UDS Flashcards
A 50-year-old male patient presents with symptoms of urgency and nocturia. During the urodynamic study, the urologist is most likely to evaluate which of the following parameters during the filling/storage phase?
Multiple-Choice Options:
A. Pves and Pdet
B. MUPP
C. FLUORO
D. EMG
Correct Answer:
A. Pves and Pdet
In-depth Explanation for All Answer Choices:
A. Pves and Pdet: Correct. During the filling/storage phase, Pves (Total bladder pressure) and Pdet (Detrusor pressure) are commonly measured using a filling cystometrogram (FCMG). These metrics are essential for understanding the patient’s symptoms and choosing appropriate treatment.
B. MUPP: Incorrect. Micturitional Urethral Pressure Profilometry (MUPP) is relevant during the emptying phase of micturition, not the filling/storage phase.
C. FLUORO: Incorrect. Fluoroscopy of the outlet during the filling/storage phase is indicated but is more pertinent to outlet evaluation rather than the bladder function alone.
D. EMG: Incorrect. Electromyography of periurethral striated musculature (EMG) is not generally a primary parameter evaluated during the filling/storage phase.
Memory Tool:
Remember “Fill, Pressure, Storage” for FCMG involving Pves and Pdet during the filling/storage phase.
Reference Citation:
Table 111.1, Urodynamics Simplified - Filling/storage phase section
Rationale for Information:
This question is important because it tests the urologist’s understanding of the parameters to be evaluated during the filling/storage phase of a urodynamic study, which is crucial for patient diagnosis and treatment.
Clinical Vignette:
A 65-year-old woman is being evaluated for difficulty in voiding. What parameters are typically evaluated during the emptying phase in a urodynamic study?
Multiple-Choice Options:
A. Pves and Pdet
B. RU
C. FLUORO and EMG
D. Flowmetry and Residual urine
Correct Answer:
D. Flowmetry and Residual urine
In-depth Explanation for All Answer Choices:
A. Pves and Pdet: Incorrect. These are key parameters during the filling/storage phase, not specifically during the emptying phase.
B. RU: Incorrect. Residual urine (RU) is important but is not the only parameter evaluated during the emptying phase.
C. FLUORO and EMG: Incorrect. These parameters provide important data but are not the primary parameters evaluated during the emptying phase.
D. Flowmetry and Residual urine: Correct. During the emptying phase, uroflow (Flowmetry) and residual urine (RU) integrate the activity of the bladder and the outlet, offering the most comprehensive data for evaluation.
Memory Tool:
Remember “Empty, Flow, Residual” to recall Flowmetry and Residual urine during the emptying phase.
Reference Citation:
Table 111.1, Urodynamics Simplified - Emptying phase section
Rationale for Information:
The question is vital for ensuring that the urologist knows what parameters to look at when diagnosing issues related to voiding, as errors can affect patient management.
A 45-year-old female comes to your clinic with complaints of urinary incontinence when she coughs or sneezes. What test is used to measure leak point pressures?
Multiple-Choice Options:
A. DLPP
B. FLUORO
C. VLPP
D. EMG
Correct Answer:
C. VLPP
In-depth Explanation for All Answer Choices:
A. DLPP: Incorrect. Detrusor Leak Point Pressure (DLPP) is more relevant for spontaneous leakage and isn’t typically used to assess leakage due to physical stress like coughing or sneezing.
B. FLUORO: Incorrect. Fluoroscopy is an imaging technique but isn’t specific for measuring leak point pressures during stress events like coughing or sneezing.
C. VLPP: Correct. Valsalva Leak Point Pressure (VLPP) is the measurement used to evaluate leak point pressures during increased abdominal pressure, such as coughing or sneezing.
D. EMG: Incorrect. Electromyography (EMG) assesses periurethral striated musculature and is not directly used to measure leak point pressures.
Memory Tool:
For Valsalva or cough-induced leaks, think “Valsalva Leak Point Pressure” or “Very Likely Physical Pressure”.
Reference Citation:
Table 111.1, Urodynamics Simplified - Filling/storage phase, parameter VLPP
Rationale for Information:
Understanding the appropriate tests for different types of incontinence is critical for patient management and ensures targeted interventions.
Clinical Vignette:
A 40-year-old male patient is being evaluated for difficulty in emptying his bladder completely. Which of the following tests would be useful in visualizing the outlet during the emptying phase?
Multiple-Choice Options:
A. FCMG
B. UPP
C. FLUORO
D. MUPP
Correct Answer:
C. FLUORO
In-depth Explanation for All Answer Choices:
A. FCMG: Incorrect. Filling Cystometrogram (FCMG) is generally used to assess the bladder during the filling/storage phase.
B. UPP: Incorrect. Urethral Pressure Profilometry (UPP) evaluates urethral pressure but doesn’t provide visualization of the outlet.
C. FLUORO: Correct. Fluoroscopy of the outlet during the emptying phase helps in visualizing and understanding outlet behavior.
D. MUPP: Incorrect. Micturitional Urethral Pressure Profilometry (MUPP) is used to evaluate urethral pressure during micturition but does not visualize the outlet.
Memory Tool:
Think “FLUORO Flows Freely” to remember that FLUORO visualizes the outlet during the emptying phase.
Reference Citation:
Table 111.1, Urodynamics Simplified - Emptying phase section, parameter FLUORO
Rationale for Information:
Correctly identifying the most appropriate imaging test for the emptying phase aids in precise diagnosis and effective treatment.
Clinical Vignette:
A 60-year-old man is experiencing urinary incontinence post-prostatectomy. Which test measures urethral pressure?
Multiple-Choice Options:
A. MUPP
B. RU
C. FCMG
D. EMG
Correct Answer:
A. MUPP
In-depth Explanation for All Answer Choices:
A. MUPP: Correct. Micturitional Urethral Pressure Profilometry (MUPP) is specifically designed to measure urethral pressure during the emptying phase, providing insights into the post-prostatectomy status.
B. RU: Incorrect. Residual urine (RU) measures the amount of urine left in the bladder after voiding but does not directly measure urethral pressure.
C. FCMG: Incorrect. Filling Cystometrogram (FCMG) focuses on bladder pressures during the filling/storage phase and is not specifically for urethral pressure measurement.
D. EMG: Incorrect. Electromyography (EMG) measures electrical activity in the periurethral striated musculature but does not measure urethral pressure.
Memory Tool:
To remember that MUPP measures urethral pressure, think “MUPP Measures Urethral Pressure Precisely.”
Reference Citation:
Table 111.1, Urodynamics Simplified - Emptying phase section, parameter MUPP
Rationale for Information:
Understanding urethral pressure measurements is crucial in the management of post-prostatectomy incontinence, making this an important question for evaluation.
Clinical Vignette:
A 35-year-old woman comes in complaining of intermittent urinary incontinence. She has tried pelvic floor exercises without much success. Which test would be best for evaluating the periurethral striated musculature?
Multiple-Choice Options:
A. EMG
B. FLUORO
C. FCMG
D. RU
Correct Answer:
A. EMG
In-depth Explanation for All Answer Choices:
A. EMG: Correct. Electromyography (EMG) is used to assess the periurethral striated musculature and can provide important information on the effectiveness of pelvic floor exercises.
B. FLUORO: Incorrect. Fluoroscopy is more relevant for visualizing the bladder outlet during the emptying phase.
C. FCMG: Incorrect. Filling Cystometrogram (FCMG) focuses primarily on bladder pressures during the filling/storage phase.
D. RU: Incorrect. Residual urine measures the amount of urine left after voiding but does not evaluate periurethral musculature.
Memory Tool:
Think “EMG Examines Muscles” to remember that EMG is used for evaluating periurethral striated musculature.
Reference Citation:
Table 111.1, Urodynamics Simplified - Emptying phase section, parameter EMG
Rationale for Information:
This question is essential to understand the correct modality for evaluating the periurethral striated musculature, especially when pelvic floor exercises have been ineffective.
Clinical Vignette: A 68-year-old male recently suffered a cerebrovascular accident and is now experiencing urinary issues. You suspect voiding dysfunction related to his neurological disease. What pattern of voiding dysfunction is most commonly seen in patients with cerebrovascular accidents?
Multiple-Choice Options:
A. Overactive Detrusor, Normal Compliance, Synergic Smooth Sphincter, Synergic Striated Sphincter
B. Overactive Detrusor, Decreased Compliance, Dyssynergic Smooth Sphincter, Synergic Striated Sphincter
C. Areflexia Detrusor, Normal Compliance, Competent but Nonrelaxing Smooth Sphincter, Fixed Tone Striated Sphincter
D. Impaired Detrusor, Increased Compliance, Open Smooth Sphincter, Dyssynergic Striated Sphincter
orrect Answer: A
In-Depth Explanation:
A: This is the most common pattern seen in cerebrovascular accident patients: Overactive detrusor, normal compliance, and both smooth and striated sphincters are synergic (Table 116.1, Row 1).
B, C, D: These are not the typical voiding dysfunction patterns for cerebrovascular accidents.
Memory Tool: CVA is “A-OK” (A option is OK) to help remember that in CVA, the detrusor is overactive but everything else is normal or synergic.
Specific Reference Citation: Table 116.1
Rationale: Knowing the typical voiding dysfunctions related to specific neurological conditions can guide treatment options and patient expectations.
Clinical Vignette: A 72-year-old female with a long history of Parkinson’s Disease is presenting with urinary urgency and frequency. What is the characteristic voiding dysfunction in Parkinson’s Disease?
Multiple-Choice Options:
A. Overactive Detrusor, Normal Compliance, Dyssynergic Smooth Sphincter, Dyssynergic Striated Sphincter
B. Overactive Detrusor, Impaired Compliance, Normal Smooth Sphincter, Synergic Striated Sphincter
C. Areflexia Detrusor, Decreased Compliance, Synergic Smooth Sphincter, Fixed Tone Striated Sphincter
D. Impaired Detrusor, Normal Compliance, Open Smooth Sphincter, Synergic Striated Sphincter
Correct Answer: B
In-Depth Explanation:
A: While detrusor overactivity is correct, the compliance is not normal, and the sphincters are not dyssynergic in Parkinson’s disease (Table 116.1, Row 5).
B: This is the characteristic pattern for Parkinson’s Disease: Overactive detrusor, impaired compliance, and normal smooth sphincter. The striated sphincter is synergic.
C, D: These options do not accurately represent voiding dysfunction in Parkinson’s Disease.
Memory Tool: Think “B for Bradykinesia” in Parkinson’s, to help remember the impaired compliance alongside detrusor overactivity.
Specific Reference Citation: Table 116.1
Rationale: Recognizing how Parkinson’s disease affects voiding can guide therapeutic approaches, improving patient quality of life.
Clinical Vignette: A 50-year-old male with Type 2 diabetes reports difficulty with urination. What pattern of voiding dysfunction is usually seen in diabetic patients?
Multiple-Choice Options:
A. Areflexia Detrusor, Increased Compliance, Synergic Smooth Sphincter, Fixed Tone Striated Sphincter
B. Overactive Detrusor, Normal Compliance, Open Smooth Sphincter, Dyssynergic Striated Sphincter
C. Impaired Detrusor, Areflexia, Overactive Smooth Sphincter, Normal Striated Sphincter
D. Impaired Detrusor, Areflexia, Overactive Smooth Sphincter, Synergic Striated Sphincter
Correct Answer: D
In-Depth Explanation:
A, B, C: These do not accurately reflect the typical voiding dysfunction pattern in diabetes (Table 116.1, Last Row).
D: The characteristic pattern in diabetes includes an impaired detrusor and areflexia, with an overactive smooth sphincter and synergic striated sphincter.
Memory Tool: “D for Diabetes” helps you remember the option D is correct for Diabetes.
Specific Reference Citation: Table 116.1
Rationale: Diabetes affects multiple body systems, including urinary function. Understanding the voiding dysfunction can guide management and improve symptom control.
Clinical Vignette: A 55-year-old male is diagnosed with Multiple System Atrophy and is experiencing urinary incontinence. What is the characteristic voiding dysfunction in Multiple System Atrophy?
Multiple-Choice Options:
A. Overactive Detrusor, Impaired Compliance, Open Smooth Sphincter, Synergic Striated Sphincter
B. Overactive Detrusor, Impaired Compliance, Non-Relaxing Smooth Sphincter, Synergic Striated Sphincter
C. Areflexia Detrusor, Normal Compliance, Synergic Smooth Sphincter, Dyssynergic Striated Sphincter
D. Overactive Detrusor, Impaired Compliance, Open Smooth Sphincter, Striated Sphincter Exhibits Denervation
Correct Answer: D
In-Depth Explanation:
A, B, C: These options do not fully represent the voiding dysfunction in Multiple System Atrophy as per Table 116.1.
D: The correct pattern includes an overactive detrusor, impaired compliance, open smooth sphincter, and the striated sphincter may show evidence of denervation.
Memory Tool: Think “D for Denervation,” to help remember that striated sphincter exhibits denervation in Multiple System Atrophy.
Specific Reference Citation: Table 116.1
Rationale: Understanding the urologic manifestations of Multiple System Atrophy can be pivotal in symptom management and improves patient outcomes.
Clinical Vignette: A 32-year-old male who suffered a spinal cord injury at T6 level reports difficulty in voiding. What pattern of voiding dysfunction should you expect?
Multiple-Choice Options:
A. Overactive Detrusor, Normal Compliance, Synergic Smooth Sphincter, Dyssynergic Striated Sphincter
B. Areflexia Detrusor, Decreased Compliance, Open Smooth Sphincter, Fixed Tone Striated Sphincter
C. Overactive Detrusor, Normal Compliance, Dyssynergic Smooth Sphincter, Synergic Striated Sphincter
D. Areflexia Detrusor, Normal Compliance, Open Smooth Sphincter, Synergic Striated Sphincter
Correct Answer: A
In-Depth Explanation:
A: This matches the pattern in suprasacral spinal cord injury: overactive detrusor, normal compliance, and the smooth sphincter is synergic but the striated sphincter may be dyssynergic if the lesion is above T7 (Table 116.1).
B, C, D: These options do not match the pattern commonly seen in suprasacral spinal cord injury.
Memory Tool: For spinal cord injury above T7, think “A for Above” to remember that the answer is A.
Specific Reference Citation: Table 116.1
Rationale: Recognizing the typical pattern of voiding dysfunction in spinal cord injuries allows for targeted interventions to manage symptoms effectively.
Clinical Vignette: A 5-year-old boy has myelodysplasia and his parents report that he has been having frequent urinary tract infections. What pattern of voiding dysfunction is commonly seen in Myelodysplasia?
Multiple-Choice Options:
A. Areflexia Detrusor, Normal Compliance, Open Smooth Sphincter, Striated Sphincter Shows Some Evidence of Denervation
B. Overactive Detrusor, Impaired Compliance, Synergic Smooth Sphincter, Fixed Tone Striated Sphincter
C. Impaired Detrusor, Normal Compliance, Dyssynergic Smooth Sphincter, Dyssynergic Striated Sphincter
D. Areflexia Detrusor, Normal Compliance, Open Smooth Sphincter, Fixed Tone Striated Sphincter
Correct Answer: A
In-Depth Explanation:
A: The typical pattern for Myelodysplasia is areflexia detrusor, normal compliance, and open smooth sphincter. The striated sphincter commonly shows some evidence of denervation (Table 116.1).
B, C, D: These options are not consistent with the pattern seen in Myelodysplasia.
Memory Tool: Remember “A for Areflexia” to keep in mind the detrusor behavior in Myelodysplasia.
Specific Reference Citation: Table 116.1
Rationale: Knowledge of voiding dysfunction in Myelodysplasia can inform treatment decisions and help prevent complications like urinary tract infections.
Clinical Vignette: A 60-year-old woman with a history of tabes and pernicious anemia comes to your office with difficulty urinating. What would be the typical voiding dysfunction seen in patients with tabes and pernicious anemia?
Multiple-Choice Options:
A. Overactive Detrusor, Impaired Compliance, Synergic Smooth Sphincter, Dyssynergic Striated Sphincter
B. Areflexia Detrusor, Normal Compliance, Synergic Smooth Sphincter, Fixed Tone Striated Sphincter
C. Impaired Detrusor, Increased Compliance, Synergic Smooth Sphincter, Loss of Sensation
D. Impaired Detrusor, Increased Compliance, Synergic Smooth Sphincter, Striated Sphincter Exhibits Denervation
Correct Answer: C
In-Depth Explanation:
A, B, D: These options do not accurately describe the voiding dysfunction observed in tabes and pernicious anemia.
C: According to Table 116.1, the typical voiding dysfunction includes impaired detrusor activity, increased compliance, and synergic smooth sphincter. The primary problem in these patients is loss of sensation.
Memory Tool: “C for Sensation Ceased” helps to remember that the primary issue is the loss of sensation.
Specific Reference Citation: Table 116.1
Rationale: Understanding the voiding dysfunctions related to tabes and pernicious anemia can aid in targeted treatment, particularly given that the primary issue is loss of sensation.
Clinical Vignette: A 45-year-old male who recently had a diskectomy presents with urinary symptoms. What pattern of voiding dysfunction is most likely?
Multiple-Choice Options:
A. Areflexia Detrusor, Normal Compliance, Competent Non-Relaxing Smooth Sphincter, Striated Sphincter Shows Evidence of Denervation
B. Overactive Detrusor, Impaired Compliance, Dyssynergic Smooth Sphincter, Dyssynergic Striated Sphincter
C. Impaired Detrusor, Increased Compliance, Synergic Smooth Sphincter, Fixed Tone Striated Sphincter
D. Areflexia Detrusor, Normal Compliance, Competent Non-Relaxing Smooth Sphincter, Synergic Striated Sphincter
Correct Answer: A
In-Depth Explanation:
A: Matches the pattern from Table 116.1 for Disk Disease: Areflexia detrusor, normal compliance, competent non-relaxing smooth sphincter, and evidence of denervation in the striated sphincter.
B, C, D: These options are not consistent with the pattern seen in Disk Disease.
Memory Tool: Remember “A for Areflexia and After diskectomy” to associate with disk disease.
Specific Reference Citation: Table 116.1
Rationale: Understanding the typical voiding dysfunction post-diskectomy can lead to more effective management and potentially quicker recovery.
Clinical Vignette: A 50-year-old female patient with Type 2 Diabetes complains of urinary incontinence. What is the typical pattern of voiding dysfunction in diabetes?
Multiple-Choice Options:
A. Impaired Detrusor, Increased Compliance, Open Smooth Sphincter, Synergic Striated Sphincter
B. Impaired Detrusor, Increased Compliance, Open Smooth Sphincter, Striated Sphincter Exhibits Denervation
C. Impaired Detrusor, Increased Compliance, Open Smooth Sphincter, Striated Sphincter Shows Evidence of Motor Neuropathy
D. Overactive Detrusor, Normal Compliance, Dyssynergic Smooth Sphincter, Fixed Tone Striated Sphincter
Correct Answer: C
In-Depth Explanation:
A, B, D: These choices do not align with the typical diabetes-induced voiding dysfunction.
C: Table 116.1 describes impaired detrusor, increased compliance, and open smooth sphincter in diabetes. Striated sphincter shows evidence of motor neuropathy.
Memory Tool: Think “C for Carbs cause Complications” to remember the impact of diabetes.
Specific Reference Citation: Table 116.1
Rationale: Recognizing how diabetes can affect urinary function is crucial for overall disease management and symptom alleviation.
