Natasha Bhate FY2 Doctor - PowerPoint Presentation

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Natasha BhateFY2 Doctor

Gynaecology Tutorial

11/04/21

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Learning Objectives

Topics covered:

Vaginal/vulval disorders

Cervical disorders

Uterine disorders

Endometrial disorders

Ovarian disorders

Urogynaecology

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SBA

A 70y/o woman has had vulval itching and discomfort for 12 months. There is a widespread erythema on both labia minora extending onto the majora and involving the fourchette. There are no ulcers and there is no inguinal lymphadenopathy. Which is the single most appropriate initial management?

Empirical treatment with potent corticosteroid ointment

Referral for urgent punch biopsy to exclude cancer

Referral to the sexual health clinic to rule out an STI

Treatment with oestrogen cream for atrophy

Vulval excision to treat the affected area

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VAGINAL/VULVAL DISORDERS

A 70y/o woman has had vulval itching and discomfort for 12 months. There is a widespread erythema on both labia minora extending onto the majora and involving the fourchette. There are no ulcers and there is no inguinal lymphadenopathy. Which is the single most appropriate initial management?

Empirical treatment with potent corticosteroid ointment

Referral for urgent punch biopsy to exclude cancer

Referral to the sexual health clinic to rule out an STI

Empirical treatment with oestrogen cream for atrophy

Vulval excision to treat the affected area

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LICHEN SCLEROSIS

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SBA

A 63y/o woman has had urinary frequency, dysuria and dyspareunia for the last 6 months. Her symptoms are markedly improve on treatment with a local oestrodial

cream. What is the most likely diagnosis?

Urinary tract infection

Genitourinary tract atrophy

Cystocele

Uretovaginal

prolapse

Urethritis

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VAGINAL/VULVAL DISORDERS

A 63y/o woman has had urinary frequency, dysuria and dyspareunia for the last 6 months. Her symptoms are markedly improve on treatment with a local oestrodial

cream. What is the most likely diagnosis?

Urinary tract infection

Genitourinary tract atrophy

Cystocele

Uretovaginal

prolapse

Urethritis

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ATROPHIC VULVOVAGINITIS

Associated with oestrogen deficiency due to:

Menopause, High dose progesterone meds, Breast ca meds (e.g. Tamoxifen/aromatase inhibitors), hyperprolactinaemia

Symptoms:

Vaginal or vulval dryness

Vaginal or vulval itching (pruritus vulvae)

Vaginal burning

Painful sex (dyspareunia)

Skin splitting (fissuring) of the entrance to the vagina (posterior fourchette)

Vaginal spotting (bleeding)

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ATROPHIC VULVOVAGINITIS

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SBA

A 35y/o para 4 woman with regular partner has post-coital bleeding. She has a regular 28 day cycle and uses the combined oral contraceptive pill. Her last cervical smear, taken 2 years ago, was normal. She has a smooth centrally red cervix with mild contact bleeding. What is the most likely diagnosis?

Cervical carcinoma

Cervical trauma from intercourse

Cervical ectropion

Cervical intraepithelial neoplasia

Cervical polyp

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CERVICAL DISORDERS

A 35y/o para 4 woman with regular partner has post-coital bleeding. She has a regular 28 day cycle and uses the combined oral contraceptive pill. Her last cervical smear, taken 2 years ago, was normal. She has a smooth centrally red cervix with mild contact bleeding. What is the most likely diagnosis?

Cervical carcinoma

Cervical trauma from intercourse

Cervical ectropion

Cervical intraepithelial neoplasia

Cervical polyp

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CERVICAL ECTROPION

T

he everted columnar epithelium has a reddish appearance – usually arranged in a ring around the external

os

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SBA

A 25y/o woman attends her first routine cervical cytology test as part of the NHS Cervical Screening Programme. This shows ‘mild dyskaryosis CIN 1’ and she is advised to have a repeat smear in 6 months time. She has had the same sexual partner for 18 months and they both have tested negative for STI’s at the start of the relationship. She has BMI of 30 and uses a progesterone only pill. She smokes 15 cigarettes/day and drinks ~25U of alcohol/week. She wants to know if there is anything she can do that might help reverse the abnormality. What single action that she can be advised about will most likely reduce her risk?

Get vaccinated against HPV (human papillomavirus) infection

Give up smoking cigarettes

Reduce alcohol consumption

Reduce body mass index

Switch to an alternative contraceptive pill

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CERVICAL DISORDERS

A 25y/o woman attends her first routine cervical cytology test as part of the NHS Cervical Screening Programme. This shows ‘mild dyskaryosis CIN 1’ and she is advised to have a repeat smear in 6 months time. She has had the same sexual partner for 18 months and they both have tested negative for STI’s at the start of the relationship. She has BMI of 30 and uses a progesterone only pill. She smokes 15 cigarettes/day and drinks ~25U of alcohol/week. She wants to know if there is anything she can do that might help reverse the abnormality. What single action that she can be advised about will most likely reduce her risk?

Get vaccinated against HPV (human papillomavirus) infection

Give up smoking cigarettes

Reduce alcohol consumption

Reduce body mass index

Switch to an alternative contraceptive pill

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SBA

A 17y/o girl is going to university next year. She is seeking information about the human papilloma virus vaccine as she missed the programme at school and is now considering having the vaccination. Which is the most appropriate piece of information to give her about the vaccine?

If she has already had sexual intercourse, she has probably already been exposed to HPV and it is not worth her having the vaccination

If she has the vaccination it will protect her against HPV and she will not need regular smear testing later in life

If she suffers from eczema or asthma she will not be able to have the vaccination due to the risk of severe allergic reactions

The vaccination is only available as part of a primary immunisation course of younger girls and she is too old to be included in the “catch-up” cohort

The vaccination is 99% effective in preventing cervical abnormalities caused by specific HPV types that can lead to cervical cancer and she is eligible to have it

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CERVICAL DISORDERS

A 17y/o girl is going to university next year. She is seeking information about the human papilloma virus vaccine as she missed the programme at school and is now considering having the vaccination. Which is the most appropriate piece of information to give her about the vaccine?

If she has already had sexual intercourse, she has probably already been exposed to HPV and it is not worth her having the vaccination

If she has the vaccination it will protect her against HPV and she will not need regular smear testing later in life

If she suffers from eczema or asthma she will not be able to have the vaccination due to the risk of severe allergic reactions

The vaccination is only available as part of a primary immunisation course of younger girls and she is too old to be included in the “catch-up” cohort

The vaccination is 99% effective in preventing cervical abnormalities caused by specific HPV types that can lead to cervical cancer and she is eligible to have it

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Cervical Disorders

HPV Vaccination

Now offered to

all adolescents

in school

year 8 (aged 12-13yrs)- girls & boys

!

Also offered to

MSM up to and including 45yrs of age

attending GUM/HIV clinics regardless of risk/sexual behaviour or disease status.

In individuals <15yrs Gardasil is administered as 2 dose schedule:

Given at 0 months & 6-24months later.

In individuals >15yrs Gardasil should be administered as a 3 dose schedule:

Given at 0 months, 2

nd

should be at least 1 month later & 3

rd

at least 3 months after the 2

nd

dose.

All 3 doses should ideally be given in 12 months but 24 month period is clinically acceptable.

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SBA

A 32-year-old lady returns to the gynaecology clinic to find out the results of her cervical screening test. You see her report says moderate dyskaryosis. What would be the next stage in her management?

Colposcopy

Recall in 6 months

Recall in 1 year

Recall in 3 years

Repeat the test today

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CERVICAL DISORDERS

A 32-year-old lady returns to the gynaecology clinic to find out the results of her cervical screening test. You see her report says moderate dyskaryosis. What would be the next stage in her management?

Colposcopy

Recall in 6 months

Recall in 1 year

Recall in 3 years

Repeat the test today

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CERVICAL SCREENING PROGRAMME

Screening is offered to all women aged 24.5-65 years.Age 24.5 years — first invitation to ensure women can be screened before they are aged 25 years.

25–49 years should be offered screening every 3 years.

Once primary HPV screening has been fully implemented, this interval will be extended to every 5 years.

50–64 years should be offered screening every 5 years.

Women 65 years of age or older are invited if:

A recent cervical cytology sample is abnormal.

They have not had a cervical screening test since 50 years of age and they request one.

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CERVICAL SCREENING PROTOCOL

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Cervical Intra-epithelial Neoplasia (CIN)

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SBA

A 43-year-old woman has recently been diagnosed with cervical cancer. Which of the following are risk factors for the development of cervical cancer?

Early menarche

Early menopause

Increased number of sexual partners

Nulliparity

Progesterone only pill

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CERVICAL DISORDERS

A 43-year-old woman has recently been diagnosed with cervical cancer. Which of the following are risk factors for the development of cervical cancer?

Early menarche

Early menopause

Increased number of sexual partners

Nulliparity

Progesterone only pill

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SBA

A 47-year-old woman has noticed increasing heaviness of her regular menstrual periods over the past year. She now she finds them unmanageable with regular flooding. Her last smear showed moderate dyskaryosis and a biopsy was taken which demonstrated CIN II. She had a normal hysteroscopy and pelvic scan 4 months ago. She has completed her family. Despite numerous medical options from her general practitioner she still feels the condition is worsening and is getting to the end of her tether. What treatment would you suggest?

Cone biopsy

Endometrial ablation

Subtotal hysterectomy

Total hysterectomy

Uterine artery

embolisation

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CERVICAL DISORDERS

A 47-year-old woman has noticed increasing heaviness of her regular menstrual periods over the past year. She now she finds them unmanageable with regular flooding. Her last smear showed moderate dyskaryosis and a biopsy was taken which demonstrated CIN II. She had a normal hysteroscopy and pelvic scan 4 months ago. She has completed her family. Despite numerous medical options from her general practitioner she still feels the condition is worsening and is getting to the end of her tether. What treatment would you suggest?

Cone biopsy

Endometrial ablation

Subtotal hysterectomy

Total hysterectomy

Uterine artery

embolisation

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Cervical Cancer Stages

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SBA

A 35-year-old Afro-Caribbean woman presents with a long history of very heavy periods. She has visited you now as she cannot cope with the bleeding and she has a swelling in her abdomen. On examination, you feel a uterus equivalent to 18 weeks pregnancy; however, she says that she has not been sexually active for 3 years. What is the most likely diagnosis?

Cervical cancer

Cervical ectropion

Endometrial carcinoma

Large endometrial polyps

Uterine fibroids

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UTERINE DISORDERS

A 35-year-old Afro-Caribbean woman presents with a long history of very heavy periods. She has visited you now as she cannot cope with the bleeding and she has a swelling in her abdomen. On examination, you feel a uterus equivalent to 18 weeks pregnancy; however, she says that she has not been sexually active for 3 years. What is the most likely diagnosis?

Cervical cancer

Cervical ectropion

Endometrial carcinoma

Large endometrial polyps

Uterine fibroids

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SBA

A 29-year-old woman who has not completed her family has a diagnosis of large subserous fibroids and troublesome heavy periods. She feels medical treatments have made no difference to the bleeding. Which treatment option should be offered?

Endometrial ablation

Hysterectomy

Hysteroscopic resection of fibroids

Myomectomy

Uterine artery

embolisation

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UTERINE DISORDERS

A 29-year-old woman who has not completed her family has a diagnosis of large subserous fibroids and troublesome heavy periods. She feels medical treatments have made no difference to the bleeding. Which treatment option should be offered?

Endometrial ablation

Hysterectomy

Hysteroscopic resection of fibroids

Myomectomy

Uterine artery

embolisation

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SBA

A 32-year-old woman complains of longstanding painful, heavy periods. She has had two normal vaginal deliveries after difficulty conceiving with both pregnancies. She suffers from significant pain on intercourse. On further questioning she also states she has had occasional rectal bleeding during her menstrual cycle throughout her life. Her past history includes an appendicectomy aged 10. Pelvic examination reveals a fixed retroverted uterus that is tender. What is the most likely explanation for her pain?

Adhesions from surgery

Chronic pelvic inflammatory disease

Endometriosis

Fibroid degeneration

Ovarian cyst

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ENDOMETRIAL DISORDERS

A 32-year-old woman complains of longstanding painful, heavy periods. She has had two normal vaginal deliveries after difficulty conceiving with both pregnancies. She suffers from significant pain on intercourse. On further questioning she also states she has had occasional rectal bleeding during her menstrual cycle throughout her life. Her past history includes an appendicectomy aged 10. Pelvic examination reveals a fixed retroverted uterus that is tender. What is the most likely explanation for her pain?

Adhesions from surgery

Chronic pelvic inflammatory disease

Endometriosis

Fibroid degeneration

Ovarian cyst

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SBA

A 24y/o woman has deep dyspareunia and dysmenorrhea and wants to relieve her symptoms. A transvaginal US shows a 4cm endometrioma on the L ovary. She has been trying to conceive for over 12months with no luck. What is the single most appropriate treatment to use?

Combined oral contraceptive pill

Danazol

Gonadotrophin-releasing hormone analogues

Laparoscopic surgery

Medroxyprogesterone acetate (Provera)

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ENDOMETRIAL DISORDERS

A 24y/o woman has deep dyspareunia and dysmenorrhea and wants to relieve her symptoms. A transvaginal US shows a 4cm endometrioma on the L ovary. She has been trying to conceive for over 12months with no luck. What is the single most appropriate treatment to use?

Combined oral contraceptive pill

Danazol

Gonadotrophin-releasing hormone analogues

Laparoscopic surgery

Medroxyprogesterone acetate (Provera)

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SBA

Which of these increases your risk of developing endometrial carcinoma?

Combined oral contraceptive pill

Early menopause

Late menarche

Multiparity

Obesity

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ENDOMETRIAL DISORDERS

Which of these increases your risk of developing endometrial carcinoma?

Combined oral contraceptive pill

Early menopause

Late menarche

Multiparity

Obesity

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SBA

A 59-year-old woman attends with one episode of watery, bloody vaginal discharge. She has never had any children and she had menopause aged 55. On examination, she is obese but her abdomen is unremarkable. On speculum examination you see some purulent bloody discharge and you take triple swabs. Considering the likely diagnosis, what would be your next course of action?

Await results of triple swabs and follow-up in clinic in one month

Dilation and curettage

Hysteroscopy and endometrial biopsy

Pipelle

biopsy and follow-up in clinic in one month

Vabra

biopsy and follow-up in clinic in one month

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ENDOMETRIAL DISORDERS

A 59-year-old woman attends with one episode of watery, bloody vaginal discharge. She has never had any children and she had menopause aged 55. On examination, she is obese but her abdomen is unremarkable. On speculum examination you see some purulent bloody discharge and you take triple swabs. Considering the likely diagnosis, what would be your next course of action?

Await results of triple swabs and follow-up in clinic in one month

Dilation and curettage

Hysteroscopy and endometrial biopsy

Pipelle

biopsy and follow-up in clinic in one month

Vabra

biopsy and follow-up in clinic in one month

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SBA

A 33-year-old woman attends the emergency department complaining of an aching pain in her left iliac fossa. This has been present intermittently for a few months. She says the pain is significantly worse today but remains focused in the left iliac fossa. She has vomited four times. She denies being sexually active. On examination, she is tender in the left iliac fossa with some voluntary guarding. Speculum examination revealed no abnormalities. There is left adnexal tenderness on vaginal examination but no cervical excitation. Her observations show heart rate 112/min, blood pressure 98/62 mmHg and temperature 36.88C. A urine result is awaited. What is the most likely diagnosis?

Appendicitis

Mittelschmerz

Ovarian cyst torsion

Pelvic inflammatory disease

Renal colic

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OVARIAN DISORDERS

A 33-year-old woman attends the emergency department complaining of an aching pain in her left iliac fossa. This has been present intermittently for a few months. She says the pain is significantly worse today but remains focused in the left iliac fossa. She has vomited four times. She denies being sexually active. On examination, she is tender in the left iliac fossa with some voluntary guarding. Speculum examination revealed no abnormalities. There is left adnexal tenderness on vaginal examination but no cervical excitation. Her observations show heart rate 112/min, blood pressure 98/62 mmHg and temperature 36.88C. A urine result is awaited. What is the most likely diagnosis?

Appendicitis

Mittelschmerz

Ovarian cyst torsion

Pelvic inflammatory disease

Renal colic

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SBA

A 38y/o woman with one previous pregnancy has progressive lower abdominal distention. She is not on any contraception & pregnancy test negative. Nil change to her menses. She has a smooth pelvic abdominal mass that is palpable below the umbilicus. An US scan shows a 10cm simple cystic right-sided mass and no ascites. What is the most likely diagnosis?

Ovarian cystadenoma

Ovarian corpus luteum cyst

Ovarian dermoid cyst

Ovarian cystadenocarcinoma

Ovarian endometrioma

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OVARIAN DISORDERS

A 38y/o woman with one previous pregnancy has progressive lower abdominal distention. She is not on any contraception & pregnancy test negative. Nil change to her menses. She has a smooth pelvic abdominal mass that is palpable below the umbilicus. An US scan shows a 10cm simple cystic right-sided mass and no ascites. What is the most likely diagnosis?

Ovarian cystadenoma

Ovarian corpus luteum cyst

Ovarian dermoid cyst

Ovarian cystadenocarcinoma

Ovarian endometrioma

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OVARIAN DISORDERS

Types of ovarian cysts:

Functional

Follicular Cysts

Corpus Luteum Cysts

Theca Lutein Cysts

Non-Functional

Cystadenoma

Malignant Cysts

Dermoid Cysts

Chocolate Cyst (ovarian endometrioma)

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SBA

A 22y/o/ woman has acute onset R iliac fossa pain with nil vomiting. She has marked tenderness to palpation in the R iliac fossa. There is no rebound tenderness, and some voluntary guarding. Temperature is 37.2 degrees, HR 80bpm, BP is 115/80mmHg. Pregnancy test is negative. US shows a 7cm R sided haemorrhagic ovarian cyst with no free fluid. What is the single most appropriate initial management.

Admit her with a view to conservative management

Allow her to go home with advice to come back if pain worsens

Perform immediate laparoscopy in case the diagnosis is torsion

Refer to the surgeons to rule out appendicitis

Request a CT scan to confirm diagnosis

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OVARIAN DISORDERS

A 22y/o/ woman has acute onset R iliac fossa pain with nil vomiting. She has marked tenderness to palpation in the R iliac fossa. There is no rebound tenderness, and some voluntary guarding. Temperature is 37.2 degrees, HR 80bpm, BP is 115/80mmHg. Pregnancy test is negative. US shows a 7cm R sided haemorrhagic ovarian cyst with no free fluid. What is the single most appropriate initial management.

Admit her with a view to conservative management

Allow her to go home with advice to come back if pain worsens

Perform immediate laparoscopy in case the diagnosis is torsion

Refer to the surgeons to rule out appendicitis

Request a CT scan to confirm diagnosis

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SBA

Which one of the following factors increases your risk of developing ovarian cancer?

Early menopause

Late menarche

Multiparity

Nulliparity

Oral contraceptive pill

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OVARIAN DISORDERS

Which one of the following factors increases your risk of developing ovarian cancer?

Early menopause

Late menarche

Multiparity

Nulliparity

Oral contraceptive pill

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SBA

A 42-year-old woman was seen by the general practitioner after she complained of fatigue, weight loss and more recently a change in bowel habit. On examination, her abdomen was distended and the doctor elicited a positive fluid thrill test. She was urgently referred to the bowel surgeons; however, on CT bilateral ovarian cysts were seen. After referral to the gynaecology oncologists she had an operation and the histological findings were of psammoma bodies. Her diagnosis is the most common ovarian carcinoma. Which type of ovarian cancer did she have?

Clear cell tumour

Endometrioid tumour

Mucinous tumour

Serous tumour

Urothelial-like tumour

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OVARIAN DISORDERS

A 42-year-old woman was seen by the general practitioner after she complained of fatigue, weight loss and more recently a change in bowel habit. On examination, her abdomen was distended and the doctor elicited a positive fluid thrill test. She was urgently referred to the bowel surgeons; however, on CT bilateral ovarian cysts were seen. After referral to the gynaecology oncologists she had an operation and the histological findings were of psammoma bodies. Her diagnosis is the most common ovarian carcinoma. Which type of ovarian cancer did she have?

Clear cell tumour

Endometrioid tumour

Mucinous tumour

Serous tumour

Urothelial-like tumour

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SBA

A 59-year-old woman presents with vague symptoms of abdominal distension and some weight loss associated with fatigue. On examination, a large pelvic mass is detected. An ultrasound scan showed a large multiloculated cyst on her right ovary and some uncertain areas in her abdomen. Her CA-125 was increased. She had a staging laparotomy and pseudomyxoma peritonei was seen. Which ovarian tumour is she likely to have?

Brenner tumour

Clear cell tumour

Endometroid tumour

Mucinous tumour

Serous tumour

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OVARIAN DISORDERS

A 59-year-old woman presents with vague symptoms of abdominal distension and some weight loss associated with fatigue. On examination, a large pelvic mass is detected. An ultrasound scan showed a large multiloculated cyst on her right ovary and some uncertain areas in her abdomen. Her CA-125 was increased. She had a staging laparotomy and pseudomyxoma peritonei was seen. Which ovarian tumour is she likely to have?

Brenner tumour

Clear cell tumour

Endometroid tumour

Mucinous tumour

Serous tumour

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SBA

A previously well 67y/o woman has abdominal distention, a large irregular pelvic mass and ascites. An US, CT scan and a raised Ca-125 confirm a likely ovarian carcinoma. What is the most appropriate first-line management?

External beam radiotherapy

High-dose progesterone therapy

Hysterectomy, bilateral oophorectomy, omentectomy and debulking

Symptomatic palliative care

Vincristine-containing chemotherapy

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OVARIAN DISORDERS

A previously well 67y/o woman has abdominal distention, a large irregular pelvic mass and ascites. An US, CT scan and a raised Ca-125 confirm a likely ovarian carcinoma. What is the most appropriate first-line management?

External beam radiotherapy

High-dose progesterone therapy

Hysterectomy, bilateral oophorectomy, omentectomy and debulking

Symptomatic palliative care

Vincristine-containing chemotherapy

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OVARIAN CANCER

Slide56

SBA

A 59-year-old woman who has had three previous vaginal deliveries complains of a feeling of ‘something coming down’ at the front of her vagina and increased urinary frequency. On examination, there is a bulge at the front of her vagina which is easily visible with a Sims’ speculum. It is worse when she coughs. What is the most likely diagnosis?

Cystocele

Enterocele

Procidentia

Rectocele

Vault prolapse

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UROGYNAE

A 59-year-old woman who has had three previous vaginal deliveries complains of a feeling of ‘something coming down’ at the front of her vagina and increased urinary frequency. On examination, there is a bulge at the front of her vagina which is easily visible with a Sims’ speculum. It is worse when she coughs. What is the most likely diagnosis?

Cystocele

Enterocele

Procidentia

Rectocele

Vault prolapse

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Cystocele

Slide59

SBA

A 60y/o nulliparous woman has had urinary frequency and urgency for the past 6 months. She occasionally has small accidents before she can get to the toilet. She frequently needs to urinate during the night. What is the most likely diagnosis?

Urinary tract infection

Interstitial cystitis

Stress incontinence

Detrusor overactivity

Mixed stress incontinence & detrusor overactivity

Slide60

UROGYNAE

A 60y/o nulliparous woman has had urinary frequency and urgency for the past 6 months. She occasionally has small accidents before she can get to the toilet. She frequently needs to urinate during the night. What is the most likely diagnosis?

Urinary tract infection

Interstitial cystitis

Stress incontinence

Detrusor overactivity

Mixed stress incontinence & detrusor overactivity

Slide61

UROGYNAE

Overactive bladder vs Stress Incontinence

Slide62

SBA

A 57-year-old woman presents with a history of having to run to the toilet and occasionally not getting there in time. She needs to wear pads every day and this is negatively impacting on her life. She also complains of waking up two or three times per night to pass urine. She has had two children by normal delivery and has never had any surgery on her bladder. She says she has been doing occasional pelvic floor exercises with little success.

Bladder Training

Botulinum toxin

Oxybutynin

Pelvic floor exercises with a trained physiotherapist

Tolteridone

Slide63

UROGYNAE

A 57-year-old woman presents with a history of having to run to the toilet and occasionally not getting there in time. She needs to wear pads every day and this is negatively impacting on her life. She also complains of waking up two or three times per night to pass urine. She has had two children by normal delivery and has never had any surgery on her bladder. She says she has been doing occasional pelvic floor exercises with little success.

Bladder Training

Botulinum toxin

Oxybutynin

Pelvic floor exercises with a trained physiotherapist

Tolteridone

Slide64

SBA

A 42 y/o woman has frequency, urgency and urge incontinence. Examination is unremarkable and a midstream specimen of urine is sterile. She is treated empirically for detrusor overactivity with oxybutynin. What is the single mechanism of action for this drug?

Anti-adrenergic

Anti-GABAergic

Antimuscarinic

Antinicotinic

Antiserotogenic

Slide65

UROGYNAE

A 42 y/o woman has frequency, urgency and urge incontinence. Examination is unremarkable and a midstream specimen of urine is sterile. She is treated empirically for detrusor overactivity with oxybutynin. What is the single mechanism of action for this drug?

Anti-adrenergic

Anti-GABAergic

Antimuscarinic

Antinicotinic

Antiserotogenic

Slide66

SBA

A 56-year-old woman has a history of leaking urine when lifting her grandchild. She can no longer do her aerobics class as she is afraid of the consequences of jumping up and down. She is very distressed and really wants something to be done about this. She is very tearful during the consultation. Considering the diagnosis, what is the first-line treatment?

Bladder training

Botulinum toxin A

Oxybutynin

Pelvic floor exercises with a trained physiotherapist

Surgery following urodynamics

Slide67

UROGYNAE

A 56-year-old woman has a history of leaking urine when lifting her grandchild. She can no longer do her aerobics class as she is afraid of the consequences of jumping up and down. She is very distressed and really wants something to be done about this. She is very tearful during the consultation. Considering the diagnosis, what is the first-line treatment?

Bladder training

Botulinum toxin A

Oxybutynin

Pelvic floor exercises with a trained physiotherapist

Surgery following urodynamics

Slide68

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Year 5 – Spring Term – Specialties Management Series –

Natasha Bhate