Clinical Challenge

Question 1

The most common modifiable risk factor for pelvic organ prolapse is:

1. congenital predisposition
2. obesity
3. asthma
4. lower uterine segment caesarean section (LUSC)
5. vaginal delivery.

Question 2

The more commonly noted presenting symptom in younger women with pelvic organ prolapse is:

1. sexual dysfunction
2. constipation
3. urinary incontinence
4. vaginal lump.

Question 3

The most helpful diagnostic test for pelvic organ prolapse is:

1. trans-abdominal ultrasound
2. trans-labial ultrasound
3. magnetic resonance imaging (MRI) of the pelvis
4. computed tomography (CT) scan of the pelvis.

Question 4

Which of the following is helpful in the treatment of pelvic organ prolapse?

1. Weight loss
2. Treatment of constipation
3. Vaginal ring pessary
4. Pelvic floor exercises
5. All of the above

Question 5

Which one of the following pain patterns is the most consistent with PPP?

1. Once per week
2. Twice per week
3. Almost every day
4. Continuous

Question 6

Which one of the following symptoms is NOT suggestive of pelvic organ pain?

1. Dysmenorrhea
2. Difficulty initiating urination
3. Irritable bowel
4. Recurrent candidiasis
5. Vulval pain

Question 7

Several muscle groups have been implicated in PPP. Which one of the following is more suggestive of the obturator internus than pelvic floor musculature?

1. Pain aggravated by movement or prolonged positions
2. Stabbing pains in the vagina or lower bowel
3. Difficulty initiating a void, or poor emptying despite urge
4. Pain with intercourse
5. Pain on insertion of the speculum

Question 8

Margaret has a laparoscopy, which did not reveal any specific pathology. A follow-up laparoscopy should be conducted:

1. Routinely at 6 months
2. Routinely at 12 months
3. Routinely at 24 months
4. When specifically indicated

Question 9

Which one of the following features in the history is the hallmark feature of LPV?

1. Urinary incontinence
2. Pain on vaginal penetration
3. Irritable bowel syndrome
4. Dysmenorrhea

Question 10

LPV is characterised by tenderness to which form of touch in the vulvar vestibule?

1. Feather
2. Gentle
3. Firm
4. Forceful

Question 11

Sonia is keen to have a definitive test to confirm the diagnosis. The most accurate advice is:

1. There is no diagnostic test.
2. Do an MRI of the pelvis.
3. Do a CT scan of the pelvis.
4. Take cervical swabs for microbiological testing.

Question 12

Co-existent vaginal candidiasis is an important factor when considering a diagnosis of LPV. Sonia completed a course of oral antifungal agents 1 week ago and asks you to check if there is a recurrence. The best time to do the vaginal swab is:

1. today
2. in 1 week
3. in 2 weeks
4. in 3 weeks.

Correspondence afp@racgp.org.au

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July Clinical Challenge (pdf 297KB)