Urogynaecology Extra Questions

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

A. Genitofemoral nerve
B. Obturator nerve
C. Peroneal nerve
D. Pudendal nerve
E. Sciatic nerve

2. The main complication of mesh repair in vaginal prolapse

A. Bladder injury
B. Bowel injury
C. Mesh erosion
D. Infection
E. Recurrence of prolapse

3. Painful bladder syndrome is characterised by all of the below except

A. Increased frequency
B. Increased night-time frequency
C. Pain related to bladder filling
D. Positive urine cultures
E. Urgency

4. In the female pelvis, the ureter forms an important relation with the ovaries and lies

A. Anterior to ovary
B. Inferior to ovary
C. Medial to ovary
D. Lateral to ovary
E. Posterior to ovary

5. Which of the following is not true about postpartum voiding dysfunction?

A. It is defined as failure to pass urine spontaneously within 6 h of vaginal delivery or catheter removal after delivery.
B. It is seen in 0.7–4 % deliveries.
C. Epidural anaesthesia is a risk factor.
D. All postpartum patients’ measurement of residual urine volume helps identify ing women with voiding dysfunction.
E. If a patient does not void within 6 h of delivery and if the residual urine volume is >500 ml, then it is advisable to keep an indwelling catheter for 24 h.

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

A. Cruikshank’s closure
B. DeLancey’s procedure
C. McCall culdoplasty
D. Moschcowitz procedure
E. Simple peritoneal closure

7. Ms. XY 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?

A. Anticholinergics
B. Gel horn pessary
C. Pelvic floor muscle training
D. TVT
E. Urodynamic studies

8. Ms. XY is 60 years old. She presents with symptoms suggestive of an overactive bladder. Urine dip is negative for leucocytes and nitrites. She does not smoke or consume caffeine. Examination reveals no prolapse. Which of the following is the most appropriate advice?

A. Bladder diary—72 h
B. Bladder scan
C. Filling and voiding cystometry
D. Flexible cystoscopy
E. MSU for culture

9. Ms. XY is 60 years old. She presents with symptoms suggestive of an overactive blad- der. Urine dip is negative for leucocytes and nitrites. She does not smoke or consume caffeine. Examination reveals no prolapse. Conservative therapies and OAB drugs have failed to improve her symptoms. After an MDT discussion, a decision is reached to try botulinum toxin A. Which of the following is an appropriate starting dose of the toxin?

A. 50 units
B. 150 units
C. 200 units
D. 250 units
E. 300 units

10. XY is 70 years old. She presents to the urogynaecology specialist nurse with the complaint of feeling a bulge per vaginam. 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?

A. Aa
B. Ba
C. C
D. D
E. Bp

11. Which of the following is not true about duloxetine?

A. Duloxetine is believed to act by increasing sphincter activity in the storage phase of the micturition cycle.
B. It is a serotonin and noradrenaline (norepinephrine) reuptake inhibitor.
C. It has clinically important interactions with other drugs including warfarin and antidepressants.
D. It is approved for the treatment of urinary incontinence.
E. With the use of duloxetine, overweight women tended to have a lesser improve- ment in incontinence quality-of-life score than women with a BMI <28.

12. Which of the following is a contraindication to suprapubic catheterisation?

A. Neurogenic bladder
B. Inability to self-catheterise
C. Intractable self injury
D. Severe incontinence
E. Very obese patients

13. All of the following statements regarding anterior wall repair are true except

A. Anterior repair is performed for symptomatic anterior vaginal wall prolapse.
B. Continuous sutures produce a more robust repair than intermittent sutures.
C. The procedure provides support along the whole length of the anterior vaginal wall, thereby supporting both the urethra and the bladder base.
D. Use of a nonabsorbable graft reduces the risk of operative failure or recurrence but is associated with a risk of graft erosion and bladder injury.
E. While troublesome urinary symptoms may be improved by anterior repair, a significant proportion of women develop new urinary symptoms following sur-gery, which will be particularly unwelcome if they were symptom-free before.

14. Which of the following is not an example of a problem arising from pelvic floor dysfunction?

A. Faecal incontinence
B. Incompetent cervix
C. Pelvic organ prolapse
D. Sexual dysfunction
E. Urinary incontinence

15. ’Long-term’ intraurethral catheters are kept in situ for at the most:

A. 2 weeks
B. 4 weeks
C. 8 weeks
D. 12 weeks
E. 16 weeks

16. 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)?

A. Aa
B. Ba
C. C
D. Ap
E. Bp

17. A 57-year-old, post menopausal woman complains of ‘something coming out of her vagina’ and difficulty in opening her bowels. She had four children uneventfully with vaginal births. Her last child birth was 18 years back. The most likely diagnosis is

A. Anterior vaginal wall prolapsed
B. Genuine stress incontinence
C. Overflow incontinence
D. Posterior vaginal wall prolapse
E. Stress incontinence

18. Which of the following statements about urethral diverticulum is true?

A. Congenital cases may occur from remnants of Gartner’s duct or abnormal union of primordial folds or persisting cell rests, especially Müllerian, and are com- monly found in children.
B. Most cases are acquired and result from repeated infections and obstruction of the periurethral glands.
C. The UD usually dissects within the urethral pelvic ligament with the orifice/ neck at 11 o’clock.
D. Traumatic childbirth, especially with assisted delivery, has been suggested as a cause of UD development, and they never develop in nulliparous patients.
E. Urethral diverticulum presents with the classical triad of dysuria, post-void drib- bling and dyspareunia in most of the patients.

19. Ms. XY is 55 years old. She suffers from symptoms of an overactive bladder. Bladder retraining has not helped her. Her recent urine analysis is negative for infection. What is next step in her management?

A. Botulinum A toxin
B. Mirabegron
C. Darifenacin once daily
D. Transcutaneous posterior tibial nerve stimulation
E. Urodynamic studies

20. A third-degree perineal tear is defined as:

A. Complete disruption of the anal sphincter muscles, which may involve either or both the external (EAS) or/and internal anal sphincter (IAS) muscles with par- tial involvement of the rectal mucosa
B. Partial or complete disruption of the anal sphincter muscles, which may involve the external (EAS) but not the internal anal sphincter (IAS) muscles
C. Partial but not complete disruption of the anal sphincter muscles, which may involve either or both the external (EAS) or/and internal anal sphincter (IAS) muscles and one third of rectal mucosa
D. Partial or complete disruption of the anal sphincter muscles, which may involve either or both the external (EAS) or/and internal anal sphincter (IAS) muscles without involvement of rectal mucosa
E. Partial or complete disruption of the anal sphincter muscles, which may involve either or both the external (EAS) or/and internal anal sphincter (IAS) muscles with some involvement of rectal mucosa

21. An 84-year-old patient who had a previous history of vaginal hys- terectomy 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?

A. Abdominal Sacrocolpopexy
B. Colpocliesis
C. Physiotherapy
D. Sacrospinous fixation
E. Transvaginal repair with mesh

22. A 55-year-old patient presents with a history of urinary symptoms of urgency, increased frequency and nocturia. The patient states that she does not have symptoms of hesitancy and feels as though she empties her bladder completely. What would be the first line of management?

A. Cystoscopy
B. Neuromodulation
C. Reduce caffeine intake and start anticholinergic medication
D. Ultrasound scan to rule out pelvic pathology
E. Urodynamics

23. A 39-year-old patient presents with symptoms of leakage of urine upon coughing, sneezing and during exercise. The symptoms started following the birth of her second child 18 months ago. What would be the first line of management?

A. Biofeedback/Electrical stimulation
B. Bladder retraining
C. Insertion of a midurethral retropubic tape
D. Pharmacotherapy with Duloxetine
E. Supervised Pelvic floor muscle training

24. A patient presents as an emergency with urinary retention. Upon taking a history, you also discover that the patient has been having hematuria for several weeks. What is an absolute contraindication to inserting a suprapubic catheter?

A. Ascites
B. Bladder tumor
C. Clotting disorders
D. History of extensive bladder reconstruction
E. Unable to fill the bladder to a volume excess of 300 ml

25. A 56-year-old para 4 woman presents with a vault prolapse. The patient is sexually active and urodynamic investigations fail to reveal urodynamic stress incontinence even after reduction of the prolapse. The patient is keen on having surgery. Which of the following operations should be offered?

A. Bilateral Sacrospinous fixation
B. Sacrocolpopexy
C. Sacrocolpopexy and insertion of a mid urethral retropubic tape D. Sacrocolpopexy with a Burch Colposuspension
E. Unilateral Sacrospinous fixation with insertion of a mid-urethral retropubic tape

26. A39-year-oldpara1patientpresentswithstressincontinencewith no other urinary symptoms. What would be the first line of management?

A. A trial of pelvic floor muscle training for at least 3 months
B. Electric stimulation in combination with pelvic floor muscle training
C. Pelvic floor electromyography (biofeedback)
D. Pelvic floor muscle training that involves 6 contractions done every 3 days for 6 months
E. Urodynamic studies

27. A patient is undergoing a vaginal hysterectomy for uterine pro- lapse and at the end of the procedure it is noted that the vault of the vagina descends to 3 cm above the hymenal ring. What should be considered in order to prevent further descent of the vault in the future?

A. McCall culdoplasty
B. Moschowitz-type operation
C. No further action
D. Sacrospinous fixation
E. Suturing the cardinal and uterosacral ligaments to the vaginal cuff

28. A fit and healthy 52-year-old patient with confirmed detru- sor overactivity has tried three different medical treatments (Oxybutynin, Solifenacin, Mirabegron). The procedure that should be offered to the patient is.

A. Botulinum toxin A injections into the bladder
B. Detrusor myomectomy
C. Percutaneous tibial nerve stimulation
D. Sacral nerve modulation
E. Urinary diversion

29. A 38-year-old patient is suffering with stress incontinence. Her BMI is 32 kg/m2 and the patient is interested in lifestyle manage- ment for her incontinence. What is the most important lifestyle change that you would recommend?

A. Avoidance of caffeinated drinks
B. Exercise
C. Reduction of alcohol intake
D. Reduction of fluid intake
E. Weight loss

30. A 38-year-old patient is suffering with symptoms of an overac- tive bladder. Her BMI is 25 kg/m2 and the patient is interested in lifestyle changes. What is the most important lifestyle change that you would rec- ommend?

A. Avoidance of caffeinated drinks
B. Exercise
C. Reduction of alcohol intake
D. Reduction of fluid intake
E. Weight loss

31. A 38-year-old patient is suffering with symptoms of an overac- tive bladder. Her BMI is 25 kg/m2 and the patient is interested in lifestyle changes. What is the most important lifestyle change that you would rec- ommend?

A. Avoidance of caffeinated drinks
B. Exercise
C. Reduction of alcohol intake
D. Reduction of fluid intake
E. Weight loss

32. 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 −2 Bp −2 tvl 9, gh 4, pb 3. The patient wants her prolapse to be treated surgically. What is the correct diagnosis and surgical treatment?

A. Stage 1 cystocele and no treatment needed
B. Stage 2 cystocele and anterior repair
C. Stage 2 rectocele and posterior repair
D. Stage 2 uterine prolapse/cystocele and vaginal hysterectomy and anterior repair
E. Stage 2 uterine prolapse/rectocele and vaginal hysterectomy and posterior repair

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

A. Stage 2 cystocele and anterior repair
B. Stage 1 cystocele and no treatment needed
C. Stage 2 rectocele and posterior repair
D. Stage 2 uterine prolapse/cystocele and vaginal hysterectomy and anterior repair
E. Stage 2 uterine prolapse/rectocele and vaginal hysterectomy and posterior repair

34. A 32-year-old multiparous woman has confirmed urodynamic stress incontinence and admits that she has not completed her family. What management would you propose for this patient?

A. Advise the patient to compete her family before consid- ering incontinence surgery
B. A periurethral bladder neck injection would be the treatment of choice for long-term relief
C. If the patient has had previous incontinence surgery and the incontinence recurs postpartum then await spontaneous recov- ery for about 3–4 months
D. If the patient has had previous incontinence surgery a Colpo- suspension is most likely to be safe and effective
E. If the patient insists on surgery an insertion of a midurethral retropubic tape would be the surgical treatment of choice

35. A 28-year-old woman presents with a history of pelvic pain, uri- nary urgency, increased frequency and nocturia. The pelvic pain tends to occur during bladder filling and is relieved by voiding and you suspect that the patient has interstitial cystitis. What other mandatory investigation is required in order to make an accurate diagnosis?

A. Cystoscopy
B. Questionnaires and symptom scales
C. Urinalysis
D. Urinary diary
E. Urodynamics

36. A 64-year-old patient presents with a history of increased urinary frequency, nocturia, urgency and occasional urgency incontinence. What would be the next line of management?

A. Cystoscopy
B. Trial of anticholinergic medication
C. Urinalysis
D. Urinary diary
E. Urodynamics

37. An 84-year-old patient presents with symptoms of urgency, urgency incontinence and nocturia. The patient is taking several different medications for other medical conditions. A diagnosis of overactive bladder is made. The general practitioner has already tried Oxybutynin but the patient had side effects (central nervous system) and this was stopped.
Which anticholinergic medication would you now consider?

A. Darifenacin
B. Fesotrodine
C. Solifenacin
D. Tolterodine
E. Trospium chloride

38. A 52-year-old patient presents with a history suggestive of an overactive bladder, but also complains of fecal incontinence. The patient has tried conservative measures and various anti cholinergics with no significant benefit. Urodynamic testing confirms detrusor over activity and some void- ing dysfunction. What is the best surgical option for this patient?

A. Augmentation cystoplasty
B. Botulinum toxin injections to the bladder and teaching the patient intermittent self-catheterisation
C. Intravesical therapy (Oxybutynin)
D. Posterior tibial nerve stimulation
E. Sacral neuro modulation

39. You have just completed a vaginal hysterectomy for a proceden- tia. However, upon catheterisation, no urine is present in the catheter bag. A cystoscopy is performed and no bladder trauma is identified. In order to assess ureteric function you give indigo carmine and after 5 minutes you observe a blue stream from the right ureteric orifice but none from the left. What would be the next line of management?

A. Contact the urologist with a view to stenting the ureter
B. Cut the sutures that you used for vault support and see if there is any change in your cystoscopy findings
C. Give an intravenous a bolus dose of a diuretic and wait another 5–10 minutes
D. Insert a catheter into the bladder and perform postoperative imaging
E. Perform an intra operative ultrasound

40. A 48-year-old morbidly obese woman has a sister who recently had surgical treatment for prolapse. She is therefore interested in finding more about the impact of obesity on the development of prolapse. The occurrence of which type of prolapse shows the most significant increase in association with morbid obesity?

A. Cystocele
B. Enterocele
C. Rectocele
D. Urethral prolapse
E. Uterine prolapse

41. A woman is contemplating having either a Sacrospinouscolpopexy (no mesh) or a Sacrocolpopexy (with mesh). The patient is keen on having a Sacrocolpopexy but is concerned about novo prolapse. What is the incidence of de novo prolapse (cystocele), after Sacro- colpopexy and Sacrospinouscolpopexy?

Sacrocolpopexy Sacrospinouscolpopexy
A. 2%. 4%
B. 8%. 8%
C. 1 4% 12%
D. 24% 12%
E. 31% 14%

A. A
B. B
C. C
D. D
E. E

Urogynaecology Extra Questions

Urogynaecology Extra Questions

Quiz Summary

Information

Results

Results

Categories

1. Question

2. Question

3. Question

4. Question

5. Question

6. Question

7. Question

8. Question

9. Question

10. Question

11. Question

12. Question

13. Question

14. Question

15. Question

16. Question

17. Question

18. Question

19. Question

20. Question

21. Question

22. Question

23. Question

24. Question

25. Question

26. Question

27. Question

28. Question

29. Question

30. Question

31. Question

32. Question

33. Question

34. Question

35. Question

36. Question

37. Question

38. Question

39. Question

40. Question

41. Question

Share This Story, Choose Your Platform!

About the Author: up2bndu@gmail.com