GERI mod 6

Question 1

Why is incontinence more common in women?

Answer 1

Childbirth/repetitive trauma, urine travel is shorter, menopause and hormones, lack of estrogen will cause vaginal changes to sphincters.

Question 2

What is a common profound complaint of incontinent patients?

Answer 2

Social isolation* and embarrassment. Also very costly, Falls are common because of the urgency to get to the bathroom. Infections are common in pads or diapers. Can cause rashes or skin breakdown.

Question 3

What are the most common types of incontinence?

Answer 3

Stress and urge

Question 4

Epesiotomies put you at high risk for what?

Answer 4

Incontinence and pelvic prolapse

Question 5

An inappropriate sense of incontinence that is neurogenic. These patients are frantic to get to the bathroom.

Answer 5

Urge

Question 6

Mixed is which two incontinence?

Answer 6

Most commonly Stress and urge. but can be a mix of any.

Question 7

MC of acute incontinence is what? They won’t have burning or pain.

Answer 7

Infection

Question 8

A blockage of flow. Can be caused by meds. Will have urgency but can’t get it out.

Answer 8

Overflow (retention) usually in men from prostate problems.

Question 9

Patient just can’t make it to the bathroom because they can’t move or get up fast enough. No sphincter issue. Can be from dementia.

Answer 9

Functional incontinence

Question 10

What are the reversible forms of incontinence?

Answer 10

Delirium, Intake of fluid poor or incorrect, stool impaction, Atrophic vaginitis/urethritis, psychological, pharmaceuticals, Excess urine output, abn labs, restrictive mobility

Question 11

What are the most common reversible causes of incontinence?

Answer 11

Atrophic vaginitis/urethritis, Meds that would cause urge - diuretics, Meds like benadryl and Ca channel blockers, opiods can cause overflow incontinence.

Question 12

What are the causes of fixed incontinence?

Answer 12

Dementia, stroke, cauda equina, MS, Parkinson, age related changes or trauma to pelvic floor.

Question 13

sympathetic/somatic diminish and parasympathetic contracts

bladder.

Answer 13

Bladder emptying

Question 14

How much vol does the bladder hold?

Answer 14

300-600L

Question 15

Closes bladder neck and inhibits parasympathetic (relaxes

bladder dome

Answer 15

Sympathetic tone

Question 16

Hx /description of symptoms:

Answer 16

UTI, duration, pain, nocturia*,
Urge vs stress - Child birth hx and C-section, Pregnancy in general is a RF even without vaginal delivery, Urge - they have to go right now!
Functional - can’t ambulate fast enough.

Question 17

Med review

Answer 17

Meds - Anticholinergics, Diuretics, opiods, Ca channel blockers

Question 18

PE

Answer 18

Sores, Atrophy vaginitis, thin skin or any break down, pelvic prolapse.

Question 19

Testing

Answer 19

Get up and go test –> Physical therapy, UA test, Post void residual ultrasound –> >150ml is elevated retention.
Testing pelvic floor strength with valsalva –> can see and grade how much pelvic organs come out.
Urge - inappropriate impulse to bladder –> EMG test.

Question 20

Weak pelvic floor.

Answer 20

Stress incontinence, treat with physical therapy. Can use lasers to tighten the tissues. Pessary helps hold up uterus and bladder.

Question 21

Bladder control remedy

Answer 21

Injection stimulation usually for urge.

Question 22

Catheters can get what?

Answer 22

Biofilms and cause infections.

Question 23

Males usually get what two incontinence?

Answer 23

Overflow and may or may not get stress from prostectomy.

Question 24

Gross hematuria

Answer 24

Visible

Question 25

How does hematuria present?

Answer 25

painless

Question 26

Hematuria is what until proven otherwise?

Answer 26

Bladder or renal cancer.
Can be from stones.
Menstruation, sexual activity, beats, blackberries, can also cause hematuria.

Question 27

Criteria for hematuria.

Answer 27

Atleast 2 dips 2-6 weeks apart.

Question 28

An endurance athlete with rabdomylosis will have what?

Answer 28

Hematuria - Myoglobin based

Question 29

Cystoscopy

Answer 29

Visual exam ordered by urologist. Need CT scan with Cystoscopy because you can visualize everything above the bladder while the urology apointment is materializing.

Question 30

With hematuria, If no infection what do you look for?

Answer 30

Kidney or glomerular causes.

Question 31

What should you be cautious about with treating UTI in women?

Answer 31

Antibiotic resistance, and not doing an impirical treatment. Let the patient wait until you find out what is causing the UTI.

Question 32

Are urine dips reliable?

Answer 32

Not really, can get false positives. In UTI the dip will have leukocytes, nitrates, RBCs, protein. Really what you need is a bacteria culture*

Question 33

What number of bacturia do you need to diagnose UTI?

Answer 33

100,000, MC is E.Coli, kelbsella

Question 34

What do you give patients for pain?

Answer 34

Pyridium

Question 35

How to you treat UTI empirically?

Answer 35

1st line: nitrofurantoin - not for kidney dz, bacterium - not for anticoag, Cipro - not for C-diff, cephlex.

Question 36

Do you treat asymptomatic chronic bacteriuria?

Answer 36

No, Will need to fix if they need procedures like hip replacements.

Question 37

How do you diagnose asymptomatic bacteriuria?

Answer 37

Do a second culture.

Question 38

Causes of Isolated proteinuria

Answer 38

DM, HTN
Microalbuminuria early stages of kidney disease.
UTI in severe cases.

Question 39

Spot check

Answer 39

How much protein in how much time. protein to creatine ratio.

Question 40

What meds should you consider in patients with proteinuria?

Answer 40

ACE and ARBS.