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Category: Obstetrics & Gynecology--->Pelvic Relaxation and Urogynecology
Page: 2

Question 6#Print Question

You are discussing surgical options with the family of an elderly patient with symptomatic pelvic organ prolapse. Le Fort colpocleisis may be more appropriate than vaginal hysterectomy and A&P repair for patients in which of the following circumstances?

a. The patient is debilitated and in a nursing home
b. The patient has had postmenopausal bleeding
c. The patient has had endometrial hyperplasia
d. The patient has had cervical dysplasia that requires colposcopic evaluation
e. The patient has a history of urinary incontinence


Question 7#Print Question

A 65-year-old woman presents to your office for evaluation of pelvic organ prolapse (POP). Her past medical history is significant for chronic hypertension, which is well controlled with a calcium channel blocker. She also has chronic constipation which requires use of a laxative to have a bowel movement. She has smoked for over 30 years, and has a chronic cough. She entered menopause at the age of 52 years, but has never taken hormone replacement therapy. Her obstetric history includes three term vaginal deliveries. Her last baby weighed 9 lb, and required a forceps delivery. The delivery was complicated by a large tear that involved the vagina and rectum.

Which of the following factors is least important in the subsequent development of POP in this patient?

a. Chronic cough
b. Chronic constipation
c. Chronic hypertension
d. Childbirth trauma
e. Menopause


Question 8#Print Question

A 43-year-old G2P2 woman is being evaluated for hysterectomy for abnormal uterine bleeding that has not responded to conservative management. She mentions during her evaluation that she has a 2-year history of leaking urine when she coughs, sneezes, or laughs. She does not appreciate a sense of urgency. She has to wear a pad when she leaves the house because of the leaking. She has tried Kegel exercises, but has not had any improvement. A urine culture and post void residual (PVR) are normal. A cough stress test in the office demonstrates leaking urine.

What is the most appropriate surgical procedure to manage this problem? 

a. Marshall-Marchetti-Krantz (MMK) procedure
b. Mid-urethral sling
c. Anterior colporrhaphy with Kelly plication
d. Burch retropubic colposuspension
e. Stamey transvaginal needle suspension


Question 9#Print Question

A 30-year-old G3P3 is being evaluated for urinary urgency, frequency, and dysuria. She also reports post-void dribbling of urine and insertional dyspareunia. Her history is significant for recurrent urinary tract infections (UTIs) as a teenager, but no other medical problems. She has had three term spontaneous vaginal deliveries, and her last baby weighed over 9 lb. She recalls having a vaginal laceration requiring multiple sutures after delivery of that child. On pelvic examination, she has a 1-cm tender suburethral mass. Palpation of the mass results in expression of a small amount of blood-tinged purulent discharge.

Which of the following is the most likely cause of this patient’s problem?

a. Urethral polyp
b. Urethral fistula
c. Urethral stricture
d. Urethral eversion
e. Urethral diverticulum


Question 10#Print Question

You evaluate a 39-year-old G2P2 on postoperative day 2 following a difficult abdominal hysterectomy for endometriosis. Her surgery was complicated by hemorrhage from the left uterine artery pedicle that required multiple sutures to control bleeding. Her estimated blood loss was 500 mL. Her only other medical problem is obesity, and her prior surgeries are two cesarean deliveries. The patient now has fever, left back pain, left costovertebral angle tenderness, and hematuria. Her vital signs are height 5 ft 2 in, weight 250 lb, temperature 38.2°C (100.8°F), blood pressure 110/80 mm Hg, respiratory rate 18 breaths per minute, and pulse 102 beats per minute. Her postoperative hemoglobin dropped from 11.2 g/dl to 9.8 g/dl, her white blood cell count is 9.5 L, and her creatinine rose from 0.6 mg/dL to 1.8 mg/dL.

What is next best step in the management of this patient?

a. Order chest x-ray
b. Order intravenous pyelogram
c. Order renal ultrasound
d. Start intravenous antibiotics
e. Transfuse two units of packed red blood cells




Category: Obstetrics & Gynecology--->Pelvic Relaxation and Urogynecology
Page: 2 of 6