LONG EXAM 1- Lower Urinary Tract Disorders, Pelvic Organ Prolapse, Anorectal Dysfunction Flashcards
The effective urethral closure is influenced by several factors which include:
Sympathetic nervous system mediation
Muscle tone and strength
Intraabdominal pressure
Muscle attachment to the pelvic walls
Muscle tone and strength
This occurs with increase in abdominal pressure and can be treated with pelvic muscle exercise, vaginal devices, lifestyle changes, and surgery.
Urinary incontinence
Stress urinary incontinence
Urgency urinary incontinence
Mixed urinary incontinence
Stress urinary incontinence
The urinary bladder function is mediated primarily by:
Parasympathetic nervous system
Involuntary muscle contractions
Sympathetic nervous system
Micturition reflex
Sympathetic nervous system
This is accomplished by voluntary relaxation of the pelvic floor and urethra, accompanied by sustained contraction of the detrusor muscle, leading to complete bladder emptying:
Normal voiding
Micturition reflex
Bladder filling and emptying
Urinary incontinence
Normal voiding
The alpha receptors of the sympathetic nervous system are primarily located at which part?
Bladder body
Bladder neck
Detrusor muscle
Brainstem
Bladder neck
The pontine micturition center serves as the final common pathway for all bladder motor neurons and transection below this area would lead to this condition:
Urinary frequency
Incontinence
Urinary retention
Detrusor overactivity
Urinary retention
This is the involuntary loss of urine associated with urgency and with effort or physical exertion or on sneezing or coughing:
Urgency urinary incontinence
Mixed urinary incontinence
Stress urinary incontinence
Insensible urinary incontinence
Mixed urinary incontinence
What is the current most accepted theory of stress urinary incontinence pathogenesis?
Loss of integrity of structures intrinsic to the urethra
Hammock theory
Connective tissue laxity in the vagina and its supporting ligaments
Integral theory
Loss of integrity of structures intrinsic to the urethra
What is the pathophysiology of overactive bladder?
Backward direction of the levator plate
Forward direction of the pubococcygeus muscle
There is no known cause that is documented
Abnormality between the micturition center and the bladder
There is no known cause that is documented
This condition involves a congenital absence of the anterior vaginal wall and the base of the bladder/urethra:
Urethral diverticuli
Ectopic urethra
Bladder extrophy
Vesicovaginal fistula
Bladder extrophy
Which one is a risk factor for urgency urinary incontinence?
Obesity
Advancing age
White women
Parity
Obesity
One of the reversible causes of urinary incontinence is:
Depression
Psychiatric cause
Enuresis
Atrophic vaginitis
Atrophic vaginitis
This is the amount of urine remaining in the bladder within 10 minutes from voiding and the abnormal threshold level is:
<50 mL
>100 mL
>150 mL
<200 mL
> 150 mL
What is the hallmark of advanced bladder testing?
Quality of life measurement
Urodynamic tests
Uroflowmetry
Cystoscopy
Urodynamic tests
This type of detrusor overactivity that refers to the involuntary detrusor contractions occurring at cystometric capacity which cannot be suppressed resulting in incontinence and bladder emptying
Neurogenic type
Phasic type
Terminal type
Idiopathic type
Terminal type
The difference between urethral pressure and vesical pressure is called:
Urethral closure pressure
Pressure profile
Total urethral pressure
Maximum urethral closure pressure
Urethral closure pressure
hat is the normal volume when one has a strong desire to void?
150 mL
200 mL
250 mL
400 mL
250 mL
The cut off pressure during a Valsalva leak point pressure measurement is:
> 60 cm of H2O
200 mmHg
100 mmHg
120 cm of H2O
> 60 cm of H2O
The flow rate during voiding with detrusor pressure is:
<15 mL/sec
<40 mL/sec
>20 cm H2O
<50 cm H2O
<50 cm H2O
Bladder training is one of the nonpharmacologic treatments for which lower urinary tract disorder?
Idiopathic overactive bladder
Stress urinary incontinence
Mixed urinary incontinence
Primary bladder neck dysfunction
Idiopathic overactive bladder
Which statement is true regarding pelvic floor muscle training?
it a a method to restore function of pelvic relaxation
it a best done with full bladder
should be done while voiding
done by preventing passage of gas
done by preventing passage of gas
Which drug agent that is used for treatment of stress incontinence has the mechanism of action on the bladder to increase its storage?
Oxybutynin
Duloxetine
Tropium chloride
imipramine
Duloxetine
This medication is a specific beta 3 receptor agonist that is used to treat urgency urinary incontinence
Mirabegron
Tolterodine
Desmopressin
imipramine
Mirabegron
This surgical procedure involves performance through two incision, one around the urethra, and one through the abdomen to gain access around the upper space of Retzius
Burch sling procedure
Pubovaginal sling procedure
Mid-urethral sling procedure
M…
Pubovaginal sling procedure
Which statement is true regarding indication and characteristics of mid-urethral retropubic slings?
The top-down route may be more effective than bottom up route
Fewer adverse events occur with the retropubic approach
The retropubic sling is favored in cases of fixed immobile urethra
The trans-obturator approach is favored in cases if pelvic relaxation
The retropubic sling is favored in cases of fixed immobile urethra
This happens when the desire to void occurs later than previously experienced despite awareness that bladder is filling
Increased bladder sensation
Reduced bladder sensation
Feeling of incomplete bladder emptying
Delayed bladder emptying
Reduced bladder sensation
The sudden and often painful inability to void despite the sensation of a full bladder and desire to urinate is called
Hesitancy
Acute urinary retention
Intermittency
Acute absent bladder sensation
Acute urinary retention
What is the term also used to describe bladder atony?
Detrusor sphincter dyssenergia
Fowler syndrome
Idiopathic hypoactive bladder
Paralytic bladder syndrome
?
What is the recommended management for non-obstructive voiding dysfunction?
Beta agonists
Calcium channel blockers
Neuromodulation
Intermittent catheterization
Neuromodulation
When should urine cytology be done with bladder pain syndrome?
History of smoking
Younger women
Inflammatory disorders
Urethral diverticula
History of smoking
This is one of the risk factors of pelvic organ prolapse:
Previous cesarean delivery
BMI > 35
History of a difficult delivery
Menopausal women
BMI > 35
Among the support system of the uterus, this pertains to the distal vagina and is made up of the muscles and connective tissue surrounding the distal vagina and perineum:
Level 1
Level 2
Level 3
Level 4
Level 3
This condition occurs when the pubocervical muscular connective tissue weakens midline or detaches from its lateral or superior connecting points:
Rectocele
Cystocele
uterine prolapse
procidentia uteri
Cystocele
Which structure is included as the endopelvic connective tissue?
Mackenrodt ligaments
Acus tendineous
Retroperitoneal portion of the uterus
Broad ligaments
Retroperitoneal portion of the uterus
What happens when there is detachment of the fibromuscular tissue of the vagina from the anterior rectum?
Resultant enterocoele
Ballooning of the vaginal wall
Persistent rectocele
Pelvic organs prolapse
Resultant enterocoele
This organ corresponds to the middle site (C) in POP-Q measurements:
anterior wall of hymen
posterior fornix
vaginal cuff
dependent portion of posterior wall
vaginal cuff
What is the stage of pelvic organ prolapse when the most distal portion of the prolapse is less than 1 cm below the plane of the hymen but no further than 2 cm less than the total vagina length:
Stage I
Stage II
Stage III
Stage IV
Stage III
The one of the goals of a conservative therapy approach to the treatment of mild to moderate prolapse is:
Prevent prolapse
Decrease the severity of symptoms
Support of the pelvic floor musculature
Delay surgical intervention
Prevent prolapse
murag except ni nga question ai
Which one is a possible complication of pessary use?
Pain
Increase urgency urinary incontinence
Menstrual irregularities
Hydronephrosis
Hydronephrosis
This is a recommended anterior compartment procedure for surgical management of pelvic organ prolapse:
Paravaginal repair
Traditional colporrhaphy
Transanal perineal repair
Iliococcygeal vaginal suspension
Paravaginal repair
What is the term used for vaginal narrowing or surgical shortening of vaginal canal?
Colporrhexis
Colpocleisis
Culdocentesis
Colpopexy
Colpocleisis
The colon plays an important role in the absorption and regulation of water and electrolytes, how much water can be absorbed in a day?
2L
3000mL
4L
5000mL
5000mL
This occurs as the normally compliant rectal vault relaxes in response to increased volume:
Rectoanal inhibitory reflex
Accommodation
Defecatory reflex
Urge to defecate
Accommodation
Which muscle is essential for passive continence?
Internal sphincter muscle
Puborectalis muscle
External sphincter muscle
Levator ani muscle
Internal sphincter muscle
Which statement is true regarding continence mechanism involving innervation or nerve supply?
IAS receives its sympathetic supply from S2-4
The autonomic nervous system provides local circuitry
The EAS acts through reflex arcs at the spinal cord w/out voluntary control
Rich sensory supply is from posterior rectal branch of the pudendal nerve
The autonomic nervous system provides local circuitry
Which condition is a risk factor for both fecal incontinence and defecatory dysfunction?
Myotonic dystrophy
Food allergy
Thyroid dse
Surgical trauma
Thyroid dse
Which one is a central nervous system disorder that causes fecal incontinence and defecatory dysfunction?
Parkinsons disease
Hirschsprung disease
Autonomic neuropathy
Pudendal neuropathy
Parkinsons disease
What is the cause of constipation in pregnancy?
Estrogen hormone
Iron supplementation
Hyperthyroidism
Drug and food allergies
Iron supplementation
What is the surgical procedure of choice for the treatment of fecal incontinence?
Graciloplasty
Sacral nerve root stimulator
Artifical sphincter
Overlapping Sphincteroplasty
Overlapping Sphincteroplasty
This procedure involves separation of the rectal mucosa from the phincter and muscularis propria, followed by resection of the rectal mucosa and plication of the distal rectal wall.
Altemeier operation
Deforme procedure
Ileorectal anastomosis
Bruel-Kjaer rectal procedure
Deforme procedure
