MRCOG Part 2 – Urogynaecology EMQ

Option List
A. Normal bladder mucosa
B. Interstitial cystitis
C. Hunner’s ulcer
D. Bladder cancer
E. Cystitis cystica
F. Normal blader neck
G. Bladder diverticulum
H. Urethrocele
I. Duplicated ureter
J. Squamous metaplasia of the trigone
Identify each of the cystoscopic images performed for in women. Each option may be used once or more than once or not at all

1. Image 1

2. Image 2

3. Image 3

4. Image 4

5. Image 5

6. Image 6

Option List
A. Offer surgical management for stress urinary incontinence
B. Bladder diary
C. Perform urine dipstick
D. Perform cystoscopy
E. 2 week referral pathway for suspected bladder cancer
F. Referral to specialist service
G. Treat the most predominant symptom
H. Non-urgent referral pathway
I. Perform multichannel filling and voiding cystometry before surgery
J. Assess post void residual urine
K. Send for a mid-stream urine culture
For the scenario described below, choose the most appropriate management option. Each option may be used once or more than once or not at all.

7. 54 year old multiparous woman has presented with urinary incontinence with symptoms of voiding difficulty. Her urine dipstick is negative. You have asked her to maintain a bladder diary. The most appropriate management option would be

8. 76 year old woman had presented to the gynaec OPD with dysuria. Urine examination, revealed no evidence of urinary tract infection with unexplained non-visible hematuria. The most appropriate management option is

9. 55 year old P2L2, had presented to the outpatient clinic with complaints of urge predominant mixed incontinence. Urine analysis was normal and She had received bladder training and SPFMT. Her urge symptoms improved with oxybutynin but symptoms of stress incontinence persisted. The most appropriate management option would be

Option List
A. Midstream urine sample for microbiology
B. Pelvic floor exercises
C. Multichannel cystometry
D. Weight loss
E. Duloxetine
F. Oxybutynin
G. Tolterodine
H. Solifenacin
I. Pre-operative counselling in a clinic setting
J. Case discussion in multidisciplinary setting
K. Joint management with urology
L. Botulinum toxin
M. Midurethral retropubic tape
N. Midurethraltransobturator tape
O. Open colposuspension
P. Laparoscopic colposuspension
Choose the most appropriate management options for urinary difficulties experienced by women. Each option may be used once, more than once or not at all.

10. A 40-year old presents with leaking urine. Her symptoms mainly occur while coughing, sneezing and gardening. There is also some degree of urgency. There is no incontinence demonstrated on examination. Urodynamics suggest evidence of urodynamic stress incontinence

11. A 76-year old with a BMI of 40 presents with symptoms of incontinence which is affecting her daily life. She is on treatment for heart failure, unstable angina and COPD. Pelvic examination reveals a small cystocele and minimal uterine descent with leakage on coughing. She has already been referred for physiotherapy which has made little difference to her symptoms.

12. A 45-year-old lady presents with symptoms of leaking urine on walking, light running and every time she laughs or sneezes. She does not have any voiding problems. There are no other medical co-morbidities. Bladder diary shows a daily intake of around 1.5 litres. Examination is unremarkable. She has already tried supervised pelvic floor exercises.

Option List
A. Paravaginal repair
B. Posterior vaginal wall repair
C. Uterosacral ligament suspension
D. Sacrospinous vault fixation
E. Pelvic floor exercises
F. Colpocleisis
G. Abdominal sacrocolpopexy
H. Posterior vaginal wall repair with mesh
I. Traditional anterior repair
J. Shelf pessary
K. Ring pessary
For each of the following case scenarios select the most appropriate treatment from the list of options given above. Each option may be used once, more than once or not at all.

13. A 49-year-old woman presents with ‘something coming down’ for the past 8 months. She has previously had a vaginal hysterectomy for heavy menstrual bleeding. She is sexually active and denies any bladder or bowel symptoms. On examination she has stage 3 apical prolapse and stage 1 anterior prolapse.

14. A 66-year-old woman presents with ‘something coming down’ and difficulty emptying her bowels. She has had a vaginal hysterectomy and posterior repair 2 years ago and was well for the first 8months post-operation. She does not report any urinary symptoms. She is not sexually active. Examination reveals a stage 2 posterior prolapse, stage 1 apical descent and a well-supported anterior wall.

15. A healthy 60-year-old sexually active women presents with a sensation of a bulge ‘down below’ and difficulty sometimes initiating urinary voiding. On examination she has stage 2 anterior compartment prolapse. The vault is well supported, as is the posterior vaginal wall. She is having to spend increasing amounts of time caring for her elderly mother and is keen on a definitive treatment as soon as possible.