gynae - urogenital and vulval

Question 1

RF UI

Answer 1

age // previous pregnancy, childbirth // hysterectomy // fat // smoking

Question 2

symptoms urge incontinence

Answer 2

(overactive bladder) - urge to urinate followed by uncontrollable leakage

Question 3

urodynamic findings urge inconinence

Answer 3

overactive detrusor

Question 4

stress incontinence symptoms

Answer 4

leaking when increased pressure eg coughing, laughing

Question 5

overflow incontinence symptoms

Answer 5

bladder outflow obstruction eg prostate

Question 6

invx incontinence

Answer 6

bladder diary 3 days // vaginal exam for prolapse // urodynamic study // dipstick

Question 7

lifestye + physio advise urge

Answer 7

reduce coffee // bladder retraining (6 weeks)

Question 8

1st line pharma mx urge

Answer 8

Anticholinergics eg oxybutynin, tolterodine, or darifenacin

Question 9

2nd line pharma mx urge

Answer 9

mirabegron (beta3agonist) - esp in elderly

Question 10

stress incontinence lifestyle + physio mx

Answer 10

pelvic floor muscle retraining (8 contractions 3x day, for 3 months) // lose weight

Question 11

medical mx stress

Answer 11

duloxetine (SNRI)

Question 12

what is a cytsocele prolapse

Answer 12

bladder prolapses backwards into vagina (anterior wall vagina prolapse)

Question 13

what is a rectocele prolapse

Answer 13

rectum prolapes forward into vagina (posterior wall vaginal prolapse)

Question 14

enterocele prolapse

Answer 14

herniation of pouch of douglas +/- intestine

Question 15

what is uterine prolapse

Answer 15

uterine prolapses down into vagina

Question 16

RF prolapse

Answer 16

age, multiparity, vaginal delivery, obese, spina bifida

Question 17

symptoms prolapse

Answer 17

pressure or heaviness // urinary incontinence, frequency, urgency

Question 18

what is a 1st degree uterine prolapse

Answer 18

in superior vagina - 1cm+ above interosus

Question 19

what is a 2nd degree uterine prolapse

Answer 19

in inferior vagina - within 1cm interosus

Question 20

what is a 3rd degree uterine prolapse

Answer 20

outside vagina

Question 21

what is a 4th degree uterine prolapse

Answer 21

procidentia - complete uterine prolapse

Question 22

escalating mx prolapse

Answer 22

weight loss + pelvic floor –> ring pessary –> surgery

Question 23

what causes atrophic vaginitis

Answer 23

decreased oestrogen

Question 24

symptoms atrophic vaginitis

Answer 24

dry vagina // bleeding // dysparenuia

Question 25

o/e atrophic vaginitis

Answer 25

pale and try

Question 26

mx atrophic vaginal

Answer 26

topical lubricant + moisturisers –> topical oestrogen

Question 27

symptoms vulvar pagets

Answer 27

crusting + red, sharp demarcation, itchy

Question 28

what cyst can get infected in vaginal opening

Answer 28

bartholians

Question 29

what is vulvodynia

Answer 29

itchy, stingy, burning vulva with no underlying cause

Question 30

mx vulvodynia

Answer 30

provoked = topical lidocaine // non-provoked = TCA, gabapentin

Question 31

symptoms lichen sclerosus

Answer 31

inflamm disorder - hypopigmented skin, scar, vv itchy, pain on urination or intercourse, figure of 8 pattern

Question 32

invx lichen sclerosus

Answer 32

clinical +/- biopsy if cancer quiery

Question 33

mx lichen sclerosus

Answer 33

topical steroids

Question 34

complication lichen sclerosus

Answer 34

cancer

Question 35

most common vulval carcinoma

Answer 35

SCC

Question 36

RF vulval carcibona

Answer 36

age 65+ // HPV // VIN // immunosuppressed // lichen scleruosus

Question 37

symptoms vulvar carcinoma

Answer 37

lump or ulcer on labia majora // inguinal lymph // itching or irritation

Question 38

mx vulvar cancer

Answer 38

vulvectomy + inguinal nodectomy