Bladder and urinary disorders

Question 1

four main sub classes of urinary incontinence

Answer 1

Stress, urge, mixed and overfloew

Question 2

What is stress incontinence?

Answer 2

leakage on effort of exertion e.g. cough/sneeze due to pelvic floor weakness / damage to urethral sphincter

Question 3

What is urgency incontinence?

Answer 3

involuntary leakage which is accompanied or immediately preceded by sudden compelling desire to pass urine that is difficult ot delay

Question 4

Urgency incontinence is often part of a larder symptom complex known as what?

Answer 4

Overactive bladder syndrome

Question 5

Non drug treatment for unrinary incontinence

Answer 5

modify fluid intake, BMI (if >30), reduction in caffeine, absorbent products

Question 6

For urge incontinence, what is the first line treatment in women?

Answer 6

Bladder training for at least 6 weeks

Question 7

For stress incontinence, what is first line treatment?

Answer 7

Pelvic floor training for at least 3 months which should include 8 contractions performed 3 times a day

Question 8

What test should be done for all women presenting with urinary incontinence?

Answer 8

Urine dipstick

Question 9

If a women is >45, has heamaturia without UTI what should be done?

Answer 9

Urgent referral

Question 10

First line medication for urge incontinence

Answer 10

Anticholingergic drug e.g. Oxybutynin or tolerodine or darifenacin

Question 11

Which anticholinergic should not be used in frail, older women with sudden deterioration in their physical / mental health

Answer 11

Oxybutynin I/R capsules

Question 12

If treatment for urge incontinence cannot be managed wiht an anticholinergic, what else can be trialled?

Answer 12

Mirabegron

Question 13

What an be used for troublesome nocturia?

Answer 13

Desmopressin

Question 14

What can be used second line for stress incontinence if pelvic floor exercise has failed?

Answer 14

Duloxetine

Question 15

By what age are children expected to no longer expereince nocturnal enuresis?

Answer 15

5 years

Question 16

What non drug treatment should be given for nocturnal enuresis in children?

Answer 16

fluid intake, diet, toileting behaviour and reward systems. If the child does not respond to this advice (more than 1-2 wet beds a week) then an alarm should be introduced.

Question 17

What drug treatment is first line for children with nocturnal enuresis?

Answer 17

Desmopressin oral or sublingual ( need to be gradually withdrawn over 3 monthd

Question 18

What TCA can be used in children who have not responcded to all toher treamtents for nocturnal enuresis?

Answer 18

Imipramine

Question 19

Can antimuscarinics be used in angle closure glaucome?

Answer 19

NO

Question 20

Can antimuscarinics be used in myasthenia gravis?

Answer 20

no

Question 21

What urinary condition are antimuscarinics contraindicated in?

Answer 21

Urinary retention

Question 22

Side effects of antimuscarinics

Answer 22

Constipation, dizziness, dry mouth, dyspepsia, flushing, headache, nausea, tacycardia,urinary disorders, vision disorders

Question 23

how often does an oxybutynin patch need to be replaced?

Answer 23

3 to 4 days

Question 24

Example of a beta 3 adrenoreceptor agonists?

Answer 24

Mirabegron

Question 25

When is mirabegron contraindicated?

Answer 25

In severe uncontrolled hypertension (>180 systolic, 110 diastolic)

Question 26

What needs to be monitored during and throughouth treatment with mirabegron>

Answer 26

BP

Question 27

Most common cause of urinary retention?

Answer 27

BPH

Question 28

What is used to relieve painful, acute urinary retention

Answer 28

Catherisation

Question 29

What drug class should be given for 2 days before removing a catherter?

Answer 29

Alphsa blocker

Question 30

First line drug treamtent for moderate-severe urinary retention in men?

Answer 30

Alphas blocker e.g. tamsulosin, doxasozin

Question 31

First line treatment for BPH

Answer 31

Tamsulosin

Question 32

If ap atient has an enlarged prostate, raised prostate specfic antigen and is at highrisk of progression, what drug(s) can be offered?

Answer 32

Finateride or dutasteride ( 5 alpha reductase inhibitors)

Question 33

When should the first dose of an alpha inhibitor be taken?

Answer 33

Before bed - risk of postural drop

Question 34

What eye condition are alpha blockers cautioned in?

Answer 34

History of cataracts

Question 35

Women of child bearing potential should handle which medications used for BPH with caution?

Answer 35

Dutasteride and Finasteride

Question 36

MHRA alert associated with Finasteride

Answer 36

risk of suicidal reports / depression

Question 37

Patients on finasteride need to be counselled about the risk of what maligancy?

Answer 37

Breast cancer

Question 38

Risk factoe associated with forming renal stones?

Answer 38

dehydration, change in urine pH, males aged 40-60, family hisotry, obesity, excessive intke of oxalate, sodium and uric acid, some drugs e.g. calcium supplementes, protease inhibitors,diuretics

Question 39

What could a patient be diagnosed with if they have a sudden, abrupt onset of severe unilateral pain radiating tothe groin +/- nausea, increased urinary frequency,dysuria, fever?

Answer 39

Renal stones

Question 40

Maximum salt intake recomendation

Answer 40

6g a day

Question 41

First line analgesia for renal colic

Answer 41

NSAIDS (if unsuitable IV paracetamol)

Question 42

What can be used to alkalise urine?

Answer 42

Potassium citrate

Question 43

Pentosan polysulfate sodium is used for bladder pain syndrome - what is the associated MHRA alert?

Answer 43

Rare risk of pigmentary maculopathy - pt need regualr ophthalmic examinsation