Urogynaecology Test Part 2

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1) 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.

2) Which of the following best describes the mechanism of action of Cyclizine?

3) 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.

4) A 38-year-old woman presents with urinary leakage on coughing and sneezing. She has

completed her family. She has had two normal deliveries. She also admits that she has

difficulty holding on due to urinary urgency and frequents the toilet at least seven times

a day but not at night. Anticholinergics have not been helpful so far.

5) 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.

6) A 60-year-old woman has an initial appointment at the gynaecology clinic. Her

presenting symptoms are urinary leakage, urgency and nocturia.

7) 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


8) A 90-year-old woman with hypertension and type 2 diabetes presents with

worsening uterovaginal prolapse that is not being controlled with shelf pessaries.

9) A 41-year-old woman presents with a long history of probable recurrent urinary tract

infections and has been treated with presumptive antibiotics when she lived abroad.

She has severe pain in the bladder area and also urinary urgency but no leaks. She also

reports occasional haematuria that resolves spontaneously. Serial urine cultures have

always been negative, including for fungus and atypical bacteria.

10) 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.


11) A 30-year-old woman presents to the gynaecology outpatient department (OPD) with a

6-month history of urinary urgency – frequency but no urge incontinence or nocturia.

The GP letter states that the urinalysis done last fortnight reported negative.

12) 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

13) 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.

14) The most caudal component of the levator ani complex.


15) A woman is referred to a urogynaecologist with recurrent UTIs. A urine dipstick

in the clinic is negative.

16) 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.

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


18) A 72-year-old woman presents to the GP with presence of blood in her urine over the

last 2 months. She has no fever or any other systemic symptoms. Routine urinalysis

shows blood 3+. She feels quite well and has been brought to the GP reluctantly by her

persuasive daughter. The patient apologises for being an encumbrance.

19) A 45 year old woman complained initially of urinary frequency

urgency and urge incontinence and also leaked urine on

coughing or straining. She was treated medically initially and her

symptoms of urinary frequency and urgency have largely

resolved. Over the last 6 months, she is finding that urinary

leakage on coughing and straining is increasingly affecting her

social life.

20) The structure separating the external and internal anal sphincters.

21) The structure accounting for the majority of the resting anal pressure

22) A healthy 57 years old woman complains of a vaginal lump 20

years after total anbdominal hysterectomy for a large fibroid

uterus. Clinical examination showed marked vault prolapse.

23) 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.

10.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

24) A 60 year old woman developed cervical cancer 12 months

earlier and was treated with combined chemotherapy and

radiotherapy. She now complains of blood in her urine which

occurs all the time

25) A 35 year old woman re-attends 6 days after TAH for menorrhagia

because of persistent leakage of clear fluid from the vagina.

Speculum examination showed the presence of urine in the

vagina and a three swab test showed the presence of dye in the


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