Prolapse, Urinary Incontinence and Fistulas MCQs

Obstetrics & Gynaecology · 82 free questions with answers & explanations.

  1. A 55-year-old multiparous woman presents with a sensation of something coming down per vaginum. She reports urinary stress incontinence and difficulty with bowel movements. Examination shows the cervix at the level of the hymen and anterior vaginal wall prolapse with a separate cystocele, along with a posterior rectocele. According to POP-Q staging, what stage is the most anterior component?
  2. A 55-year-old multiparous woman has uterovaginal prolapse with the cervix 3 cm below the hymen at maximum Valsalva. According to POP-Q staging, this is classified as:
  3. A 40-year-old woman with stress urinary incontinence demonstrates a positive cough stress test and urethral hypermobility. Urodynamics confirm urodynamic SUI without detrusor overactivity. After failure of pelvic floor muscle training for 3 months, the procedure of choice with the strongest evidence for surgical cure is:
  4. A 55-year-old multiparous woman presents with feeling of a lump per vaginum. POP-Q examination shows: Aa +1, Ba +2, C 0, D -4, Ap -2, Bp -1, GH 4, PB 2, TVL 9. What is the MOST accurate POP-Q staging?
  5. A 45-year-old woman complains of leaking urine when she coughs, sneezes, or laughs. There is no urgency or frequency. Urodynamic study shows a leak point pressure of 65 cmH2O with no detrusor overactivity. Which of the following surgical options provides the HIGHEST long-term success rate?
  6. A 65-year-old multiparous woman presents with stress urinary incontinence (SUI). Urodynamic assessment shows urethral hypermobility with Valsalva leak point pressure (VLPP) of 35 cmH2O. This VLPP value indicates:
  7. In the POP-Q (Pelvic Organ Prolapse Quantification) system, a patient with the leading edge of prolapse 3 cm beyond the hymen (point C at +3 cm) has what POP-Q stage?
  8. A 58-year-old presents with urinary incontinence on coughing and sneezing. Urodynamic testing shows a leak point pressure of 45 cmH₂O and no detrusor overactivity. Maximum urethral closure pressure is 12 cmH₂O. Which condition is present and which surgical procedure addresses the specific defect?
  9. A 35-year-old presents with continuous dribbling of urine since a difficult obstructed labour 2 weeks ago. Dye test: bladder is filled with methylene blue; a tampon placed in vagina shows blue staining at the apex. Intravenous injection of indigo carmine does not stain the tampon. What type of fistula is present?
  10. In the POP-Q (Pelvic Organ Prolapse Quantification) system, a woman has Ba point at +2 cm, C point at 0 cm, and Bp point at -3 cm. How is this classified?
  11. The SIFUT (Stress Incontinence Fistula Urethra Test) distinguishes vesico-vaginal fistula from urethro-vaginal fistula. Which dye test is used and what result confirms a urethro-vaginal fistula?
  12. A 56-year-old multiparous woman presents with stress urinary incontinence (SUI). Urodynamic studies confirm genuine stress incontinence with a urethral closure pressure of 18 cmH2O (normal >30 cmH2O), indicating intrinsic sphincter deficiency (ISD). Mid-urethral sling (MUS) surgery with retropubic tension-free vaginal tape (TVT) is planned. What is the theoretical mechanism by which TVT corrects SUI based on the integral theory?
  13. The POP-Q (Pelvic Organ Prolapse Quantification) system uses nine standardized landmarks. A woman with a stage III anterior vaginal wall prolapse has Aa = +2 cm, Ba = +5 cm, C = –5 cm, D = –7 cm, Ap = –2 cm, Bp = –2 cm. What do the measurements Aa and Ba represent, and what does Ba = +5 indicate specifically?
  14. In the POPQ (Pelvic Organ Prolapse Quantification) system, a patient has the following measurements: Aa +2, Ba +4, C +1, D +0, Ap -2, Bp -2, Gh 4.5, Pb 2.0, TVL 8.0. What is the POPQ stage?
  15. The SISTER trial (2004) compared Burch colposuspension versus autologous fascial pubovaginal sling for urodynamic stress incontinence (USI). What was the key finding that influenced current management of USI?
  16. The POP-Q (Pelvic Organ Prolapse Quantification) system uses the hymenal ring as the reference landmark (point 0). In staging Stage II prolapse, the leading edge of the prolapse is located:
  17. The POP-Q (Pelvic Organ Prolapse Quantification) system uses a fixed reference point for all measurements. That reference point is:
  18. A 45-year-old woman with stress urinary incontinence (SUI) is found to have urethral hypermobility but no intrinsic sphincter deficiency (ISD) on urodynamics. After conservative physiotherapy failure, the surgical procedure with highest long-term cure rate is:
  19. A 58-year-old woman presents with stress urinary incontinence (SUI) confirmed on urodynamics. She fails 3 months of supervised pelvic floor muscle training. She has no detrusor overactivity. POP-Q staging shows Stage I anterior vaginal wall prolapse. According to current NICE/IUGA guidelines, the MOST appropriate next intervention is:
  20. A 32-year-old woman develops a vesicovaginal fistula (VVF) 14 days after total abdominal hysterectomy. The fistula is 0.8 cm, located 1.5 cm above the trigone, with edges that are non-inflamed and viable on cystoscopy. What is the MOST appropriate timing and route for surgical repair?
  21. The POP-Q (Pelvic Organ Prolapse Quantification) system uses the hymen as the fixed reference plane (0 point). In a woman with Stage III cystocele, the leading edge of the cystocele is located where?
  22. A woman develops a vesico-vaginal fistula (VVF) 2 weeks after a total abdominal hysterectomy. Classic dye test (intravesical methylene blue) shows dye in the vagina. Cystoscopy localises the fistula to the trigone, 2 cm from the right ureteric orifice. What is the minimum recommended waiting period before surgical repair of a post-hysterectomy VVF?
  23. The POP-Q (Pelvic Organ Prolapse Quantification) system uses the hymenal remnant as the fixed reference point (0 cm). A woman has Aa = +1, Ba = +3, C = +4, gh = 5, pb = 3, tvl = 9, Ap = −1, Bp = −1, D = +2. What POP-Q stage is her anterior compartment prolapse?
  24. A 45-year-old with stress urinary incontinence (SUI) undergoes urodynamic assessment. Which urodynamic parameter most directly quantifies the functional urethral length and sphincter mechanism, distinguishing intrinsic sphincter deficiency (ISD) from urethral hypermobility?
  25. A 60-year-old postmenopausal woman presents with stress urinary incontinence (SUI). Urodynamic study confirms urodynamic stress incontinence (USI) with Valsalva leak point pressure (VLPP) of 45 cm H₂O. She has stage II anterior vaginal wall prolapse (POP-Q Aa +1, Ba +2). She has failed pelvic floor muscle training for 6 months. What does the VLPP measurement indicate and which surgical treatment has the highest long-term success rate for SUI in this context?
  26. A 35-year-old woman from rural India presents with continuous leakage of urine from the vagina 3 weeks after a prolonged obstructed labour and difficult vaginal delivery. Methylene blue test confirms a vesicovaginal fistula (VVF). The fistula is 1.5 cm, located 2 cm above the interureteric ridge, with surrounding tissue inflammation. What is the optimal timing for surgical repair?
  27. The POP-Q (Pelvic Organ Prolapse Quantification) system uses six points relative to the hymenal ring. A woman has Aa = +1, Ba = +3, C = +4, D = +3, Ap = −1, Bp = −1, TVL = 9, GH = 4, PB = 3. Which stage of prolapse does she have?
  28. Urodynamic stress incontinence (USI) is distinguished from detrusor overactivity (DO) on multichannel cystometry by which finding?
  29. A 62-year-old postmenopausal woman has uterovaginal prolapse. On examination, the cervix is 2 cm above the hymen at maximum Valsalva. The posterior vaginal wall bulges 1 cm beyond the hymen. Using the POP-Q (Pelvic Organ Prolapse Quantification) system, the cervix position would be coded as which value?
  30. A 50-year-old woman complains of leaking urine on coughing and sneezing (stress urinary incontinence). Urodynamic studies show urethral pressure profilometry with maximum urethral closure pressure (MUCP) of 10 cmH2O. There is no detrusor overactivity. What does the reduced MUCP indicate, and which surgical procedure has the best long-term outcomes?
  31. The POP-Q (Pelvic Organ Prolapse Quantification) system uses 6 points referenced to the hymenal ring. Point C measures which anatomical landmark?
  32. The urodynamic investigation of choice to distinguish stress urinary incontinence (SUI) from overactive bladder (OAB) and confirm genuine stress incontinence before planning surgical intervention is:
  33. The POP-Q (Pelvic Organ Prolapse Quantification) system measures six vaginal wall landmarks. A patient has the following measurements: Aa +2, Ba +3, C -1, Ap -1, Bp -1, D -5, TVL 9, GH 4, PB 3. What is the POP-Q Stage?
  34. The mid-urethral sling (MUS) procedure is the gold standard surgical treatment for stress urinary incontinence. What is the PRIMARY mechanism of action of the tension-free vaginal tape (TVT) retropubic sling?
  35. A 58-year-old woman with anterior vaginal wall prolapse to the hymen and stress urinary incontinence undergoes urodynamic evaluation. Cystometry shows first sensation at 120 mL, maximum cystometric capacity 420 mL, no detrusor overactivity, and Valsalva leak point pressure (VLPP) of 52 cmH2O. What does the VLPP value indicate about the mechanism of incontinence?
  36. A 58-year-old multiparous woman presents with a bulge at the vaginal introitus. On examination, the leading edge of the anterior vaginal wall protrudes 2 cm beyond the hymen on maximum Valsalva; total vaginal length (TVL) is 8 cm. Using the POP-Q system, this measurement (point Ba = +2 cm) corresponds to which stage?
  37. A 45-year-old woman complains of involuntary leakage of urine on coughing, laughing, and sneezing. She has no urge or nocturia. Urodynamics shows normal detrusor pressure, bladder neck descent on Valsalva, and involuntary urethral pressure drop with increased abdominal pressure. The diagnosis and first-line non-surgical treatment is:
  38. A 58-year-old woman presents with a bulge at the vaginal introitus. On examination, the cervix is 3 cm beyond the hymenal ring. No cystocele or rectocele is seen. Using POP-Q (Pelvic Organ Prolapse Quantification) system, where the hymenal ring is 0 and points are: point C (cervix) = +3, total vaginal length = 9 cm, Aa = -2, Ba = -2, Ap = -3, Bp = -3. What is the POP-Q stage?
  39. A 45-year-old multiparous woman leaks urine whenever she laughs, coughs, or exercises. Urodynamic testing shows urethral hypermobility and leakage with Valsalva at 150 mL bladder fill, with no detrusor overactivity. Maximum urethral closure pressure is 28 cmH₂O. Conservative management (pelvic floor exercises) has failed. The MOST appropriate surgical procedure is:
  40. A 26-year-old woman develops a vesicovaginal fistula (VVF) following prolonged obstructed labour. She presents 3 weeks post-partum with constant urinary dribbling. The MOST important initial step before planning surgical repair is:
  41. According to the POP-Q (Pelvic Organ Prolapse Quantification) system, a woman has point C (cervix) at +2 cm (2 cm beyond the hymen), total vaginal length 8 cm, and Aa point at +3 cm. In the POP-Q staging, what is the Stage?
  42. The SISTER trial compared Burch colposuspension with pubovaginal sling for stress urinary incontinence. At 2-year follow-up, the primary outcome of complete continence showed which result?
  43. A 52-year-old multiparous woman presents with a sensation of a lump in the vagina. On examination, the leading edge of the prolapse descends 2 cm beyond the hymen at maximum Valsalva. According to the Pelvic Organ Prolapse Quantification (POP-Q) system, this corresponds to:
  44. A 45-year-old woman leaks urine with coughing, sneezing, and exercise. Urodynamic study confirms genuine stress urinary incontinence (SUI) with a urethral closure pressure of 28 cmH₂O and no detrusor overactivity. She has failed supervised pelvic floor muscle training. The gold standard surgical procedure for genuine SUI is:
  45. According to the POP-Q (Pelvic Organ Prolapse Quantification) system, a woman has point Ba at +3 cm, point Bp at +2 cm, and the total vaginal length is 8 cm. What stage of prolapse does she have?
  46. In the POP-Q (Pelvic Organ Prolapse Quantification) system, point C describes:
  47. The SISTER trial (2004) compared which two surgical procedures for stress urinary incontinence and found equivalent continence rates at 2 years?
  48. A vesicovaginal fistula (VVF) 3 months post-total hysterectomy is being evaluated. Cystoscopy and examination under anaesthesia show a 1.5 cm supratrigonal fistula. The PREFERRED surgical repair approach is:
  49. A 55-year-old woman complains of a vaginal bulge and stress urinary incontinence. On POP-Q examination, the leading edge of prolapse (Ba point) is at +2 cm beyond the hymen, and the cervix (C point) is at 0 cm. What is the POP-Q stage of the anterior compartment prolapse?
  50. A vesicovaginal fistula is confirmed in a 30-year-old woman 14 days after total abdominal hysterectomy. The fistula is 5 mm on cystoscopy and she has continuous urinary incontinence. Initial conservative management includes:
  51. The tension-free vaginal tape (TVT) procedure for stress urinary incontinence is mechanistically based on which concept?
  52. A 58-year-old multiparous woman presents with stress urinary incontinence (SUI). Urodynamic testing confirms urodynamic stress incontinence (USI) with urethral hypermobility. Conservative treatment (PFMT) for 3 months has failed. Which surgical procedure has the BEST long-term evidence (> 10 years) for cure of stress urinary incontinence?
  53. A 35-year-old woman develops a vesicovaginal fistula (VVF) 14 days after total abdominal hysterectomy for fibroids. She presents with continuous painless urinary incontinence. The optimal timing of surgical repair is:
  54. A 58-year-old multiparous woman presents with urinary leakage on coughing and sneezing. Urodynamic study shows involuntary detrusor contractions at 150 mL during filling phase with simultaneous leakage. What is the diagnosis and first-line treatment?
  55. According to the POP-Q (Pelvic Organ Prolapse Quantification) system, Stage III prolapse is defined as:
  56. In the POP-Q (Pelvic Organ Prolapse Quantification) system, Stage II prolapse is defined as the leading edge of the prolapse being located:
  57. Which urodynamic finding differentiates stress urinary incontinence from detrusor overactivity (urgency incontinence) on filling cystometry?
  58. A vesico-vaginal fistula (VVF) develops 10 days after an abdominal hysterectomy. The most common site of iatrogenic VVF following hysterectomy is:
  59. In the POP-Q (Pelvic Organ Prolapse Quantification) system, Stage II prolapse is defined as:
  60. A woman reports leakage of urine with coughing, sneezing, and exercise with no urgency. Urodynamic study shows a significant leak at 60 cmH2O Valsalva leak point pressure with no detrusor overactivity. The most appropriate surgical treatment is:
  61. A vesico-vaginal fistula (VVF) following prolonged obstructed labor in a young primipara is most likely located at:
  62. The Baden-Walker halfway system for grading pelvic organ prolapse grades cystocele as Grade 3 when:
  63. The SISTER trial compared Burch colposuspension to autologous fascia lata pubovaginal sling for stress urinary incontinence. What was the key finding at 2-year follow-up?
  64. A 45-year-old woman presents with continuous urinary leakage day and night following a difficult instrumental delivery 3 months ago. She has no urgency or stress incontinence. Dye test (methylene blue in bladder) stains the vaginal swab blue. The MOST likely diagnosis is:
  65. In the POP-Q (Pelvic Organ Prolapse Quantification) system, point Ba is defined as:
  66. The tension-free vaginal tape (TVT) procedure for stress urinary incontinence works by which mechanism?
  67. A 55-year-old multiparous woman has a prolapse in which the cervix descends 2 cm beyond the hymenal ring. The leading point is at +2 cm on POP-Q examination. Stage of prolapse according to POP-Q is:
  68. A 45-year-old woman complains of urine leakage when she laughs or coughs. Urodynamic study shows involuntary detrusor contractions during filling phase. The most appropriate first-line medical treatment is:
  69. A vesico-vaginal fistula develops 10 days after a difficult hysterectomy for fibroid uterus. Dye test confirms the fistula. What is the minimum recommended waiting period before surgical repair to allow oedema and inflammation to subside?
  70. In the POP-Q (Pelvic Organ Prolapse Quantification) system, which TWO reference points define the leading edge of the anterior vaginal wall prolapse?
  71. According to the POP-Q (Pelvic Organ Prolapse Quantification) system, a woman has point Aa = 0, point Ba = 0, point C = -3, point Bp = -3, and total vaginal length = 8 cm. Her prolapse stage is:
  72. The gold standard investigation for urodynamic stress incontinence (USI) requiring surgical correction is:
  73. A vesicovaginal fistula develops 14 days after an abdominal hysterectomy. The site is supratrigonal. The OPTIMAL timing and approach for repair is:
  74. A 52-year-old woman complains of urgency, frequency, nocturia, and urge incontinence for 6 months. She has no stress leakage on cough test and no prolapse. Urinalysis is normal. The FIRST-LINE treatment is:
  75. The POP-Q system stages pelvic organ prolapse using anatomical reference points. Stage III prolapse is defined as:
  76. A 45-year-old woman complains of urinary leakage with coughing and sneezing for 2 years. Urodynamic studies show urethral hypermobility with a leak-point pressure of 55 cmH₂O and no detrusor overactivity. What is the first-line surgical treatment?
  77. In the POP-Q (Pelvic Organ Prolapse Quantification) system, a woman has point Ba at +1, C at +4, D at +1, and total vaginal length (tvl) of 9 cm. The prolapse is BEST classified as:
  78. The mid-urethral tape (TVT — tension-free vaginal tape) was originally designed to support which anatomical structure to restore continence in stress urinary incontinence?
  79. A vesico-vaginal fistula (VVF) following obstructed labour is BEST characterised by which histological finding at the fistula margin that distinguishes it from post-surgical VVF?
  80. Vesicovaginal fistula (VVF) post-hysterectomy is MOST commonly located at which anatomical level?
  81. The POP-Q (Pelvic Organ Prolapse Quantification) system uses six measurement points (Aa, Ba, C, D, Gh, Pb, TVL) relative to the hymen. In a woman with Stage III cystocele on POP-Q, the anterior vaginal wall point Ba is:
  82. A 45-year-old woman with a vesicovaginal fistula (VVF) following an uncomplicated total abdominal hysterectomy presents 10 days postoperatively with continuous urinary leakage. The fistula is 3 mm at the vault, confirmed on cystoscopy. What is the MOST appropriate timing and approach for surgical repair?
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