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1 An 84-year-old patient who had a previous history of vaginal hysterectomy 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?CorrectIncorrect
- A patient is undergoing a vaginal hysterectomy for uterine prolapse 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 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 17-year-old G1P1 presents to your office for her yearly well-woman examination. She had an uncomplicated vaginal delivery the previous year. She has been sexually active for the past 4 years and has had four different sexual partners, but has been monogamous in the previous year with the same partner. Her menses occurs every 28 days and lasts for 4 days. She denies any intermenstrual spotting, postcoital bleeding, or vaginal discharge. She reports no tobacco, alcohol, or illicit drug use. Which of the following are appropriate screening tests for this patient?
5.A 44-year-old woman (gravida 5, para 5) comes in complaining that she has noticed a bulge protruding fromher vagina. Her other medical problems include hypertension, diabetes mel-litus, and alcoholism. She stands at work as a grocery clerk. She has a family history of genital prolapse. On examination, you notice a uterine prolapse, cystocele, and rectocele. Which of the following is a major risk factor for her pelvic support disorder?CorrectIncorrect
6.A 49-year-old parous woman comes in complaining that over the last several years, it feels as though “her organs are progressively falling out her vagina.” She also complains of losing urine with coughing, occasional urgency, and sometimes a feeling of incomplete emptying of her bladder with voiding. On further examination, which of the above-mentioned options will you likely find?CorrectIncorrect
7.. A 56-year-old woman complains that she is “sitting on a ball.” She says constipation is a significant problemand that sometimes she needs to push stool out of her rectumby inserting a finger in the vagina and pressing on a bulge. On further examination, which of the above-mentioned options will you most likely find?CorrectIncorrect
- A 68-year-old woman complains of something falling out of her vagina, and she thinks it causes a constant backache. The backache is least symptomatic when she gets up in the morning and worsens as the day goes on. She says she cannot understand why she has this, because 4 years ago she had an abdominal hysterectomy and urethral suspension (Burch procedure) to correct the “falling out” and some problemwith urine loss. Her ability to hold her urine is excellent since the first surgery. Given her history, on examination which of the above-mentioned do you expect to find?
9.A 90-year-old woman comes to your office complaining that she feels as though she is “sitting on a ball.” On examination, you find that the vagina is essentially turned inside out, and the entire uterus lies outside the vaginal introitus. This condition is known as which of the following?CorrectIncorrect
- When performing a vaginal hysterectomy for any indication, prevention of future enterocele or vaginal vault prolapse is aided by which of the following?