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]
.
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 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 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)
Label A-C
Rectal intussusception (A),
recto-anal intussusception (B)
and rectal prolapse (C).
Which tonsil is shown here [1]
Palatine
