12/5/2020 UROGYNECOLOGY : DR. CHAN UROGYNECOLOGY : DR. CHAN MCQ Your email address (garimella.gowthami@lyceum.edu.ph) will be recorded when you submit this form. Not you? Switch account . In the surgery of pelvic organ prolapse, the aim of the abdominal sacral col-popexy, is to replace defective ligaments and fascia by recreating new 1 point connec-tive support to attach the vaginal gina vault to the a. Cervix b. Sacrospinous ligament c. Sacrum d. Iliococcygeal ligament Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 1/30 12/5/2020 UROGYNECOLOGY : DR. CHAN What is / are the preventive measure/s against Pelvic floor dysfunction: 1 point a. Preventive caesarean section b. Liberal episiotomy policy c. Instrumental delivery d. Pelvic floor exercises Clear selection Helen is a 60 yr old woman, known diabetic has dribbling, incomplete 1 point bladder emptying. Helen's post void residual urine determination revealed 300 ml. Her condition is caused by A. Weakness of the pelvic floor B. Involuntary contractions of the bladder C. Overdistended bladder because of its inability to empty. D. Urinary fistula Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 2/30 12/5/2020 UROGYNECOLOGY : DR. CHAN In healthy women, the most common cause of fecal incontinence is : 1 point a. Aging process b. Damage to the anal sphincters at the time of vaginal gina delivery c. Chronic straining with constipation d. Rectovaginal gina fistula Clear selection A patient was referred to you because of Post partum Urinary retention. She is on Clean intermittent self catheterization. When should she 1 point discontinue her present management a. when her residual urine reduces to < 100-150 ml b. when her residual urine becomes 500 ml c. when her residual urine becomes 500 ml, insert indwelling catheter for 24 hours d. when her residual urine reduces to <500 ml Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 3/30 12/5/2020 UROGYNECOLOGY : DR. CHAN Andria complains of frequency, urgency and urge incontinence. She had nocturnal enuresis since childhood. What is the possible cause for her symptoms? 1 point a. weakness of her pelvic floor b. fistula c. overflow incontinence d. abnormal contraction of the detrusor muscle Clear selection Anna a 30 yr old G2P2 (2002) S/p CS 2x 5 years ago has frequency, urgency and urge incontinence. How will you manage the patient. 1 point a. Estrogen b. Bladder retraining c. Burch colposuspension d. Botox injection Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 4/30 12/5/2020 UROGYNECOLOGY : DR. CHAN Stimulation of this center causes the urethral sphincters to open while 1 point facili-tating the detrusor to contract and expel the urine. a. Higher brain center b. Pontine Micturition Center c. Primitive voiding center d. Spinal cord Clear selection . In infants, the higher center of voiding control (the brain) is not mature enough to command the bladder. Voluntary continence usually is attained 1 point by what age? a. 2 years old b. 3-4 years old c. 1 year old d. 4 – 5 years old Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 5/30 12/5/2020 UROGYNECOLOGY : DR. CHAN The ideal surgical procedure for a 65 year old sexually active patient , G5P5 S/P NSD with Pelvic organ prolapse stage 4? 1 point a. Vaginal gina hysterectomy b. Vaginal gina hysterectomy with sacrospinous ligament fixation c. Subtotal or Total hysterectomy with abdominal sacral colpopexy d. Le Fort Colpocleisis Clear selection Isa, had radical pelvic surgery because of cervical cancer. Few weeks after 1 point the surgery she developed chronic urinary retention. The nerve transected by the surgery that led to her urinary retention is the a. Pudendal nerve b. Pelvic nerve c. Hypogastric nerve d. Parasympathetic nerve e. Sympathetic nerve Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 6/30 12/5/2020 UROGYNECOLOGY : DR. CHAN A 35 year old G5P5 (5005) has vaginal gina vault prolapse stage 4 with BMI of 1 point 30. She prefers to undergo surgery for her prolapse. What is the best management option for her condition? a. Le fort colpocleisis b. Vaginal gina hysterectomy c. abdominal sacral hysteropexy d. abdominal sacral colpopexy Clear selection Tonya , a 25 year old nurse had a motor vehicle accident. She allegedly 1 point suffered a fracture of the lumbar spine. She had immediate urinary retention. An in-dwelling catheter was put in place. What center was affected in her case? a. Pontine Micturition center b. Cerebral cortex c. Sacral micturition center d. Higher brain center Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 7/30 12/5/2020 UROGYNECOLOGY : DR. CHAN Kris, a 30 year old patient G0, has frequency, urgency, urge incontinence and nocturia. She had a history of nocturnal enuresis till 10 yrs old. What is 1 point the first line treatment for her condition? a. anti muscarinic / anticholinergic b. bladder drill/ bladder retraining c. estrogen d. TENS Clear selection Storage symptoms of incontinence are: 1 point a. Overflow incontinence b. Dribbling c. Feeling of incomplete emptying D. Nocturia Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 8/30 12/5/2020 UROGYNECOLOGY : DR. CHAN A 24 year old G3P3 (300) delivered 1 week ago by mediolateral episiotomy and repair , forceps delivery with epidural anesthesia . She consulted at the 1 point ER with complains of distended abdomen, abdominal pain, perineal pain and drib-bling and incomplete bladder emptying. What is/are the possible cause/s of her urinary retention ? a. Multiparity b. OASIS c. Instrumental delivery d. All of the above Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 9/30 12/5/2020 UROGYNECOLOGY : DR. CHAN Magdalena s/p vaginal gina hysterectomy and Mc Call culdoplasty 3 months ago complained of stress incontinence whenever she coughs which started after her surgery. She claims to have no urinary incontinence symptoms 1 point before surgery. A thorough physical examination was done and only a positive cough stress test was noted. What explanation can you give the patient to explain her incontinence? a. Vesicovaginal gina Fistula b. Occult stress incontinence c. New onset Overactive bladder d. Recurrent UTI Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 10/30 12/5/2020 UROGYNECOLOGY : DR. CHAN A 50 year old G0, BMI 20, patient comes to you for consult because of a mass felt at the introitus. She works as a laundrywoman and carries heavy loads. Her mother and her eldest sibling also has prolapse. What are the predisposing factors that may be responsible for symptoms? 1 point A. Obesity B. Poor collagen fibers / family history C. Multi-parity D. all of the above Clear selection What is the role of the hypogastric nerve in the micturition cycle? 1 point a. it will stimulate the beta 3 receptors leading to the relaxation of the detrusor muscle b. it will cause contraction of the detrusor muscle by working on the M3 receptor. c. It will inhibit the pudendal nerve resulting to relaxation of the external sphincter d. It works as a loop sensory nerve send signal to the pelvic efferent nerve and will cause the contraction of the detrusor muscle Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 11/30 12/5/2020 UROGYNECOLOGY : DR. CHAN Bea, is a 40 year old G5P5 (5005) s/p LTCCS with biggest baby weighing 9 1 point lbs. Her BMI is 22 . She works as a gym instructor. She complains of a vaginal gina mass or “buwa “ since her 5th delivery. What do you think are the risk factors that contributed to her condition. a. obesity b. heavy lifting c. childbirth d. macrosomia Clear selection Which endopelvic fascia is damaged in patients with prolapsing rectum is: 1 point a. cardinal ligament b. pubocervical fascia c. rectovaginal gina fascia d. uterosacral ligament Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 12/30 12/5/2020 UROGYNECOLOGY : DR. CHAN A patient can be referred to as having Covert Post Partum Urinary retention when she: 1 point a. is symptomatic and has inability to void accompanied by discomfort b. does not empty her bladder but is asymptomatic c. all of the above d. none of the above Clear selection Maria Lourdes, a 60 year old G5P5 (5005) has pelvic organ prolapse stage 4. She recently had angioplasty a few months ago. What is the ideal management for this patient? 1 point a. Vaginal gina Hysterectomy with Sacrospinous ligament fixation b. Abdomino Sacral colpopexy c. Vaginal gina pessary d. Observation Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 13/30 12/5/2020 UROGYNECOLOGY : DR. CHAN Childbirth may result in pelvic floor laxity as a consequence of weakening and stretching of the muscles and connective tissue during delivery. The stretching of the pelvic tissues may also damage what particular nerve? 1 point A. Pelvic nerves B. Pudendal nerves C. Hypogastric nerves D. None of the above Clear selection What is the risk factor for prolapse present in this 40 year old patient who 1 point works as a teacher complaining of pelvic organ prolapse. She is a G5P5 (5005) all NSD, largest baby weighed 9 lbs, BMI 22.5. a. obesity b. lifting heavy objects c. menopause d. childbirth and delivery Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 14/30 12/5/2020 UROGYNECOLOGY : DR. CHAN A 35 year old G3P3 (3003) complains of leaking whenever she coughs laughs or sneezes. She also has urgency and frequency. Her BMI is 30. What is a non pharmacological treatment that addresses all her condition? 1 point a. lose weight b. decrease her cafeine intake c. she should lift weights to lower her BMI d. estrogen Option 7 Clear selection Which autonomic nervous system is at play when Rachel‘s bladder contracts and micturition occurs. 1 point a. Parasympathetic nervous system b. Sympathetic nervous system c. Peripheral nervous system d. Pons Micturition center Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 15/30 12/5/2020 UROGYNECOLOGY : DR. CHAN Hannah, a 70 year old refuses to undergo any conservative or surgical procedure for her Pelvic Organ Prolapse stage 4 because of her age. Complication of untreated prolapse is/are? 1 point a. Asymptomatic upper urinary tract obstruction b. Hydronephrosis c. reflux nephropathy d. all of the above e. a and b Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 16/30 12/5/2020 UROGYNECOLOGY : DR. CHAN Vanessa G4P4 (4004) S/P NSD sought consult because of urinary incontinence which started about the time after her first delivery and progressively be-came worse with each vaginal gina delivery. Which of the following obstetrical practices are associated pelvic organ prolapse and incontinence? 1 point a. Midline episiotomy b. Perineal massage c. Mediolateral episiotomy d. Forceps delivery Clear selection Anna complains of leakage of urine with coughing and sneezing. She also urgency and runs to the toilet to urinate 15 x a day. What is she suffering from? 1 point A. stress urinary incontinence B. overactive bladder C. Chronic urinary retention D. mixed stress urinary incontinence and overactive bladder Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 17/30 12/5/2020 UROGYNECOLOGY : DR. CHAN In an empty bladder , which autonomic nervous system is inhibited so that 1 point we don’t contract the detrusor muscle? a. Sympathetic nervous system b. Parasympathetic nervous system c. Pudendal nerve d. Somatic nerve Clear selection Who would benefit from a Vaginal gina hysterectomy with prolapse repair surgery ? 1 point a. A 40 year old G5P5 with POPQ Stage 4 obese patient b. A 65 year old G5P with POPQ Stage 4 obese patient c. A 40 year old G5P5 with Myoma uteri patient d. A frail 80 year old patient , G5P5 S/P NSD with Pelvic organ prolapse stage 4 Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 18/30 12/5/2020 UROGYNECOLOGY : DR. CHAN Hannah is a 3rd year medical student who notices frequency, urgency night 1 point before exams. Which Micturition center is affected by emotions ? a.Higher brain center b. Pontine Micturition Center c. Primitive voiding center d. Spinal cord Clear selection Gina comes back to you 6 months post surgery after an abdominal hysterectomy because of myoma uteri. She developed a vaginal gina bulge that protrudes beyond the hymen. To what ligament(s) should the vaginal gina apex 1 point be attached to minimize the risk of vaginal gina vault prolapse? a. Round ligament b. Cardinal and uterosacral ligaments c. Uteroovarian ligament d. Sacrospinous ligament Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 19/30 12/5/2020 UROGYNECOLOGY : DR. CHAN A patient who has undergone radical pelvic surgery for Cervical carcinoma presents with incomplete emptying , dribbling, and urinary retention. 1 point Which nerves are affected during the surgery that lead to her incontinence ? A. Afferent Pelvic nerves B Efferent Pelvic nerves C. Both a and b D. Hypogastric nerves Clear selection Lorraine a 50 year old G0 has urgency, urge incontinence which she noted a few months after the Pandemic started . What is the possible cause of her incontinence? 1 point a. abnormal contraction of her bladder b. weakness of the pelvic floor c. overflow incontinence d. fistula Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 20/30 12/5/2020 UROGYNECOLOGY : DR. CHAN Isa, a 29 year old G5P5 (5005) patient all NSD, smoker with chronic bronchitis, comes to you with complaints of pelvic organ prolapse. She claims that her grandmother and mother also had the same problem. The 1 point underlying pathophysiology of her condition are the following except? a. Inherent connective tissue weakness b. Childbirth injury c. Obesity d. Chronic pulmonary disease Clear selection The ideal surgical procedure for a frail 80 year old patient , G5P5 S/P NSD with Pelvic organ prolapse stage 4 who prefers an obliterative vaginal gina surgery? 1 point a. Vaginal gina hysterectomy b. Vaginal gina hysterectomy with sacrospinous ligament fixation c. Subtotal hysterectomy with abdominal sacral colpopexy d. Le Fort Colpocleisis Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 21/30 12/5/2020 UROGYNECOLOGY : DR. CHAN Gina has leakage of urine every time she laughs, coughs or sneezes. She has no urgency, urge incontinence. What physical exam will appears to be a reliable and simple test for the diagnosis of stress urinary incontinence? 1 point a. Immediate leakage with cough stress test b. Positive bulvocavernous reflex c. Demonstration of pelvic relaxation with sim’s speculum d. Delayed leakage with cough stress test Clear selection Dina has leakage whenever she coughs, laughs or sneezes which she noted a few days after childbirth . What is the possible cause of her 1 point incontinence? a. abnormal contraction of her bladder b. weakness of the pelvic floor c. overflow incontinence d. fistula Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 22/30 12/5/2020 UROGYNECOLOGY : DR. CHAN Victoria g1P1 (1001) S/p NSD 2 months ago. She complains of urgency. She has no stress incontinence, urgency , urge incontinence, dribbling, incomplete bladder emptying. What is your diagnosis? 1 point a. stress urinary incontinence b. Overactive Bladder c. Post partum urinary retention d. none of the above Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 23/30 12/5/2020 UROGYNECOLOGY : DR. CHAN A 70 year old G5P5 (5005) has pelvic organ prolapse stage 4. She is a hypertensive, diabetic with cardiovascular disease. BMI of 30. She tried vaginal gina pessary for a year but now prefers to undergo surgery. She is no longer sexually active and her cardiologist suggested a quick procedure. What is the best management option for her condition? 1 point a. Conservative option eg. Pessary b. Vaginal gina hysterectomy c. Le fort Colpocleisis d. anterior posterior vagnal repair Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 24/30 12/5/2020 UROGYNECOLOGY : DR. CHAN When the bladder is full, stretch receptors in the wall of the bladder send nerve impulses to the sacral region of the spinal cord. What nerve will it connect to that is responsible for the contraction of the muscle of the bladder and relaxation of the internal urethral sphincter. 1 point a. Parasympathetic afferent nerve b. Parasympathetic efferent nerve c. Sympathetic afferent nerve d. Sympathetic efferent nerve Clear selection Isa has vaginal gina vault prolapse few months after she underwent vaginal gina hysterectomy. She wishes to undergo Surgery. What surgical procedure will offer the best result? 1 point A. Abdominosacral Hysteropexy b. Vaginal gina pessary c. Abdominosacral colpopexy d. Le fort colpocleisis Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 25/30 12/5/2020 UROGYNECOLOGY : DR. CHAN Maricar has dribbling, feeling of incomplete emptying, which she noted a few days after childbirth .A KUB, post void residual volume ultrasound revealed void-ed volume of 300 ml and a post void residual volume of 600 ml. What is the pos-sible cause of her incontinence? 1 point a. abnormal contraction of her bladder b. weakness of the pelvic floor c. bladder atony d. fistula Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 26/30 12/5/2020 UROGYNECOLOGY : DR. CHAN Jackie, a 25 yr old G1P1 (1001) was admitted at the ER with complaints of 1 point hypogastric pain, dribbling and feeling of incomplete emptying. She is 2 days postpartum and was sent home less than 24 hours after delivery. On physical examination, a mass was felt at the hypogastric area. How will you manage her? a. Do an transvaginal gina ultrasound to follow up with result at the OPD b. Give her pain reliever then send her home c. Insert a catheter and measure volume drained d. Insert an indwelling catheter for 24 hours Clear selection What is the ideal surgical procedure for a 40 year old G5P5 S/P NSD with Pelvic organ prolapse stage 4? 1 point a. Vaginal gina hysterectomy b. Vaginal gina hysterectomy with sacrospinous ligament fixation c. Subtotal hysterectomy with abdominal sacral colpopexy d. Le Fort Colpocleisis Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 27/30 12/5/2020 UROGYNECOLOGY : DR. CHAN Gina a 40 year old G3P3 (3003) has stress incontinence, urgency and freGina, quency and complains of a mass protruding from her vagina. gina POPQ 1 point revealed Ba +3, Cx +4, Bp 0 , Gh 6, TVL 10 cm. The baseline assessment for the patient are the following except : a. Urodynamic testing b. Complete History, physical examination, c. Urinalysis, urine culture, d. Post Void Residual volume e. Bladder diary Clear selection Who would benefit from an abdominal prolapse surgery ? 1 point a. A 40 year old G5P5 with POPQ Stage 4 obese patient b. A 65 year old G5P with POPQ Stage 4 obese patient c. A 40 year old G5P5 with POPQ Stage 4 obese patient with comorbidi-ties RHD, DM d. A frail 80 year old patient , G5P5 S/P NSD with Pelvic organ prolapse stage 4 Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 28/30 12/5/2020 UROGYNECOLOGY : DR. CHAN Esmeralda, is a 40 year old G5P5 (5005) s/p Forceps delivery (1) with biggest baby weighing 6 lbs 5 oz. Her BMI is 22 . She works as Math instructor. She complains of a vaginal gina mass or “buwa “ since her 5th 0 points delivery. What do you think are the risk factors that contributed to her condition. a. obesity b. heavy lifting c. childbirth d. macrosomia Clear selection The use of which of the following obstetrical practices are protective of 1 point the anal sphincter at the time of vaginal gina birth? a. Mediolateral episiotomy and repair b. Median episiotomy and repair c. Forceps delivery d. None of the above Clear selection https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 29/30 12/5/2020 UROGYNECOLOGY : DR. CHAN A copy of your responses will be emailed to garimella.gowthami@lyceum.edu.ph. Submit Page 1 of 1 This form was created inside of Lyceum-Northwestern University. Report Abuse Forms https://docs.google.com/forms/d/e/1FAIpQLScsc1OaLfPk4FgWqO0NqKg2O2ip3dNDkvIEq3bjXGzEfmltLQ/viewform 30/30
