Miscellaneous: Pelvic prolapse, urinary incontinence, and pediatrics

Question 1

How does one present when they have pelvic prolapse

Answer 1

1. ) Sensation of bulge or protrusion in vagina
2. ) Urinary or fecal incontinence, incomplete bladdar emptying

Diagnosis: Make woman perform valsalva maneuver while in lithotomy position

Question 2

What is the treatment for pelvic prolapse

Answer 2

1. ) High fiber diet and weight reduction, limit straining and lifting
2. ) Pessary
3. ) Vaginal/abdominal hysterectomy with vaginal vault suspension

Question 3

What are the four types of urinary incontinence

Answer 3

1. ) Total - uncontrolled loss at all times in all positions
2. ) Stress - After cough, sneeze, lifting which incrases intra-abdominal pressure with urethral sphincter insufficiency secondary to laxity of pelvic floor musculature
3. ) Urge incontinence - detrusor hyperrflexia or sphincter dysfunction - neurogenic disorders
4. ) Overflow with urinary retension

Question 4

What is the cause of total incontinence and treatment

Answer 4

Loss of sphincter control from previous surgery, nerve damage, cancer, etc, or there could be a fistula

Must rule out fistula

Treatment: Surgery

Question 5

Which subset of people does stress incontinence happen in and what is the treatment

Answer 5

In multiparous women or after pelvic surgery

Treatment: Kegel exercises, pessary, vaginal vault suspension

Question 6

What is the treatment for urge incontinence

Answer 6

1. ) Anticholinergic medications

2. ) Tricyclic antidepressants

Question 7

What is the treatment for overflow incontinence

Answer 7

Place urethral catheter, treat underlying disease

Question 8

What are the causes of infectious vulvovaginitis in kids (malodorous, yellow green purulent discharge)

Answer 8

1. ) Group A strep
2. ) STD’s from sexual abuse
3. ) Contact dermatitis and eczema
4. ) Foreign objects
5. ) Sarcoma botryoides - bunches of grapes within the vagina

Question 9

What is precocious puberty

Answer 9

Onset of secondary sexual characteristics in child

Question 10

What should you differentiate when someone presents with precocious puberty

Answer 10

Whether it is estrogen excess (breasts with vaginal bleeding from ovarian cysts/tumors) or if it is androgen excess (pubic/axillary hair, enlarged clitoris from adrenal tumors or CAH)

Question 11

What are the causes and treatment of peripheral precocious puberty

Answer 11

1. ) Ovarian cyst - no tx, will resolve
2. ) CAH - glucocorticoids
3. ) Adrenal/ovarian tumors - surgical resection
4. ) McCune-Albright syndrome - antiestrogens (tamoxifen) or estrogen synthesis blockers (ketoconazole)

Question 12

What is the treatment for central precosious puberty

Answer 12

Leuprolide (also used to diagnose central vs. peripheral with stimulation test)

Question 13

If it is peripheral precocious puberty, what is the next step to help you determine diagnosis

Answer 13

Ultrasound of ovaries/gonads/adrenals

1. ) If positive, Ovarian cyst, adrenal tumor, and/or adrenals
2. ) If negative, Exogenous estrogen, CAH

Question 14

What is the initial step in diagnosis if secondary sexual characteristics are seen before age 8

Answer 14

1. ) Bone age radiograph

2. ) GnRH stimulation test