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Category: Obstetrics & Gynecology--->Pelvic Relaxation and Urogynecology
Page: 5

Question 21# Print Question

A 78-year-old woman with chronic obstructive pulmonary disease, chronic hypertension, and history of myocardial infarction requiring angioplasty presents to your office for evaluation of “something hanging out of her vagina.” She had a hysterectomy for benign indications at the age of 48 years. For the past few months, she has been experiencing pelvic pressure and a bulge at the vaginal opening. She reports that 2 weeks ago, something fell out of her vagina. Pelvic examination demonstrates total eversion of the vagina. There is an arc of superficial ulceration at the vaginal apex measuring 2 to 3 cm in diameter.

Which of the following is the best next step in the management of this patient?

A. Biopsy of the vaginal ulceration
B. Schedule abdominal sacral colpopexy
C. Place a pessary
D. Prescribe oral estrogen
E. Prescribe topical vaginal estrogen cream


Question 22# Print Question

A 40-year-old G3P3 presents for a routine annual examination. She tells you that she gets up several times during the night to void. She also reports that during the day she sometimes gets the urge to void, but cannot quite make it to the bathroom in time. She does not leak urine when she coughs or sneezes. Upon further questioning, she admits to drinking several large glasses of iced tea and water on a daily basis, because her mother always told her to drink lots of liquids to decrease her risk of developing a UTI. She attributes this to getting older and is not extremely concerned, although she often wears a pad when she goes out because she is afraid she will leak urine. The patient is otherwise healthy, and does not take any medication. She has had three vaginal deliveries of infants weighing between 7 lb and 8 lb. An office dipstick of her urine does not indicate any blood, bacteria, WBCs, or protein. Her urine culture is negative.

Based on her office presentation and history, which of the following is the most likely diagnosis? 

A. Stress urinary incontinence (SUI)
B. Urinary tract infection
C. Urge incontinence
D. Vesicovaginal fistula
E. Mixed incontinence


Question 23# Print Question

A 40-year-old G3P3 presents for a routine annual examination. She tells you that she gets up several times during the night to void. She also reports that during the day she sometimes gets the urge to void, but cannot quite make it to the bathroom in time. She does not leak urine when she coughs or sneezes. Upon further questioning, she admits to drinking several large glasses of iced tea and water on a daily basis, because her mother always told her to drink lots of liquids to decrease her risk of developing a UTI. She attributes this to getting older and is not extremely concerned, although she often wears a pad when she goes out because she is afraid she will leak urine. The patient is otherwise healthy, and does not take any medication. She has had three vaginal deliveries of infants weighing between 7 lb and 8 lb. An office dipstick of her urine does not indicate any blood, bacteria, WBCs, or protein. Her urine culture is negative.

Which of the following treatments should you recommend to the patient as the next step in the management of her problem?

A. Instruct her to start performing Kegel exercises
B. Tell her to hold her urine for 6 hours at a time to enlarge her bladder capacity
C. Instruct her to eliminate excess water and caffeine from her daily fluid intake
D. Prescribe an anticholinergic
E. Schedule a cystoscopy


Question 24# Print Question

A 40-year-old G3P3 presents for a routine annual examination. She tells you that she gets up several times during the night to void. She also reports that during the day she sometimes gets the urge to void, but cannot quite make it to the bathroom in time. She does not leak urine when she coughs or sneezes. Upon further questioning, she admits to drinking several large glasses of iced tea and water on a daily basis, because her mother always told her to drink lots of liquids to decrease her risk of developing a UTI. She attributes this to getting older and is not extremely concerned, although she often wears a pad when she goes out because she is afraid she will leak urine. The patient is otherwise healthy, and does not take any medication. She has had three vaginal deliveries of infants weighing between 7 lb and 8 lb. An office dipstick of her urine does not indicate any blood, bacteria, WBCs, or protein. Her urine culture is negative.

This patient returns to your office 3 months later, and continues to be symptomatic after following your advice for conservative self-treatment.

Which of the following is the best next step in management?

A. Prescribe Ditropan (oxybutynin chloride)
B. Prescribe estrogen therapy
C. Schedule a mid-urethral sling
D. Refer her to an urologist for urethral dilation
E. Schedule a voiding cystourethrogram


Question 25# Print Question

An 18-year-old G0 comes to see you with a chief complaint of a 3-day history of urinary frequency, urgency, and dysuria. She panicked this morning when she noticed bright red blood in her urine. She also reports some midline lower abdominal discomfort. She had intercourse for the first time 5 days ago and reports that she used condoms. On physical examination, there are no lacerations of the external genitalia, there is no discharge from the cervix or in the vagina, and the cervix appears normal. Bimanual examination is normal except for mild suprapubic tenderness. There is no flank tenderness, and the patient’s temperature is normal.

Which of the following is the most likely diagnosis?

A. Chlamydia cervicitis
B. Pyelonephritis
C. Acute cystitis
D. Acute appendicitis
E. Monilial vaginitis




Category: Obstetrics & Gynecology--->Pelvic Relaxation and Urogynecology
Page: 5 of 6