EBCOG Part 1 Urogyneacology Day 2 EMQ

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 of not at all.

1. 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.

2. 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.

3. 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 pharmacological therapy from the list above. Each option may be used once, more than once or not at all.

1. 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.

2. 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.

3. 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 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 management for each of the following clinical scenarios. Each option may be used once, more than once or not at all.

1. 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.

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

3. 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 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 surgical intervention from the list of options above. Each option may be used once, more than once or not at all

1. 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

2. 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.

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