449.A 50-year-old multiparous woman comes to your office to rule out
cancer. She reports a growing mass or fullness on the anterior wall of her
vagina. Upon physical examination you detect a soft, bulging, and a very
compressible mass on the anterior surface of the vagina. When you push
on the bulging mass she feels the need to urinate. You order a CT because
you suspect which of the following?
a. Rectocele
b. Cystocele
c. Cervical cancer
d. Didelphic uterus
e. Indirect inguinal hernia
450.A 30-year-old woman makes her first prenatal visit to your office. She
is excited and anxious as this is her first pregnancy. She brings up the topic
of pain relief during vaginal delivery. She states that she would like to try
“natural birth” but would like to have the option of some pain relief. How-
ever, she would prefer notto have a caudal epidural block. You suggest a
pudendal nerve block. One of the advantages of a pudendal nerve block is
that the woman can still feel uterine contractions and thus can actively par-
ticipate in the birthing process, yet also has some pain relief. What would
you tell your patient regarding how to perform a pudendal nerve block and
an advantage to performing the injection transvaginally versus injecting
through perineal skin?
a. The pudendal nerve serves the skin around the anterior/lateral entrance of the
vagina; the nerve wraps around the ischial spine, which is used as landmark;
transvaginal administration is less painful since the upper portion of the vagina
has fewer pain receptors
b. The pudendal nerve serves the skin around the posterior/lateral entrance of the
vagina; the nerve wraps around the ischial spine, which is used as a landmark;
transvaginal administration is less painful since the upper portion of the vagina
has fewer pain receptors
c. The pudendal nerve serves the skin around the anterior/lateral entrance of the
vagina; the nerve wraps around the ischial tuberosity, which is used as land-
mark; transvaginal administration is less painful since the upper portion of the
vagina has fewer pain receptors
d. The pudendal nerve serves the skin around the posterior/lateral entrance of the
vagina; the nerve wraps around the ischial tuberosity, which is used as a land-
mark; transvaginal administration is less painful since the upper portion of the
vagina has fewer pain receptors
Pelvis 545