Structural Abnormalities

Question 1

Obese pt presents w/ pelvic pain and pressure, urinary Sxs, dyspareunia and bulging mass that increases w/ Valsalva. Pt’s job involves lot of heavy lifting

Dx? (general)

Answer 1

Dx = POP (pelvic organ prolapse)

Question 2

Postmenopausal women w/ h/o many vag births presents w/ pelvic organ prolapse presents to your office. You perform a split speculum exam and notice prolapse of the uterus below the level of the hymen/halfway past it

What stage of prolapse is this?

Answer 2

Pelvic Organ Prolapse

Uterus below the level of the hymen = Stage 3

Question 3

Staging of Pelvic Organ Prolapse

1. what stage occurs when prolapse occurs at the level of the hymen
2. above the hymen/halfway to it
3. what does stage 4 mean

Answer 3

Staging of Pelvic Organ Prolapse

1. at the level of the hymen = stage 2
2. above the hymen/halfway to it = stage 1
3. stage 4 = complete prolapse/max descent

Question 4

During PE of pt w/ suspected POP what 2 positions should you evaluate them in and what should you have them do

Answer 4

PE of pt w/ suspected POP

1. lithotomy + standing positions
2. Have pt strain during PE

Question 5

3 main types of Tx for uterine prolapse

• tx for postomenopausal women

Answer 5

Tx for uterine prolapse

1. Kegels
2. Pessaries
3. Surgical correction

tx for postomenopausal women = estrogen replacement

Question 6

What is uterine prolapse

Answer 6

Uterine prolapse = uterus herniates into the vagina

Question 7

Rectocele

1. occurs when the rectum prolapses/herniates in the ______ wall of the vagina
2. name of the surgery that can be done to Tx it

Answer 7

Rectocele

1. Occurs when the rectum prolapses/herniates in the POSTERIOR wall of the vagina
2. surgery = POSTERIOR Colporrhapy

Question 8

Obese, postmenopausal women presents w/ vaginal fullness/pressure, back pain w/ standing and vaginal spotting

Dx?

Answer 8

Dx = Uterine prolapse

Question 9

Obese, postmenopausal women c/o constipation and difficulty having BMs. She often has to use her fingers to push her vagina backwards to have a BM.

Dx?

Answer 9

Dx = Rectocele

Question 10

Obese, postmenopausal women c/o pelvic pressure/pain, incomplete emptying of bladder, dyspareunia and urinary leakage during sex. Pt has h/o bladder infxns. On PE pt had hypermobile urethra.

Dx?

Answer 10

Dx = Cystocele

Question 11

Cystocele

1. occurs when the bladder prolapses/herniates in the ______ wall of the vagina
2. name of the surgery that can be done to Tx it

Answer 11

Cystocele

1. occurs when the bladder prolapses/herniates in the ANTERIOR wall of the vagina
2. surgery = ANTERIOR colporrhapy

Question 12

Complete/partial rotation of ovary –> impedance of blood supply

Answer 12

Complete/partial rotation of ovary –> impedance of blood supply = ovarian torsion

Question 13

Pt w/ h/o ovarian cysts presents w/ acute onset of colicky, RLQ abd pain and N/V. Vitals reveal low grade fever. PE reveals TTP in RLQ w/ involuntary guarding. TVUS w/ doppler imaging reveals decr flow.

Dx?
what type of Tx must be done? (general)

Answer 13

Dx = Ovarian Torsion
Tx = surgery
note: more common on R than L

Question 14

Ovarian Torsion in pregnancy

What 2 times during pregnancy are pts at highest risk for developing it

Answer 14

Ovarian Torsion in pregnancy

Highest risk = @14 wks + immed postpartum

Question 15

Tx of Ovarian Torsion

What is always done to assess viability of the ovary (only not done if ovary necrotic)

Answer 15

Tx of Ovarian Torsion

1. Detorsion always done to assess viability of the ovary (only not done if ovary necrotic)

Question 16

Tx of Ovarian Torsion

After detorsion what are the 2 possible procedures that are additionally performed and indications for each

Answer 16

Tx of Ovarian Torsion after Torsion

1. cystecomy - if detorsion restores reperfusion
2. ooporectomy (remove ovary) - if detorsion does NOT restore reperfusion