Chapter 42. Neurology Flashcards
Question 42-1:
MSA can have urologic symptoms and signs at the time of diagnosis. Which urologic features suggest consideration of MSA?
A. Loss of parasympathetic innervation of the detrusor
B. Poor contractility and incomplete emptying
C. Incontinence
D. Denervation of the sphincter due to loss of anterior horn cells
E. All are true
Answer 42-1: E.
All of these are true. MSA is usually
diagnosed by the neurologic presentation,
however, some patients will have prominent
early urologic complaints which may initially
result in a missed neurologic diagnosis. There
is loss of parasympathetic innervation of the
detrusor which results in poor contractility and
incomplete emptying. In addition, there is
denervation of the sphincter due to loss of
anterior hom cells with resultant incontinence.
(p753)
Question 42-2: Which of the following is reasonable first-line treatment for detrusor overactivity? A. Botulinum-A toxin B. Cannabis C. Anticholinergic medications D. Desmopressin E. All of the above
Answer 42-2: C.
Anticholinergic medications are the mainstay
of treatment of detrusor overactivity with
incontinence. All of the other treatments are
used, but they would not be considered firstline.
If anticholinergics are ineffective or not
tolerated, then the other possibilities can be
considered. (p756)
Question 42-3:
Patients with spinal cord disease may have overactivity of the bladder and incomplete emptying. Which is the most effective management for these issues?
A. Anticholinergic for the overactivity and intermittent self-catheierization for the incomplete emptying
B. Anticholinergic for the incomplete emptying and intermittent self-catheterization for the incomplete emptying
C. Intennittent self-catheterization treats both conditions
D. Anticholinergics treat both conditions
Answer 42-3: A.
The combination of bladder overactivity with
incontinence plus incomplete emptying can be
a difficult management problem. The
anticholinergic helps the overactivity and
intennittent self-catheterizations help the
incomplete emptying. (p758)
Question 42-4:
A patient with multiple sclerosis loses the ability to self catheterize. Which would be the next technique to manage incomplete bladder emptying?
A. Suprapubic catheter
B. Foley catheter
C. Nursing visits through home health around the clock for bladder care
Answer 42-4: B.
Indwelling catheter is helpful when the patient
is no longer able to perform the selfcatheterization
and there is no one at the house
who can perform the task regularly. It would
be unreasonable for home health to come so
frequently during the day and night to perform
all intenninent catheterizations. A suprapubic
catheter is used later in the course of the
disease. (p758)
Question 42-5:
The patient above has a Foley catheter for some time, but then he develops marked
detrusor overactivity and there is forced leakage around the catheter. Check of the catheter does not reveal obstructions. Which would be the next best step?
A. Suprapubic catheter
B. Replace the Foley catheter with one of larger diameter which can allow faster urine flow
C. Continue present management, but place absorbent garments for the leakage
Answer 42-5: A.
A suprapubic catheter would be the next step
in management of this patient. A larger Foley
catheter could partially treat this problem, but
the increased size of the catheter can further
damage the sphincter, so that leakage around
the catheter can eventually become worse. A
suprapubic catheter can solve the problem of
incomplete drainage as well as incontinence,
because the bladder is continuously empty, as
long as the catheter is functioning correctly.
(p756 )
Question 42-6: Erectile dysfunction is common in male patients with neurologic and vascular disease. Which is the most appropriate first-line treatment? A. Sildenafil B. Implanted prosthesis C. Prostaglandin E I injection
Answer 42-6: A.
Sildenafil or other similar drug is first-line
treatment for erectile dysfunction.An
implanted prosthesis can be used for patients
who fail to respond to oral medications, but
would certainly not be first-line treatment.
Prostaglandin El injections are also used for
patients with erectile dysfunction who have
been refractory to oral medications. (P761)
Question 42-7:
Sacral nerve stimulators are occasionally used for patients with incontinence. Which is the most likely mechanism of action?
A. Stimulation of sphincter motor neurons to inhibit incontinence
B. Stimulation of pelvic afferents which have an inhibitory effect on the detrusor
C. Excitatory block of the detrusor muscle
Answer 42-7: B.
Sacral nerve stimulators are used for patients
who have incontinence which does not
respond to anticholinergic medication. The
most likely mechanism is stimulation ofthe .
presacral region of the pelvic afferents which
have an inhibitory effect on the detrusor.
Questions 42-8 through 42-10: The following questions present urologic problems. For each select the best surgical procedure from the following list. A. Bladder neck suspension B. Augmentation cystoplasty C. Artificial sphincter D. Urinary diversion with stomacollection bag Questian 42-8: Sphincter failure.
Answer 42-8: C.
Artificial sphincter is used for patients with
sphincter failure. (p760)
Questions 42-8 through 42-10: The following questions present urologic problems. For each select the best surgical procedure from the following list. A. Bladder neck suspension B. Augmentation cystoplasty C. Artificial sphincter D. Urinary diversion with stomacollection bag Question 42-9: Stress incontinence.
Answer 42-9: A.
Bladder neck suspension would be appropriate
for stress incontinence. (p760)
Questions 42-8 through 42-10: The following questions present urologic problems. For each select the best surgical procedure from the following list. A. Bladder neck suspension B. Augmentation cystoplasty C. Artificial sphincter D. Urinary diversion with stomacollection bag Question 42-10: Intractable incontinence.
Answer 42-10: D.
Patients with intractable incontinence may
need urinary diversion with stoma collection
bag. (p760)
