MET EOYS10 Flashcards
Which drug class would cause prostate to shrink?
alpha blockers
5-alpha reductase Inhibitors
phosphodiesterase-5 (PDE5) inhibitors
Antimuscarinics
5-alpha reductase Inhibitors
Both normal and abnormal prostate growth is driven by the androgen dihydrotestosterone (DHT), which is formed from testosterone under the influence of 5-alpha reductase.
Dexamethasone Suppression Test is used to diagnosis
Addisons disease
Cushing syndrome
Conns syndrome
Graves disease
Cushing syndrome
Dexamethasone at night (i.e. 10pm) and their cortisol and ACTH is measured in the morning (i.e. 9am). The intention is to find out whether the dexamethasone suppresses their normal morning spike of cortisol.
Short synacthen test is used to diagnose
Addisons disease
Cushing syndrome
Conns syndrome
Graves disease
Short synacthen test is used to diagnose
Addisons disease
The test involves giving synacthen, which is synthetic ACTH. The blood cortisol is measured at baseline, 30 and 60 minutes after administration. The synthetic ACTH will stimulate healthy adrenal glands to produce cortisol and the cortisol level should at least double. A failure of cortisol to rise (less than double the baseline) indicates primary adrenal insufficiency (Addison’s disease).
What is a normal and abnormal response to Dexamethasone suppression test? [2]
Abnormal: high levels of cortisol
Normal: low levels of cortisol
Which drug targets B3 receptors in urge incontinence
Mirabegron
Finasteride
Oxybutynin
Botox
Which drug targets B3 receptors in urge incontinence
Mirabegron
Mirabegron is a beta-3 receptor agonist which will cause detrusor muscle relaxation
What is the name for the nerve that supplies the sympathetic action of the hindgut? [1]
Lumbar splachnic nerve
What is the name for the nerve that supplies the sympathetic action of the midgut? [1]
Lesser and least splachnic nerve
Which of these is not a definition for constipation?
infrequent stools, more than 3 per week
passage of hard stools
a sensation of incomplete evacuation
infrequent stools, more than 2 per week
Which of these is not a definition for constipation?
infrequent stools, more than 3 per week
passage of hard stools
a sensation of incomplete evacuation
infrequent stools, more than 2 per week
Explain how the micturition reflex works
Full bladder: sensory feedback from (S2-4) to micturition centre
micturition centre sends signal to brain to ask if socially acceptable to urinate or not
if yes: able to control sphincter via somatic nature of pudendal nerve AND parasympathetic action of detrusor muscle, contracting the bladder
Hormonal control of bladder:
Normal bladder contraction is caused by the release of []
The release of [] causes the stimulation of [] receptors on the [] smooth muscle
Normal bladder contraction is caused by the release of Ach
The release of Ach causes the stimulation of muscarininc (80%: M2) receptors on the detrusor smooth muscle
Which diagnostic score would use to assess micruition? [2]
What would scores be for mild, moderate and severe? [3]
Internation Prostate Symptom Score (IPSS)
Mild: 0-7
Moderate: 8-19
Severe: 20-35
AND
Input / Output Chart = voiding diary to create a frequency / volume chart
What does a normal flow-rate recording look like? [1]
What ([] ml/s) would demonstrate unobstructed flow-rate [1]
Fast and short
20 ml/s = unobstructed
What is an important consideration with regards to treating bladders?
When a bladder is obstructed, starts to contract a bit randomly: causes changes in pressure (and symptoms)
Bladder isnt overactive - is just blocked.
If treat overactivity then might not do anything - so need to treat blockages
What is urethral milking?
Put hands behind testicles and bring forward after urinating to ensure all urine is expelled from U bend in urethra (stops dribbling)
Explain drugs used to treat bladder problems / LUTS [4]
alpha blockers(‘stretchers’): stretch prostates open
5-alpha reductase Inhibitors: (‘shrinkers’) shrink prostates
phosphodiesterase-5 (PDE5) inhibitors: PDE5 inhibitors facilitate smooth muscle relaxation through the NO/cGMP pathway, with effects in the bladder, prostate, and urethra.
Antimuscarinics (for OAB)
Combination
What is difference between stress and urge urinary incontinence? [2]
And their sources [2]
Stress UI: Leakage on effort or exertion (increased abdominal pressure)
Urge UI: Leakage accompanied by urgency
(stress incontinence – when urine leaks out at times when your bladder is under pressure; for example, when you cough or laugh. urge incontinence – when urine leaks as you feel a sudden, intense urge to pee, or soon afterwards)
Explain how stress incontinence occurs
weaking of pelvic floor or urethral sphincter
support is diminished, this causes intra-abdominal pressure to push more urine into urethra
Explain how urge incontinence occurs
Larger squeezes on bladder muscle occur
overcomes sphincter and urine comes out urethra
How do you prioritise treatment options for urge incontinence / overactive bladder? [7]
- Always treat overactive component first
- Next approach conservative measures (fluid intake / caffiene / pads)
- Next pelvic floor exercises
- Tablets
- Botox
- Posterior and / or sacral nerve stimulation
- surgery
Explain 3 drug classes used for urge incontinence / OAB [3]
.
The EAS is supplied by which nerve?
The IAS is innervated by which NS?
- What are sympathetic and parasympathetic nerve roots?
EAS: supplied by inferior branch of the pudendal nerve
IAS: Enteric NS
- Sympathetic: L1-L2 via hypogastric nerves (excitatory)
- Parasympathetic: S2-S4: pelvic nerves (inhibitory)
What factors do we rely on for continence? [5]
Anorectal angle
Stool consistency and colonic transit time
Rectal compliance
Rectal filling – sensation
Rectoanal inhibitory reflex (RAIR)
How does the anorectal angle work?
The tonic contraction produced by the puborectalis muscle, creates what is called a ‘flap valve’
Maintains the angle, whereby the anterior rectal wall is pushed downwards onto the anal canal when the intra-abdominal pressure during straining, laughing and coughing rises, thus stopping the passage of faeces into the anal canal
Stool consistency:
Ability of the rectum to retain stool is known as []?
Which two structures provide a mechanical barrier and retard progression of stool? [2]
Ability of the rectum to retain stool is known as reservoir continence
Lateral angulations in the sigmoid colon AND the valves of Houston provide a mechanical barrier and retard progression of stool.
It is the weight of the stool that tends to accentuate these angles and thus enhance their barrier effect
What is rectal compliance? [1]
Explain how rectal compliance helps continence [1]
Rectal compliance: the ability of the rectum to adapt to the imposed stretch is called
Extrinsic afferent neurones mediate the conscious sensation of urgency which is activated by mechanoreceptors.
Got to be full, have to know that it is full
Explain what the rectoanal inhibitory reflex (RAIR) is
RAIR: a relaxation response in the IAS following rectal distension. Increase in pressure causes the relaxation !
Defaction involves the relaxation of which two muscles? [2]
EAS and puborectalis muscles
Explain proper mechanism for defecation xx
Hold breath forcibly trying to exhaled: causes increase in abdo pressure & muscles of the the anterior abdo wall tense to funnel the pressure down to pelvis; Valsalva manoeuvre
Relaxation leads to stool enter lower rectum
Explain how the closing reflex occurs
Last bolus of stool is passed and then the ‘closing reflex’ of the EAS is stimulated by the releases of traction.
Upon voiding, receptor adaptation in ampulla recti removes inhibitory drive to IAS - thus contraction of IAS
Voluntary contraction of EAS closes anus off.
Smooth muscles in sigmoid relax (enteric nervous system) re-establishing of reservoir function.
What is the definition of constipation?
purely symptomatic – not at diagnosis
infrequent stools (more than 3 per week) OR
passage of hard stools (less than 25% of the time) OR
a sensation of incomplete evacuation (>25% of the time) or
What is primary constipation? [1]
Name 3 types of primary constipation [3]
Primary constipation: no identifiable organic cause include:
- normal transitconstipation: due to inadequate calorie, fibre, or water intake, difficulty with defecation and hard stools, overlap with IBS-C since pain and bloating are common.
-
slow transitconstipation: infrequency and slow movement of stool
due to bloating, abdominal pain and infrequent urge to defecate (ineffective colonic propulsion due to deficit and abnormalities of the enteric system that has a control on the motility of the large)
- pelvic floor dyssynergia.
What is rectal intussusception?
What is rectal prolapse?
Rectoanal intussusception: is an invagination of the rectal wall into the lumen of the rectum.
Rectal prolapse: occurs when your rectum, part of your large intestine, slips down inside your anus
When do you perform endo-anal ultrasound?
Structure
* obstetric sphincter tear
* latrogenic sphincter tear
* radiation damage
* congenital malformations
Function
* pudendal neuropathy
What does High Resolution Anorectal Manometry measure / ID? [2]
Pressure / time graphs of sphincter or rectum
Sphincter function: Resting pressure, Squeeze pressure, Endurance Squeeze, Rectoanal inhibitory reflex (RAIR)
Rectal sensation:
* hypersensitivity (associated with faecal incontinence)
* hyposensitivity (associated with constipation)
What are the triad of symptoms for minimal change disease? [3]
Nephrotic syndrome - triad of proteinuria, hypoalbuminaemia and oedema
Minimal change disease is a relatively common cause of nephrotic syndrome and has its name due to renal changes not being seen on a standard microscope. However, under an electron microscope, effacement of the podocyte foot processes can be observed. In minimal change disease, the permeability of the glomerular basement membrane increases, allowing albumin to leak into the urine, causing proteinuria.
IgA nephropathy is a cause of nephritic syndrome and typically occurs a few days following an [] infection
IgA nephropathy is a cause of nephritic syndrome and typically occurs a few days following an upper respiratory tract infection
Do you use surgery or medication for urge incontinence? [1]
Do you use surgery or medication for stress incontinence? [1]
medication for urge incontinence
surgery for stress incontinence
Label A-C
Rectal intussusception (A),
recto-anal intussusception (B)
and rectal prolapse (C).
Which structure in the bladder is under voluntary somatic control?
Detrusor muscle
Internal urethral sphincter
External urethral sphincter
Rugae of the bladder
Which structure in the bladder is under voluntary somatic control?
Detrusor muscle
Internal urethral sphincter
External urethral sphincter
Rugae of the bladder
Stimulation of which receptor would treat urinary incontinence?
Beta 1
Beta 2
Beta 3
M3
Stimulation of which receptor would treat urinary incontinence?
Beta 1
Beta 2
Beta 3
M3
The sympathetic nervous system acts on the internal urethral sphincter via which receptor?
Alpha 1
Alpha 2`
Beta 2
Beta 3
The sympathetic nervous system acts on the internal urethral sphincter via which receptor?
Alpha 1
Alpha 2`
Beta 2
Beta 3
Which nerve carries sympathetic innervation to the bladder?
Ilioinguinal nerve
Hypogastric nerve
Pudendal nerve
Pelvic nerve
Which nerve carries sympathetic innervation to the bladder?
Ilioinguinal nerve
Hypogastric nerve
Pudendal nerve
Pelvic nerve
Which of the following is correct regarding muscle activity during the storage phase of micturition?
Storage requires relaxation of the detrusor muscle of the bladder and simultaneous contraction of the internal and external urethral sphincters.
Storage requires relaxation of the detrusor muscle of the bladder and simultaneous relaxation of the internal and external urethral sphincters.
Storage requires contraction of the detrusor muscle of the bladder and simultaneous contraction of the internal and external urethral sphincters.
Storage requires relaxation of the detrusor muscle of the bladder and simultaneous relaxation of the internal and external urethral sphincters.
Which of the following is correct regarding muscle activity during the storage phase of micturition?
Storage requires relaxation of the detrusor muscle of the bladder and simultaneous contraction of the internal and external urethral sphincters.
Storage requires relaxation of the detrusor muscle of the bladder and simultaneous relaxation of the internal and external urethral sphincters.
Storage requires contraction of the detrusor muscle of the bladder and simultaneous contraction of the internal and external urethral sphincters.
Storage requires relaxation of the detrusor muscle of the bladder and simultaneous relaxation of the internal and external urethral sphincters.
Relaxation of the detrusor muscle and contraction of the internal urethral sphincter (IUS) is under the control of which receptors respectively?
B2-adrenoreceptors and A1-adrenoreceptors respectively
B3-adrenoreceptors and A1-adrenoreceptors respectively
A1-adrenoreceptors and B3-adrenoreceptors respectively
A1-adrenoreceptors and B2-adrenoreceptors respectively
Relaxation of the detrusor muscle and contraction of the internal urethral sphincter (IUS) is under the control of which receptors respectively?
B2-adrenoreceptors and A1-adrenoreceptors respectively
B3-adrenoreceptors and A1-adrenoreceptors respectively
A1-adrenoreceptors and B3-adrenoreceptors respectively
A1-adrenoreceptors and B2-adrenoreceptors respectively
A spinal cord lesion (above T12) would cause which of the following deficits regarding storage and voiding of the bladder?
Inability for the detrusor muscle to relax, inability for the internal sphincter to relax, and constant relaxation of the external urethral sphincter.
Inability for detrusor muscle to relax, inability for the internal urethral sphincter to contract, and constant relaxation of the external urethral sphincter.
Inability for the detrusor muscle to contract, inability for the internal urethral sphincter to contract, and constant relaxation of the eternal urethral sphincter.
Inability for the detrusor muscle to contract, inability for the internal urethral sphincter to relax, and constant relaxation of the external urethral sphincter.
Inability for detrusor muscle to relax, inability for the internal urethral sphincter to contract, and constant relaxation of the external urethral sphincter.
After a spinal cord lesion above T12, sympathetic input to the bladder is lost, leading to an inability of the detrusor muscle to relax, and an inability of the internal urethral sphincter to contract. Afferent signals via the sensory pelvic nerve are also unable to reach the brain, so the external urethral sphincter remains constantly relaxed.
What is the action of B3-adrenoreceptor agonists on the control of micturition?
Bind to B3-receptors on the detrusor muscle to cause contraction, promoting the voiding of urine.
Bind to B3-receptors on the internal urethral sphincter to cause contraction, preventing the voiding of urine.
Bind to B3-receptors on the internal urethral sphincter to cause relaxation, promoting the voiding of urine.
Bind to B3-receptors on the detrusor muscle to cause relaxation, increasing the bladders storage capacity.
What is the action of B3-adrenoreceptor agonists on the control of micturition?
Bind to B3-receptors on the detrusor muscle to cause contraction, promoting the voiding of urine.
Bind to B3-receptors on the internal urethral sphincter to cause contraction, preventing the voiding of urine.
Bind to B3-receptors on the internal urethral sphincter to cause relaxation, promoting the voiding of urine.
Bind to B3-receptors on the detrusor muscle to cause relaxation, increasing the bladders storage capacity.
Which receptors, when stimulated, cause detrusor muscle contraction?
5-alpha-reductase
Acetylcholine
β3-adrenoreceptors
M3 muscarinic receptors
M3 muscarinic receptors
β3-adrenoreceptors cause relaxation of the detrusor rather than contraction.
What is the typical male urinary flow rate?
15-20ml/s
20-25ml/s
25-30ml/s
30-35ml/s
What is the typical male urinary flow rate?
15-20ml/s
20-25ml/s
25-30ml/s
30-35ml/s
Which tonsil is shown here [1]
Palatine
How do you distinguish between the different zones of the adrenal cortex? [3]
