neuro9

Question 1

volitional control of micturition

Answer 1

dorsomedial frontal lobe connected to the medial region of the pontine micturition center; leads to decr in urethral pressure followed by incr contraction of the detrusor muscle

Question 2

what does lateral region of the pontine micturition center do

Answer 2

contracts the urethral sphincter to promote storage of urine

Question 3

what happens when PMC is damaged

Answer 3

when bladder becomes distented, the micturition reflex is activated at the spinal level; loss of inhibitory control

Question 4

what is the spinobulbospinal circuit in bladder continence?

Answer 4

relfex arc that starts in the urinary bladder and projects to the pontine micturition center, with outflow connections to the parasymp sacral spinal motor nuc

Question 5

what is the spinal segmental relfex arc in bladder continence

Answer 5

afferent fibers from the detrusor muscle to the Onuf’s nuc in the sacral spinal cord at S2-S4 and efferent fibers to the striated sphincter muscles through the pudendal nerve

Question 6

spastic bladder

Answer 6

uninhibited detrusor contractions

Question 7

atonic bladder

Answer 7

increased capacity, increased compliance; low voiding pressure and flow rate

Question 8

detrusor-sphincter dyssynergia (DSD)

Answer 8

inapprop contraction of the external sphincter with detrusor contraction; can result in urinary retention, vesicoureteral reflux, and subsequent renal damage

Question 9

overflow incontinence

Answer 9

LMN problem; lesions at the level of the conus medullaris, cauda equina, or sacral plexus; or peripheral nerve dysfunction

Question 10

spastic bladder

Answer 10

UMN problem; lesions involving the frontal lobes, pons, or suprasacral spinal cord

Question 11

voiding dysfunction in parkinsons patients

Answer 11

voiding dysfunction in 0-70% of patients; detrusor hyperreflexia is most common; pseudodyssynergia occurs as a conseq of sphincter bradykinesia

Question 12

spinal shock and urinary dysfunction

Answer 12

during spinal shock, the bladder is acontractile, but gradually over weeks reflx detruso contractons develop in response to low filling volumes

Question 13

spinal cord injury and urinary sx

Answer 13

spinal cord injury produces detrusor hyperreflexia, loss of compliance, and detrusor-sphincter dyssynergia

Question 14

bladder dysfunction in MS

Answer 14

some common sx are irritative symptoms, obstructive symptoms, detrusor hyperreflexia, detrusor-sphincter dyssynergia

Question 15

pudendal nerve

Answer 15

motor and sensory fibers to the penis and clitoris

Question 16

parasymp nerves to the genitalia

Answer 16

S2 through S4, participate in erect

Question 17

sympathetic nerves to the genitalia

Answer 17

T11 through T12 levels, through the hypogastric plexus; imp in ejaculation

Question 18

chemicals released by parasymps that contrubute to sustained erection

Answer 18

nitric oxide and cGMP

Question 19

pharmacologic therapy of erectile dysfunction

Answer 19

inhib of cGMP-specific phosphodiesterases

Question 20

treatments for spastic bladder

Answer 20

anticholinergic agents, tricyclic antidepressants, desmopressin, intravesical capsaicin

Question 21

treatments for stress incont

Answer 21

alpha adrenergic agonists, estrogen therapy, duloxetine

Question 22

treatments for atonic bladder with overflow incont

Answer 22

Crede’s maneuver or valsalva to empty the bladder; intermittent self-catheterization; pharmacotherapy usually not effective

Question 23

treatment for detrusor dyssynergia

Answer 23

intermittent catheterization, suprapubic catheterization, sacral nerve stimulaton, alpha-1 blockage (doxazosin)

Question 24

tolteridine

Answer 24

anti-cholinergic

Question 25

oxybutinin

Answer 25

anti-cholinergic

Question 26

trospium

Answer 26

anti-cholinergic

Question 27

solifenacin, darifenacin

Answer 27

anti-cholinergic

Question 28

imipramine

Answer 28

tricyclic antidepressant

Question 29

amitriptyline

Answer 29

tricyclic antidepressant

Question 30

desmopressin

Answer 30

DDAVP

Question 31

acetanilide

Answer 31

beta 3 adrenoreceptor agonist

Question 32

sildenafil

Answer 32

phosphodiesterase inhib

Question 33

nerve stimulation in treatment of spastic bladder

Answer 33

sacral, tibial, or pudendal; last resort

Question 34

how do anticholinergics work to treat spastic bladder

Answer 34

increae bladder capacity and decrease strength of involuntary contractions

Question 35

how does intravesical capsaicin work to treat spastic bladder

Answer 35

neurotoxic effecr on the afferent C fibers that drive volume-determined reflex detrusor contraction

Question 36

how do alpha adrenergic agonists treat stress incontinence

Answer 36

increased intrinsic urethral tone due to effects on the urethral sphincter