BC Pelvic Prolapse/ Vag DC/Vag Pruritis Flashcards
What are risk factors for incontinence?
Obesity, Parity, Mode of Delivery, Age, Smoking
What are the mechanism of Stress incontinence?
Urethral hypermobility, intrinsic sphincteric deficiency
What is urethral hyper mobility thought to stem from?
insufficiency support of the pelvic floor musculature and vaginal connective tissue to the urethre and bladder neck.
What is the strongest risk factor for incontinence?
obesity
A 63-year-old G4P2 female, presents with a 2-year history of having “something bulging” out of her vagina during straining. She is not emptying her bladder completely and often “double voids.” She denies any urinary incontinence or gastrointestinal symptoms. Past gynecologic history is significant only for an abdominal hysterectomy and oophorectomy.
What is the most likely diagnosis?
a) Rectocele.
b) Cystocele.
c) Enterocele.
d) Detrusor dyssynergia.
e) Procidentia.
Cystocele
54 year old multipara with a connective tissue disorder, presents with the physical findings of a rectocele
Which of the following symptoms, would you most likely elicit from her ?
A- constipation B- diarrhea C- the need for digital decompression of the bulge to defecate D- dyspareunia E- Vaginal bleeding
C-the need for digital decompression of the bulge to defecate
Which one of the following findings on pelvic
examination is compatible with a diagnosis of
procidentia?
a) The patient is asked to “bear down” during pelvic ultrasound to confirm that it is the uterus that descends and not some other structure.
b) An ulcerated solid mass is visible at the introitus.
c) The cervix is elongated to such an extent that it readily protrudes beyond the introitus when the patient is asked to “bear down”.
d) A visible lump is seen to protrude through the introitus when the patient is asked to “bear down”.
e) The uterus descends below the introitus with or without the patient standing.
e)The uterus descends below the introitus with
or without the patient standing.
An 85 year old G5P5 female presents to your office
with difficulty voiding and dysuria of 6 months
duration. On examination, you observe the cervix is
at the level of the introitus. Which one of the
following would be the best initial management?
a) Oral anticholinergics
b) Vaginal hysterectomy
c) Pelvic floor exercises
d) Insertion of a pessary
e) Oral antibiotics
d)Insertion of a pessary
When do you get the positive amine test?
In BV (positive whiff test with addition of KOH prep) fishy odor
How do you diagnose candida
KOH wet mount reveals hyphe and spores
What does saline wet mount with clue cells mean
BV (squamous epithelial cells dotted with coccobacilli (gardnerlla)
How do you treat BV
oral metronidazole, topical metronidazole
How do you manage candida in pregnancy
Treatment in pregnancy is usually topical.
What are problems with asymptomatic BV in pregnancy?
recurrent perm labour, perm birth, postpartum endometritis
How do you diagnose thrichomoniasis
Saline wet mount
