous ligaments
O. Superficial transverse perineal muscles

From the list of options above, choose the single most appropriate anatomical struc- ture from the list of descriptions below. Each option may be used once, more than once or not at all.

20. The most caudal component of the levator ani complex.