EBCOG Part 1- Urogyenacology -Day 4(S.B.A)

1) A 60-year-old woman presents with vault prolapse. In treating post-hysterectomy vaginal vault prolapse, the operation with the highest success rate is

2) Ms. Anderson is 60 years old. She presents with a picture of mixed incontinence with stress as a predominant feature. A urinary tract infection has been ruled out. She does not smoke or consume caffeine. A grade 1 cystocele is noted on examination. Which of the following treatment options are best suited to her?

4) Your colleague is evaluating a 60 year old multiparous women with pelvic organ prolapse. The consultant has asked him to draw a diagram of her prolapse as per the POP-Q system. He has given the following is diagram. Which of the following statement is incorrect?

 4. You have obtained consent from a 67-year-old woman for a vaginal hysterectomy plus pelvic floor repair and a possible sacrospinous fixation. She is diagnosed with stage 2 uterovaginal prolapse. After you complete the hysterectomy and anterior vaginal wall repair, you pull on the vault and it comes down to 1 cm above the introitus. Which of the following options would you perform next?

5.  You review a woman in the urogynaecology outpatient clinic. You decided to start her on anticholinergic therapy as she has symptoms of overactive bladder that has failed to respond to lifestyle modification and bladder retraining. How long will it take before she can expect to see the full benefits of taking this medication?

6. Your consultant examines a 65-year-old patient who presented with symptoms of pelvic organ prolapse. She had a hysterectomy 10 years previously. The prolapse is noticed. The most distal portion of the prolapse protrudes more than 1 cm below the hymen but no farther than 2 cm less than the total vaginal length. What is the stage of this prolapse?

7.The nerve that is susceptible to entrapment injuries during sacrospinous ligament fixation as it runs behind the lateral aspect of the sacrospinous ligament is the:

 8. Vault prolapse can be prevented at the time of vaginal hysterectomy by:

9. A 55-year-old woman is seen in the clinic complaining of feeling a lump in the vagina. She has a history of vaginal hysterectomy six years previously. On examination, she has a complete vaginal vault prolapse, stage 4 POPQ.Which of the following options would you recommend to her?

10. Ms. XY is 70 years old. She presents to the urogynaecology specialist nurse with the complaint to feeling a bulge per vaginum. She has had a TAH +BSO 15 years ago. Which point corresponds to the vaginal vault/cuff scar on the POP –Q (pelvic organ prolapse quantification system)?

11. A 49-year-old woman who has multiple uterine fibroids is booked for total abdominal hysterectomy with conservation of the ovaries. What is her risk of developing post-hysterectomy vault prolapse (PHVP)?

 12. Ms. Jones is 70 years old. She presents to the urogynaecology specialist nurse with the complaint of feeling a bulge per vaginum. She has had a TAH + BSO 15 years ago. Which of the following points on the POP-Q system will not be recorded as a part of her assessment?

13. An 84-year-old patient who had a previous history of vaginal hysterectomy presents with a stage 3 vault prolapse. The patient has limited mobility and has previously had difficulty with the use of vaginal pessaries. What is the most appropriate treatment option?

14. A patient presents with symptoms of a prolapse. On examination, the pelvic organ quantification score is Aa 0, Ba 0, C −5, D −7, Ap −2Bp −2 tvl 9, gh 4, pb 3. The patient wants her prolapse to be treated surgically. What is the correct diagnosis and surgical treatment?

15.Which of the following is incorrect statement regarding POP-Q system for prolapsed grading?