GP

Question 1

what are the types of incontinence + how do they differ

Answer 1

stress - urine leaks when bladder under pressure (cough, laugh - can occur with prolapse)

urge - overactive bladder, sudden/intense urge to pass urine so often passes small amount

Question 2

what are red-flags to consider for urinary incontinence

Answer 2

haematuria
persistent UTI

recent back trauma, pelvic surgery
saddle anaesthesia

poor renal function
abnormal neurology
FLAW - systemic/constitutional symptoms

Question 3

what is stress incontinence + its risk factors

Answer 3

stress = urine leaks when bladder is under pressure (from cough, laugh)

RF: old age, high parity (can occur alongside prolapse), menopause

Question 4

what is urge incontinence + its risk factors

Answer 4

urge = sudden/intense urge to pass urine, so often passes small amounts
presents with nocturia

RF: detrusor overactive, high caffeine intake

Question 5

how is urinary incontinence diagnosed

Answer 5

urine dipstick - check if infection
incontinence diary

Question 6

how is stress incontinence managed

Answer 6

stress = urine leaks from bladder’s pressure (laugh/cough)

conservative: more exercise, lose weight, physio
pelvic floor strengthening

medical: duloxetine (SSRI)

surgical: tape, colposuspension

Question 7

how is urge incontinence managed

Answer 7

urge = urinates often with small amounts as constant urge to urinate

conservative: more exercise (bladder training), lose weight
restrict fluids, avoid caffeine

review medication - ACEi, diuretic, hormone replacement therapy, sedatives

medical: antimuscarinic, botox injections into detrusor muscle (as urge incontinence due to detrusor overactivity)

Question 8

what are 4 potential causes of back pain (not MSK related)

Answer 8

cauda equina syndrome
infection - if immunosuppressed (taking steroids), or IV drug use
tumour - systemic symptoms (fever, weight loss), PMH
renal colic, pylonephritis

Question 9

how does cauda equine present

Answer 9

bilateral sciatica (leg pain)
saddle anaesthesia
bladder/bowel dysfunction

Question 10

how does pyelonephritis or renal colic present

Answer 10

dysuria, haematuria
flank pain

fevers + costovertebral angle tenderness if pyelonephritis

Question 11

what exams are done for cauda equina

Answer 11

PR exam to check anal tone
straight leg raise

Question 12

what is the most common causative organism of UTI

Answer 12

e.coli

gram -ve rod

Question 13

how do complicated + uncomplicated UTI differ

Answer 13

complicated - functional/structural impairment (kidney, bladder), UTI occurring in pregnancy

uncomplicated - otherwise healthy + non-pregnant, no functional/structural urinary tract abnormalities

Question 14

how does UTI present

Answer 14

dysuria, increased frequency
haematuria
suprapubic tenderness
back/flank pain, costovertebral angle tenderness (pyelonephritis)

fever, rigor

Question 15

how to diagnose UTI

Answer 15

urine dipstick - shows nitrite/leukocyte
urine microscopy - shows bacteria, WBC
urine culture/sensitivity - growth of >10^5

Question 16

how is UTI managed

Answer 16

conservative: fluid + sodium citrate sachet, urinate after intercourse

medical:
nitrofurantoin or trimethoprim
if pen-allergic, then ciprofloxacin

safety-netting: higher temp, unable to eat/drink, pain worsening

Question 17

if a pregnant women has a UTI, what medication is given

Answer 17

it depends on what trimester

tri 1 = nitro, tri 3 = tri

if 1st trimester = avoid trimethoprim, so give nitrofuranatonin

if 3rd trimester = avoid nitrofuranatonin, so give trimethoprim
as nitro causes haemolytic anaemia in newborn