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Urogynaecology(EMQ)- Urogyn Module part-2

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1)

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.

2)

A 45 year old woman complains of urinary frequency, urgency and
urge incontinence. Clinical examination showed an 18 weeks size
fibroid uterus with a small cystocele but no rectocele

3)

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
vagina.

4)

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

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

6)

. 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.

7)

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.

8)

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

9)

A 34 year old nulliparous woman complains of urinary frequency,
urgency, deep dyspareunia and bladder pain. Urine dipstix shows
persistent haematuria but culture is negative.

10)

A 45 year old woman remains in hospital 8 days after Burch
colposuspension because she is unable to empty her bladder
spontaneously. The supre-pubic catheter has been removed and
she now has a urethral catheter

11)

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

12)

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

13)

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

14)

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

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

16)

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.

17)

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.

18)

.A 60-year-old woman has an initial appointment at the gynaecology clinic. Her
presenting symptoms are urinary leakage, urgency and nocturia.

19)

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.

20)

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.

21)

A 33 year old woman complains of debilitating urinary frequency,
urgency and urge incontinence but no other symptoms. Clinical
examination is normal and urine microscopy and culture are
negative.

22)

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.

23)

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.

24)

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.

25)

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

26)

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

27)

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.

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

29)

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

30)

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
unremarkable.

31)

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

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