FCPS Part-2 Written -Urogynecology & Gynecological Infection

1. An 82 years 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?

2.A 53years old patient presents with a history of urinary symptoms of urgency, increased frequency and nocturia. She  does not have symptoms of hesitancy and feels as though she empties her bladder completely. What would be the first line of management?

3.  A 42 years old patient presents with symptoms of leakage of urine upon coughing, sneezing and during exercise. The symptoms started following the birth of her second child 18 months ago. What would be the first line of management?

4.A  35 years old patient presents in emergency with c/o urinary retention. Upon taking a history, you also discover that the patient has been having hematuria for several weeks. What is an absolute contraindication to inserting a suprapubic catheter?

5. 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?

6. A 39 years old P1 patient presents with stress incontinence with no other urinary symptoms. What would be the first line of management?

7. A 45years old  patient is undergoing a vaginal hysterectomy for 3^rd degree  uterine prolapsed 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?

8.A fit and healthy 52 years old patient with confirmed detrusor overactivity has tried three different medical treatments(Oxybutynin, Solifenacin, Mirabegron). The procedure that should be offered to the patient is

9. A 38 years old patient is suffering with stress incontinence. Her BMI is 32 kg/m2 and the patient is interested in lifestyle management for her incontinence. What is the most important lifestyle change that you would recommend?

10. A patient presents with symptoms of a prolapse. On examination, the pelvic organ quantification score is Aa 0, Ba 0, C −5, D −7, Ap −2Bp −2 tvl 9, gh 4, pb 3. The patient wants her prolapse to be treated surgically. What is the correct diagnosis and surgical treatment?

11. A 32 years old multiparous woman has confirmed urodynamic stress incontinence and admits that she has not completed her family. What management would you propose for this patient?

12.A 28 years old woman presents with a history of pelvic pain, urinary urgency, increased frequency and nocturia. The pelvic pain tends to occur during bladder filling and is relieved by voiding and you suspect that the patient has interstitial cystitis. What other mandatory investigation is required in order to make

an accurate diagnosis?

13. A 64 years old patient presents with a history of increased urinary frequency, nocturia, urgency and occasional urgency incontinence. What would be the next line of management?

14. An 84 years old patient presents with symptoms of urgency, urgency incontinence and nocturia. The patient is taking several different medications for other medical conditions. A diagnosis of overactive bladder is made.The general practitioner has already tried Oxybutynin but the patient had side effects (central nervous system) and this was stopped. Which anticholinergic medication would you now consider?

15. A 52 years old patient presents with a history suggestive of an overactive bladder, but also complains of faecal incontinence. The patient has tried conservative measures and various anticholinergics with no significant benefit.

Urodynamic testing confirms detrusor overactivity and some voiding dysfunction. What is the best surgical option for this patient?

16. You have just completed a vaginal hysterectomy for a procedentia. However, upon catheterisation, no urine is present in the catheter bag. A cystoscopy is performed and no bladder trauma is identified. In order to assess ureteric function you give indigo carmine and after 5 minutes you observe a blue stream from the right ureteric orifice

but none from the left. What would be the next line of management?

17. A 48-year-old morbidly obese woman has a sister who recently

had surgical treatment for prolapse.

She is therefore interested in finding more about the impact of

obesity on the development of prolapse.

The occurrence of which type of prolapse shows the most significant

increase in association with morbid obesity?

18. May be injured during local anaesthetic instillation for episiotomy, during labour or from vaginal prolapse surgery. It can result in pre‐sacral and vulval haematomas

19. A 68 year old patient is seen in clinic due to overactive bladder symptoms and bothersome nocturia. She is a non‐smoker, BMI 27 kg/m², BP 140/90. She takes the following medications:

 amlodipine 10mg OD

 ramipril 5mg OD

Examination reveals only vaginal atrophy but no evidence of prolapse. MSU shows no signs of infection or haematuria.

20. A 32 year old patient comes to see you as she has noticed urinary leakage when she coughs or sneezes since her last last pregnancy 2 years ago. Her BMI is 24.5 kg/m² and on history she has a normal fluid intake including avoidance of caffeinated drinks. Examination reveals mild objective weakness of the pelvic floor

21. You are reviewing a 55 year old patient in clinic. Her BMI is 25kg/m². She has been avoiding

caffeine and limiting her fluid intake to 2 litres per day with minimal evening intake. She has not

been able to tolerate oral oxybutynin or tolteridone due to dry mouth.

22. A 65 year old patient undergoes vaginal hysterectomy. The vault descends to the introitus

during closure. Which procedure, if any, is appropriate to prevent PHVP (post hysterectomy vault prolapsed) ?

23. A 66 year old patient with symptomatic PHVP (post hysterectomy vault prolapse) has consented to surgery. She has short vaginal length and is sexually active

24. A patient is being assessed for vaginal vault prolapse. The distance from the plane of the hymen to point C describes what?

25. A 70 year old patient has a grade I PHVP (post hysterectomy vault prolapse). She is active, generally well and her only regular

medication is Ramipril 2.5mg

26. A 24 years old woman presented with recurrent episodes of bacterial vaginosis despite initial successful treatments. She is married to the same partner from last 6 years with no other significant risk factor in history. Which of the following consistently decreases recurrence rate of these episodes?

27. A 28years old woman presented with c/o a 3 cm painful vulval abscess from last few days. On examination there is redness around the lesion, otherwise woman is healthy. U plan empirical antibiotic therapy while waiting for cultures with plan of incision and drainage. Which of the following is least effective against MRSA?

28. you prescribe doxycycline to a patient with c/o vulval abscess , she should be warned about which of the following while taking this medication?

29. a 22 year old patient has presented with first episode of painful vulval lesions. These first appeared as blisters. Which of the following is true regarding this type of infection?

30. A 30 years old woman presented with recently diagnosed HIV infection. She gives history of a single painless sore on vulva 5 months back that resolved without treatment after almost 2 weeks. Now presented with complaint of painless warty genital lesions from last 1 week. What you think is wrong with this patient?

31. A 22 years old woman has presented with a 4 days history of painless vulval nodules that has progressed to become ulcers that bleed easily. Minimal inguinal lymphadenopathy present. She is married to same partner from last 4 years. Giemsa stain of lesion shows Donovan bodies. What is her diagnosis?

32. A 28years old woman presented with complaint of recent onset of dysuria, vaginal discharge and p/v spotting. Her saline preparation shows flagellated organisms. She had this infection before and is allergic to metronidazole. What is next best option for her?

33. Which of the following mechanism is responsible for tubal damage caused by chlamydia trachomatis infection?

34. A 25years old woman has presented with her concerns regarding getting pregnant. She had a single episode of PID 4 years back. What is her risk of infertility after single episode of PID?

35. a 40 years old woman with H/O uncomplicated vaginal hysterectomy 2 weeks back. She has received peri operative antibiotic prophylaxis. Now has presented with C/O right sided lower abdominal pain from last few days which has progressed to become more generalized now. She also has 1 day history of fever and refuse to eat. On examination her BP is 90/60, PR is 108/min . her abdominal examination shows peritonitis with extreme tenderness. Which of the following is most liely?

36. A 22 years old woman has presented in emergency with 2 days history of progressive malaise, fever, anorexia, body aches and diarrhea. She has history of an IUCD insertion 1.5years back. Her last menstrual period was 4 days bac. She had a new relation 3 months back. On examination her BP is 80/550, PR is 110/min. she has diffuse macular rash , with mild tenderness on abdominal and vaginal examination. Also has redness in oropharynx and vaginal mucosa.  After sending bacterial cultures you start IV antibiotics for which of following organism?

37. A 24 years old woman presents with the complain of vaginal discharge. Her high Vaginal swab results show that she has bacterial vaginosis. Which infection needs treatment of an asymptomatic sexual partner?

38. A 23 year old woman presents with 2 days complain of

bilateral lower abdominal pain. On examination, her temperature is 101F with

bilateral adnexal tenderness.  Her tests been negative for Chlamydia and gonorrhea one month back. What is the management for this woman?

39. A 26 years old woman presents with complain of irregular vaginal bleeding, in the form of post-coital and intermenstrual bleeding and menorrhagia. Her temperature is 100F. On bimanual examination, there is adnexal tenderness and cervical motion tenderness. pregnancy test is negative. You diagnosed a pelvic inflammatory disease (PID). The patient tells you that she had unprotected sex. What is the recommended regimen for this patient?

40. A 23 year old woman presents with complain of vaginal discharge from last 2 days. She has h/o recurrent episodes of vulvovaginal candidiasis. You prescribe an induction and maintenance regimen for six months. She is worried about use of contraception as she had an IUCD inserted two months earlier. What advice would you offer her?

41. A 24 year old woman comes for follow-up after a diagnosis of PID three weeks back. Results of swabs were negative for chlamydia and gonorrhoea. You explained the significance of PID and its sequelae. She tells you that the symptoms resolved and she had her antibiotics regularly. What else should you check at this visit?

42. A 24 year old woman presents with complain of small multiple painful vulval ulcers. On examination, the base of the ulcer was erythematous and inguinal lymph nodes were palpable and painful. What is the most likely diagnosis?

43. A 22 year old woman presents with complain of multiple painful ulcers on the vulval area. On examination, the ulcers are sharply demarcated with a yellow exudate in the base. Her right inguinal lymph nodes are also palpable and painful.What is the most likely causative organism?

44. a 25 year old woman has presented with complain of chronic pelvic pain from last 9 months. U plan a diagnostic laparoscopy after initial investigation. On laproscopy you

notice inflammation of the liver capsule and adjacent peritoneum. What is the most likely causative organism?

45. A 22 years old woman presents with complain of vaginaldischarge. Her swab was taken from the endocervix, microscopic examination reveals a Gram-positive diplococcus. What organism looks like this under a microscope?

46. A 22 year old pregnant woman presented with c/o anogenital warts. She is diagnosed with human papillomavirus (HPV) infection-type What are her treatment options?

47. A 23 years old pregnant woman presented to you two weeks back with complain of vaginal discharge associated with abdominal pain. She was diagnosed with PID and azithromycin 1 g as a single dose was given. You arranged for contact tracing. What is the next step?

48. A 24 year old woman presented with c/o lower abdominal pain and fever. You You diagnosis her as c/o moderate PID and prescribe a combination of a single intramuscular injection of cefoxitin and oral doxycycline and antipyretics. She is worried about her future fertility as a result of her PID. Where is she best treated to preserve her fertility?

49. A 23year old woman presents with complain of bilateral lower abdominal pain and fever. On examination, her temperature is 102F with bilateral adnexal tenderness.

What is your first line of investigation?

50. A 23 years old woman visits you as she wants testing for gonorrhea as her husband has been married twice before in last few years but uses condoms for contraception.

What tests should you offer her?