Chapter 28: Urinary Incontinence And Uterovaginal Prolapse Flashcards
You are a trainee intern in a general practice seeing Debbie, a 54 year old para 2 Pākehā woman who presents with an increasing problem of hesitancy and delay in starting micturition. Which of the following options is the LEAST important in her initiating micturition?
Pressure in the proximal urethra becomes lower than pressure in the bladder
Relaxation of the pelvic floor muscles
Parasympathetic stimulation of the detrusor muscle
Narrowing of the urethrovesical angle
Blocking cortical inhibition of the sacral reflex arc
Narrowing of the urethrovesical angle
You are a trainee intern in a general practice with Seiko, a 40 year old para 4 Japanese woman who presents with a 3 month history of leakage of urine whenever she coughs or sneezes. You suspect that she has stress incontinence. Which of the following statements is MOST LIKELY to support your presumed diagnosis of stress incontinence if obtained during your history taking?
For the last 3 months she has had difficulty in initiating micturition
She has had leakage of urine with orgasm for the last three months
She has had nocturia twice a night for the last four years
She first started leaking urine when coughing and sneezing for three months after the birth of her third child who was born with forceps. This resolved spontaneously
She had recurrent urinary tract infections (UTIs) during her 4th pregnancy. Her 4th child was born via caesarean section for a placenta praevia.
The correct answer is: She first started leaking urine when coughing and sneezing for three months after the birth of her third child who was born with forceps. This resolved spontaneously
You are a trainee intern in a general practice seeing Joyce, a 60 year old para 1 NZ European woman who presents with the inability to hold urine over the last six months. Now she must pass urine every two hours, otherwise she experiences leakage. You suspect that Joyce has an overactive bladder. Which of the following statements is LEAST likely to support your presumed diagnosis of overactive bladder if obtained during your history taking?
Joyce needs to rush to the toilet when she becomes aware of the need to pass urine
Joyce sometimes leaks urine before getting to the toilet
Joyce has increased urinary frequency at night
Joyce experiences burning when passing urine
Joyce sometimes leaks urine in bed at night
Joyce experiences burning when passing urine
You are a trainee intern in a general practice and have been asked to see Jane, a 65 year old para 1 NZ European woman who has presented with a “bladder problem” that she has had for three months. Which of the following questions would be LEAST LIKELY to assist with the diagnosis of her bladder problem?
Do you have any associated bowel leakage or constipation?
Did you have any bleeding problems when going through your menopause?
Do you leak urine? If so, when does it occur?
Do you need to get up to pass urine at night?
Do you have a persistent cough?
What medications to you take?
Do you have frequency of passing urine?
Have you had any weight gain?
Did you have any problems during your pregnancy or the birth?
Did you have any bleeding problems when going through your menopause?
You are a trainee intern in general practice seeing Kahurangi, a 45 year old para 4 wahine Māori, who presents with a 12month history of increasing stress incontinence. Her children were all born vaginally at term. She has a BMI of 32. She smokes 15 cigarettes per day and has a chronic cough. Her hypertension is controlled with labetalol. Kahurangi tends to become constipated, and then uses laxatives. She has regular periods. Her husband has had a vasectomy. Examination shows some laxity of the anterior vaginal wall and the perineum, but no demonstrable stress incontinence, and no other abnormalities. An MSU is negative for infection and glucose. Kahurangi asks about factors predisposing her to stress incontinence. Of the following issues noted above, which is the LEAST likely to be a predisposing factor to her stress incontinence?
Being para 4 (all vaginal births)
Her age of 45
Her smoking 15 cigarettes per day
Her obesity - BMI 32
Her chronic cough
Her use of the antihypertensive drug labetalol
Her use of the antihypertensive drug labetalol
It isnt a diuretic
You are a trainee intern in a general practice with Moon, a 72 year old G1P1 woman of Chinese ethnicity, who has presented with a “bladder problem”. She has symptoms of both stress urinary incontinence and an overactive bladder. The onset of the problem was six months ago with some hesitancy and slow stream of urine during voluntary urination possibly suggestive of retention with overflow. Which of the following aspects of a pelvic examination would be the LEAST LIKELY to assist with the diagnosis of her bladder problem?
Undertaking a bimanual examination
Use of the left lateral position, and the Lucy (Sims) speculum
Assessing if any uterine prolapse or posterior wall laxity?
Assessing the laxity of the anterior vaginal wall
Assessing perineal muscular activity
Assessing presence or absence of an anal reflex
Taking a routine cervical smear
Taking a routine cervical smear
You are a trainee intern in general practice seeing Shihong, a 45 year old nulliparous woman of Chinese ethnicity who presents with a 12 month history of increasing urinary frequency and nocturia. More recently she has had urine leakage on the way to the toilet when she hasn’t made it in time. The amount of urine passed with each void is less than previously. She has no pain or dragging sensation, no stress incontinence and no other bowel or bladder symptoms. Her periods are still regular and normal. She has never tried to conceive in any relationships. There is no abnormality on abdominal examination and she has a normal BMI. Which of the following is the MOST likely finding on vaginal examination?
No anterior or posterior vaginal wall prolapse
Cystocoele and rectocoele
Cystocoele
Rectocoele
Enterocoele and rectocoele
Enterocoele
No anterior or posterior vaginal wall prolapse
You are a trainee intern in general practice seeing Rangi, a 45 year old nulliparous wahine Māori who presents with a 12 month history of increasing urinary frequency and nocturia. More recently she has had urine leakage on the way to the toilet when she hasn’t made it in time. The amount of urine passed with each void is less than previously. She has no pain or dragging sensation, no stress incontinence and no other bowel or bladder symptoms. Her periods are still regular and normal. She has never tried to conceive in any relationships. There is no abnormality on general or vaginal examination and she has a normal BMI. Which of the following is the MOST important INITIAL investigation?
Cervical smear
MSU for culture
Cystoscopy
Pelvic and renal ultrasound
A glucose tolerance test
Urodynamics
MSU for culture
You are a trainee intern in gynaecology clinic seeing Kay, a 70 year old para 1 Pākehā woman who has presented with a “bladder problem”. Kay has a picture of mixed incontinence with symptoms of both stress urinary incontinence and urge incontinence. She has difficulty initiating urination. Kay has a normal BMI. Abdominal examination is unremarkable. Vaginal examination reveals atrophic tissues and a moderate cystocele. Bimanual examination is unremarkable.. An MSU was negative for infection. Which of the following investigations would now be MOST appropriate for Kay?
Urodynamic testing
Urinalysis for glycosuria and ketonuria
Blood test for glucose and HbA1C
IVP
Renal ultrasound scan and post void residual
Repeat of the MSU
Renal ultrasound scan and post void residual
You are a trainee intern in general practice with Aroha, a 45 year old para 4 wahine Māori who presents with a 12 month history of increasing stress incontinence. Her children have all been born vaginally at term. She has a BMI of 32, smokes 15/day, has a chronic cough, and her hypertension is controlled with labetalol. She tends to become constipated, and then uses laxatives. Aroha has regular periods. Her husband has had a vasectomy. Examination shows a cystocele and deficient perineum, but no demonstrable stress incontinence. An MSU is negative for infection and glucose. Which of the following general treatment principles for management of stress incontinence is LEAST likely to apply to Aroha?
Advise her to stop smoking
Treat her constipation by dietary means
Recommend physiotherapist-taught pelvic floor exercises
Prescribe a vaginal oestrogen cream
Encourage weight loss
Prescribe a vaginal oestrogen cream
You are a trainee intern in a gynaecology clinic seeing Denise, a fit 30 year old Para 3 Pākehā school teacher referred in with urinary incontinence since the birth of her third child 12 months ago. She says this is worse when she laughs, coughs or bends to pick up the children. Denise has no nocturia, urinary frequency, urgency or dysuria. Pelvic examination shows a mild cystocoele and rectocoele and demonstrable stress incontinence. A recent urine sample was negative for infection. Which of the following options would be your INITIAL TREATMENT RECOMMENDATION?
A ring pessary
Incontinence pads
Pelvic floor physiotherapy and lifestyle advice
Mid-urethral sling (eg TVT)
Tri-cyclic antidepressant e.g. amitriptyline
Anti-cholinergic medication e.g. oxybutynin
Pelvic floor physiotherapy and lifestyle advice
You are a trainee intern in general practice seeing Noeleen, a 45 year old para 0 Pākehā woman who presents with 12 months of increasing urinary frequency, nocturia, urgency and urge incontinence. In the last three weeks she has had three episodes of urinary incontinence which have been embarrassing for her and she is anxious about this happening at work. Urine volumes are less than previously. She has no stress incontinence and no other bowel or bladder symptoms. Her periods are still regular and normal. Noeleen has never tried to conceive in any relationship. There is no abnormality on general or vaginal examination and she has a normal BMI. An MSU three days ago was normal. Noeleen would prefer, at least initially, an option that is “natural” and avoids medications. Which of the following options is MOST LIKELY to be recommended?
Bladder retraining with physiotherapy
Vaginal oestrogen cream
Anti-cholinergic medications
Physiotherapy-pelvic floor exercises (Kegel’s)
Electrical therapy
Bladder retraining with physiotherapy
You are a trainee intern in general practice seeing Gail, a 45 year old nulliparous Pākehā woman who presents with a 12 month history of increasing urinary frequency, nocturia, and urine leakage on the way to the toilet. Three days prior to seeing you she had an episode of urge incontinence. The amount of urine passed with each void is less than previously experienced. She has no stress incontinence and no other bowel or bladder symptoms. Her periods are still regular and normal. She has never tried to conceive in previous relationships. There is no abnormality on general or vaginal examination and she has a normal BMI. An MSU from three days ago was normal. You arrange a physio referral for bladder retraining exercises, and prescribe an anticholinergic medication. From the following options, what is the MOST COMMON side-effect of the anticholinergic medication that you would advise her about?
Drowsiness
Dry mouth
Macular degeneration
Nausea
Dizziness
Dry mouth
You are a trainee intern in a gynaecology clinic with Mary, a 55 year old para 4 Pākehā woman in with a history of feeling a bulge at the opening to her vagina. Her GP has advised her that she has a prolapse of her bladder. Her four pregnancies all went overdue, and she always required help in labour, including forceps for the births. All the children weighed between 3800 and 4200 grams. She is obese with a BMI of 31 and has a chronic smokers cough – she smoked 25/day until a year ago. Menopause was at age 44. Of the following options, what is the MOST LIKELY predisposing factor to her prolapse?
Her obesity with BMI of 30
The prolonged labours with forceps required for delivery
Her history of smoking until aged 54
Her chronic cough
Her becoming postmenopausal at 44
The prolonged labours with forceps required for delivery
You are a trainee intern in a gynaecology clinic seeing Malia, a 55 year old para 4 New Zealander of Indian ethnicity who was referred by her GP with a rectocele. Malia had become aware of a bulge at the entrance to her vagina. Along with the bulge, which other symptom of a rectocele is Malia MOST LIKELY to have?
Constipation and difficulty with defaecation
Vaginal discharge
Dyspareunia
Stress incontinence
Urinary hesitancy with difficulty initiating urination
Postmenopausal bleeding
Backache
Constipation and difficulty with defaecation
