Structural Abnormalities

Question 1

a 45-year-old female complaining of pressure in the pelvis and vagina along with discomfort when straining. She also feels that her bladder hasn’t fully emptied after urinating.
What is the diagnosis

Answer 1

cystocele

Question 2

what is a bladder prolapse

Answer 2

cystocele - bulge of bladder into vagina

Question 3

what are symptoms of cystocele

Answer 3

pressure in pelvis and vagina, discomfort when straining and feeling the bladder hasnt fully eptied after urinating

Question 4

how is cystocele diagnosed

Answer 4

POP-Q (pelvic organ prolapse quantification): quantifes extent and location of defects, US or MRI
can also do a VCUG

Question 5

what is the treatment of cystocele

Answer 5

prophylaxis: kegel exercises
estrogen therapy after menopause
fflexible ring pessary to support the bladder or surgical rapir with mesh augmentation

Question 6

a 50-year-old female with pelvic pressure reports and a sensation of a mass present in the vagina. She reports chronic constipation and a sensation that the rectum is not completely emptied following a bowel movement. Occasionally, she experiences episodes of fecal incontinence.
What is the diagnosis

Answer 6

rectocele

Question 7

what is a rectocele

Answer 7

herniation of rectum into posterior wall of vagina

Question 8

how is rectocele diagnosed

Answer 8

POP-Q
colonoscopy to rule out cancer and rectal studies if indicated

Question 9

what is the treatment of rectocele

Answer 9

kegel exercises
pelvic floor retraining
behavioral changes
bowel regimen
pessary
surgical repair or mesh augmentation

Question 10

a 23-year-old female who comes to the emergency department because of sharp, non-radiating, left lower quadrant pain that has worsened in intensity over the last three hours. She has nausea but denies diarrhea, urinary symptoms, or vaginal discharge. Her temperature is 37°C (98.6°F), pulse is 110/min, respirations are 24/min, and blood pressure is 140/90 mmHg. Pulse oximetry in room air shows an oxygen saturation of 98%. Physical examination shows left lower quadrant tenderness with guarding. Pelvic examination shows left adnexal tenderness without cervical motion tenderness or discharge. A urine pregnancy test is negative. Doppler ultrasound of the left lower quadrant is obtained.
what is the diagnosis

Answer 10

ovarian torsion

Question 11

how is ovarian torsion diagnosed

Answer 11

abdominal US with doppler flow
gold standard = laparoscopy

Question 12

what is the treatment of ovarian torsion

Answer 12

laparoscopic surgery to uncoil ovary

Question 13

a 63-year-old, G5P5, Hispanic woman with a three-day history of increased pelvic pressure and a “bulge” that is felt in her vagina when she coughs. Additionally, she complains of incomplete emptying of her bladder, constipation and has noticed a recent worsening of lower back pain.

what is the diagnosis

Answer 13

uterine prolapse

Question 14

how is uterine prolapse diagnosed

Answer 14

spectulum or bimanual pelvic exam

Question 15

what is the treatment of uterine prolapse

Answer 15

asymptomatic 1st or 2nd degree - may not require treatment
symptomatic 1st-2nd degree: pessary
severe/persistent: hysterecotomy