Surgical Management Of Vaginal Vault Prolapse! Trivia Questions Quiz

23 Questions

Settings
Please wait...
Surgical Management Of Vaginal Vault Prolapse! Trivia Questions Quiz

Welcome to the trivia questions quiz on the Surgical Management of Vaginal Vault Prolapse! This condition is when the upper portion of the vagina sags or drops into the vaginal canal or outside. Doctors may opt to have a hysterectomy or give vaginal vault suspension to give their patients a chance at a normal life. Take the quiz, and see what you know about these two options for a patient.


Questions and Answers
  • 1. 
    A 44-year-old woman (gravida 5, para 5) comes in complaining that she has noticed a bulge protruding from her vagina. Her other medical problems include hypertension, diabetes mel-litus, and alcoholism. She stands at work as a grocery clerk. She has a family history of genital prolapse. On examination, you notice a uterine prolapse, cystocele, and rectocele. Which of the following is a major risk factor for her pelvic support disorder?
    • A. 

      Childbirth

    • B. 

      Hypertension

    • C. 

      Diabetes mellitus

    • D. 

      Positive family history

    • E. 

      Environmental factors—job

  • 2. 
    A 49-year-old parous woman comes in complaining that over the last several years, it feels as though “her organs are progressively falling out her vagina.” She also complains of losing urine with coughing, occasional urgency, and sometimes a feeling of incomplete emptying of her bladder with voiding. On further examination,whichoftheabove-mentioned options will you likely find?
    • A. 

      Cystocele

    • B. 

      Rectocele

    • C. 

      Enterocele

    • D. 

      Hemorrhoid

  • 3. 
    A 56-year-old woman complains that she is “sitting on a ball.” She says constipation is a significant problem and that sometimes she needs to push the stool out of her rectum by inserting a finger in the vagina and pressing on a bulge. On further examination, which of the above-mentioned options will you most likely find?
    • A. 

      Rectocele 

    • B. 

      Cystocele

    • C. 

      Enterocele 

    • D. 

      Hemorrhoid

  • 4. 
    A 68-year-old woman complains of something falling out of her vagina, and she thinks it causes a constant backache. The backache is least symptomatic when she gets up in the morning and worsens as the day goes on. She says she cannot understand why she has this because 4 years ago she had an abdominal hysterectomy and urethral suspension (Burch procedure) to correct the “falling out” and some problem with urine loss. Her ability to hold her urine is excellent since the first surgery. Given her history, on the examination which of the above-mentioned do you expect to find?
    • A. 

      Enterocele

    • B. 

      Cystocele

    • C. 

      Rectocele

    • D. 

      Hemorrhoid

  • 5. 
    A 90-year-old woman comes to your office complaining that she feels as though she is “sitting on a ball.” On examination, you find that the vagina is essentially turned inside out, and the entire uterus lies outside the vaginal introitus. This condition is known as which of the following?
    • A. 

      Fourth-degree prolapse or procidentia

    • B. 

      Vaginal evisceration

    • C. 

      Third-degree prolapse

    • D. 

      Second-degree prolapse

    • E. 

      First-degree prolapse

  • 6. 
    A 54-year-old postmenopausal woman G4P4 presents with a complaint of vaginal fullness and pressure. Figure 19–1 depicts a visual drawing of your examination findings on pelvic examination, including split speculum examination. The letter A represents which of the following? (grafico)
    • A. 

      Enterocele

    • B. 

      Sigmoidocele 

    • C. 

      Rectocele

    • D. 

      Cystocele

  • 7. 
    An 18-year-old nulliparous woman comes into your office, complaining of a 24-hour history of urinary frequency, urgency, and suprapubic pain. She had intercourse for the first time earlier this week. She is using a diaphragm for birth control. Which of the following statements reflects current knowledge about uncomplicated urinary tract infections?
    • A. 

      In women who have frequent UTIs related to coitus, infection can be prevented with low-dose postcoital antibiotics.

    • B. 

      A teenager is more likely to have asymptomatic bacteriuria than is a postmenopausal woman.

    • C. 

      Use of a diaphragm helps prevent the development of UTIs.

    • D. 

      In a freshly voided, clean-catch urine specimen, leukocyte esterase and nitrites, in combination have a poor test performance in diagnosing UTI.

    • E. 

      Cystitis occurs two times more commonly in men than in women.

  • 8. 
    A woman complains of postvoid dribbling of urine when she stands, painful intercourse, and dysuria. She has no other symptoms. Which of the following is she most likely to have?
    • A. 

      A urethral diverticulum

    • B. 

      Genuine urinary stress incontinence

    • C. 

      Detrusor instability

    • D. 

      A urinary fistula

    • E. 

      UTI

  • 9. 
    A 38-year-old multigravid woman complains of the painless loss of urine, beginning immediately with coughing, laughing, lifting, or straining. Immediate cessation of the activity stops the urine loss after only a few drops. Which of the following is this history most suggestive of?
    • A. 

      Stress incontinence

    • B. 

      Urge incontinence

    • C. 

      Fistula

    • D. 

      Urethral diverticulum

    • E. 

      UTI

  • 10. 
    Kegel exercises were designed to do which of the following?
    • A. 

      Improve the tone of the muscles surrounding the bladder base and proximal bladder neck

    • B. 

      Prevent denervation of pelvic muscles after childbirth

    • C. 

      Decrease the muscle atrophy associated with aging

    • D. 

      Increase the blood flow to the perineum to speed the healing of an episiotomy

    • E. 

      Strengthen the abdominal muscles after childbirth

  • 11. 
    A 10-year-old patient’s mother gives a history of the child constantly wetting herself, requiring the continuous use of diapers since birth. The child is otherwise very healthy and happy and does well in school. Which of the following diagnoses would most closely fit this clinical history?
    • A. 

      Ectopic ureter with fistula to the vagina

    • B. 

      Maternal anxiety

    • C. 

      Stress incontinence

    • D. 

      Urethral diverticula

    • E. 

      Vesicovaginal fistula

  • 12. 
    A 52-year-old postmenopausal woman complains of urinary frequency, urgency, and urge incontinence. She is otherwise healthy. Which of the following should be included in the behavioral treatment you recommend?
    • A. 

      Bladder retraining

    • B. 

      Relaxation techniques

    • C. 

      Anticholinergic medication

    • D. 

      Voiding every hour during the daytime

  • 13. 
    A 35-year-old woman (gravida 4, para 4) complains that she loses urine intermittently and without warning. At other times, she cannot get to the bathroom in time when she first feels the urge to void and also loses urine. She denies dysuria or loss of urine with exercise. Pelvic examination is normal, except for a first-degree cystocele. Postvoid residual is 150 mL. Of the following options, which is the best plan?
    • A. 

      Perform urodynamic testing looking for a neurogenic bladder

    • B. 

      Give her a trial of anticholinergic medication

    • C. 

      Do an intravenous pyelogram (IVP) looking for a urinary fistula

    • D. 

      Teach clean intermittent self-catheterization

    • E. 

      Instruct in Kegel exercises

  • 14. 
    Which of the following is the most common cause of rectovaginal fistula?
    • A. 

      Obstetrical delivery

    • B. 

      Irradiation to the pelvis

    • C. 

      Carcinoma

    • D. 

      Hemorrhoidectomy

    • E. 

      Crohn’s disease

  • 15. 
    If a rectovaginal fistula is identified, which of the following should initial treatment include?
    • A. 

      Vaginal repair of the fistula

    • B. 

      Systemic steroids and antibiotics

    • C. 

      Rectal pull-through operation

    • D. 

      Bowel resection

  • 16. 
    Fecal incontinence is most likely related to which of the following?
    • A. 

      Innervation of the pelvic floor and the anal sphincters

    • B. 

      Interplay between the pubococcygeus muscle and rectum

    • C. 

      Normal colonic transit time

    • D. 

      Urinary retention

    • E. 

      Nulliparity

  • 17. 
    When performing a vaginal hysterectomy for any indication, prevention of future enterocele or vaginal vault prolapse is aided by which of the following?
    • A. 

      Reattachment of the cardinal and uterosacral ligaments to the vaginal cuff

    • B. 

      Complete a purse string suture closure of the cul-de-sac peritoneum

    • C. 

      Placing a vaginal pack for 24 hours postoperatively

    • D. 

      Closing the vaginal mucosa

    • E. 

      Reattachment of the round ligaments to the vaginal cuff

  • 18. 
    A 30-year-old woman complains of 36 hours of urinary frequency, dysuria, and pelvic pain. She has never had a UTI and has no medical problems. Which of the following is the most likely pathogen?
    • A. 

      Escherichia coli

    • B. 

      Staphylococcus saprophyticus

    • C. 

      Klebsiella pneumonia

    • D. 

      Proteus mirabilis

    • E. 

      Enterococci

  • 19. 
    Which of the following is the recommended treatment regimen?
    • A. 

      3-day course of trimethoprim-sulfamethoxazole (TMP-SMZ)

    • B. 

      7-day course of tetracycline

    • C. 

      7-day course of ciprofloxacin

    • D. 

      3-day course of amoxicillin

    • E. 

      7-day course of erythromycin

  • 20. 
    If the patient is pregnant and in the third trimester, which of the following is the appropriate therapy?
    • A. 

      3- to 7-day course of nitrofurantoin

    • B. 

      1-day course of nitrofurantoin

    • C. 

      3- to 7-day course of amoxicillin/clavulanic acid (Augmentin)

    • D. 

      3- to 7-day course of TMP-SMZ

  • 21. 
    A 49-year-old woman had a radical hysterectomy and lymph node sampling for stage 1B squamous cell cancer of the cervix. A suprapubic catheter was placed at the time of surgery. She is now 8 weeks postoperative and has not been able to void. She is also leaking urine with activity, coughing, and sneezing. What is the most likely reason for voiding difficulty?
    • A. 

      Innervation to the lower urinary tract was transected

    • B. 

      Overdistention of the bladder

    • C. 

      Postoperative swelling around the bladder

    • D. 

      Outflow obstruction

    • E. 

      Spasm of the pelvic floor muscles

  • 22. 
    A 49-year-old woman had a radical hysterectomy and lymph node sampling for stage 1B squamous cell cancer of the cervix. A suprapubic catheter was placed at the time of surgery. She is now 8 weeks postoperative and has not been able to void. She is also leaking urine with activity, coughing, and sneezing. The most likely etiology of her incontinence is which of the following?
    • A. 

      Stress incontinence

    • B. 

      Urge incontinence

    • C. 

      Overflow incontinence

    • D. 

      Ureterovaginal fistula

    • E. 

      Urethral diverticulum

  • 23. 
    Which of the following is a normal urologic consequence of aging?
    • A. 

      Elevated postvoid residual from 50 to 100 mL

    • B. 

      Incontinence

    • C. 

      Increased daytime diuresis

    • D. 

      Increased bladder capacity

    • E. 

      Delayed sensation of first desire to void