A 65-year-old female complains of frequency and urgency of ...

[waynest]

A 65-year-old female complains of frequency and urgency of urination and episodes of urinary incontinence. On pelvic examination, there is smooth, soft bulge of the anterior vaginal wall that is more pronounced with straining.
 
  These findings are indicative of:
  A. Rectocele
  B. Cystocele
  C. Uterine prolapse
  D. Anteflexed uterus

Question 2

During a pelvic examination, a clinician asks the patient to bear down to inspect the vaginal outlet for:
 
  A. Cystocele
  B. Rectocele
  C. Prolapsed uterus
  D. All of the above

[nguyenhoanhat]

Answer to Question 1

ANS: B
A cystocele can contribute to urinary frequency, urgency, and infection, and stress incontinence. The bimanual examination reveals a smooth, soft bulge of the anterior vaginal wall that is more pronounced with straining. Kegel exercises may be helpful, but surgical repair may be needed.

Answer to Question 2

ANS: D
During a pelvic examination, the clinician can inspect the external genitalia for lesions, ulcerations, inflammation, warts, swelling, discharge, or nodules. Inspect the perineum and anal areas for fissures, hemorrhoids, inflammation, lesions, ulcers, warts, or nodules. Assess the support of the vaginal outlet by asking the patient to bear down while you look for bulging at the introitus, suggesting a cystocele, rectocele, or prolapsed uterus.