Which of the following regarding uterine descent is not correct?

1. Which of the following regarding uterine descent is not correct? • First degree descent implied the cervix descends below its normal Ievel on straining but does not protrude from the vulva • First degree descent implied the cervix descends below its normal Ievel on straining and protrudes from the vulva • Second degree descent implies the cervix reaches upto the vulva on straining • Procidentia means whole of the uterus is prolapsed outside the vulva

2. Answer • b

3. Which of the following are etiologies of uterovaginalprolapse : • Aging • Estrogen deprivation • Intrinsic collagen abnormalities • Chronic increase in intraabdominal pressure • Acute and chronic trauma of vaginal delivery • All of above

4. Answer • f

5. All of the following are supports of the uterus except: • Mackenrodt’s ligaments • Uterosacral ligaments • Broad ligament • Pubocervical fascia • Rectovaginal fascia

6. Answer • c

7. Following are the first level of support in DeLancy system • Cardinal ligament • Pubocervical fascia • Rectovaginal fascia • Pubo-urethral ligaments • Perineal body

8. Answer a

9. Following is not a posterior vaginal wall defect • Enterocele • Rectocele • Perineal body descent • Perineal tear

10. Answer • a

11. Which of the following is false regarding the examination of a patient with prolapse? • The maximal extent of prolapse is demonstrated with a standing straining examination when the bladder is empty • Resting tone & voluntary contraction of the anal sphincters should be assessed during rectovaginal examination • Women with prolapse and urinary incontinence should have stress testing performed with the prolapse reduction because this will mimic bladder and urethral function when the prolapse is treated • Screening for presence of UTI or CIN is not needed at the time of examination

12. Answer • d

13. Which of the following is not an indication for use of pessary • When future childbearing is intended in near future • Refusal for operation by patient • As a therapeutic test • Prolapse with pregnancy • Non healing decubitus ulcer

14. Answer • e

15. All of the following are complications associated with pessary except • B.vaginitis, ulceration of vaginal wall • Cervicitis • Carcinoma of vaginal wall • Impaction of pessary • Reduction of prolapse • Strangulation of prolapsed tissue

16. Answer • e

17. Following are true for management of prolapse except • Any decision for surgical intervention should take account of how prolapse is affecting lifestyle • Vaginal pessary can be used in elderly patients with prolapse with associated medical complications which contradict surgery • Vaginal hysterectomy is the only treatment of prolapse in all women • Sling surgeries are indicated in women desiring to retain reproductive function • Assessment of SUI is must during examination of prolapse so that the same can be corrected during surgery

18. Answer • c

19. Managenent of 3rd degree prolapse in a 27yrs P1+0 can be all except • Vaginal hysterectomy • Fothergill’s surgery • Sling surgery • Ring pessary

20. Answer • a