Physiology
What is a normal PVR
<50. Maybe <100 in the very old. >300 Get US to look for hydrnephrosis.
Normal bladder capacity 300-600cc. First urge to void is between 150-300
What is the most common form of incontinence in women 75 and over
Urge Incontinence
Medications are effective for stress incontinence and if so which medications are used. True or false
What is false
What is the most common type of vaginitis that older women might get
What is atrophic vaginitis
What is the AUA symptom scale
Patients answers questions related to:
Incomplete emptying, frequency, straining, nocturia, intermittency, weak stream, and urgency.
How does Oxybutynin work
What is a muscarinic acetylcholine receptor blocker.
Try switching to other if first doesn't work.
Can make cognition worse (concern with dementia or MCI.
Titrate up after 2 weeks if not effective and tolerating side effects.
Use for a minimum of 4-6 weeks and follow up. May take up to 12 weeks to get full effect.
Check PVR at woman at high risk for retention. Stop if over 150 or more than 1/3 of output.
What is the first line treatment for urge incontinence and how would you prescribe it?
What is behavioral and time voiding?
What process can result in a cure in 38% of women with stress incontinence
What are Kegals
Which two types of incontinence might fecal impaction cause
What are urge and overflow.
Also can have nerve damage with long term impaction.
What are three possible causes of overflow incontinence other than BPH
Atony secondary to: peripheral neuropathy- DM, MS, etoh, tabes dorsales, parkinsons, pernicious anemia, anticholinergics, lower spinal cord injury, or damage to the spinal detrusor afferents by disc herniation, spinal stenosis, tumor or congenital abnormality, detrusor-sphincter dysynergia (from spinal cord injury) . Narcotic analgesics can also cause.
Woman: uncommon. Surgery or cystocele which prolapses and kinks on urethra.
Paul McCartney
What is Shawshank Redemption
What Movie is this.
What is Casablanca
This gait is associated with incontinence. What might the diagnosis be?
What is normal pressure hydrocephalus
What movie is this and who is the main actor.
For an extra 100 points, what is the name pf the bad guy?
What is Goldfinger and who is Sean Connery.
Who is Odd Job
How does Tamsulosin work and how might it affect the eyes
What is a selective alpha 2 blocker and what is a floppy iris?
For 200 dollars each, what are two causes of urge incontinence other than idiopathic?
What are upper motor neuron damage and bladder irritation?
What is the most successful treatment for stress incontinence
What is surgey
What are 2 lifestyle changes which can help with incontinence?
Weight loss. 3 X risk of incontinence in women if obese.
Diet: avoid or limit foods which can irritate the bladder:
Alcohol:Spicy Foods: Acidic Foods: Citrus fruits, tomatoes, and tropical juices can irritate the bladder. Artificial Sweeteners: Some studies suggest a link between artificial sweetener consumption and urinary incontinence. Carbonated Drinks: Even without caffeine, carbonated drinks can irritate the bladder.
Access to toilet or urinal
Diuretics in AM
Decreased fluids in the evening, elevate legs prior to going to bed
What are three possible side effects from Finasteride and how long does it take to work?
Special bonus question for an extra 100 points: What other use is there for Finasteride?
Gynecomastia
–Can cause decreased libido and decreased ejaculatory or erectile dysfunction.
–Can increased depression and self-harm.
–Don’t use when trying to conceive. Exposure to woman hurt baby.
–Do prostate cancer screening before starting. (lowers PSA 50 %) You should see this and of you don't could be cancer.
Decreased Libido
What is make pattern baldness
How does Mirabegron or Mirbetriq work
Beta 3 Agonist
For 200 each, what are 5 treatments or meds for urge incontinence?
What is behavioral, muscarinic acetylcholine receptor blocker, Beta 3 agonist, botulism injections,
neuromodulation, augmentation cystoplasty.
How does the association with sleep help differentiate this type of incontinence from one other
What accidents from stress incontinence doesn't usually occur during sleep or in bed whereas urge is more likely
For $ 200 each, what features of incontinence would raise concerns for a more serious problem?
Lifelong or sudden onset of inct.
-Abd or pelvic pain.
-Hematuria without uti
-change in gait or LE weakness
-cardiopulmonary or neurologic symptoms
-MS changes
-Recurrant UTI’s
-elevated PVR ( >1/3 total volume)
Advanced prolapse beyond hyman
Difficulty passing cath.
Long term cath.
Back pain
Stool inct.
Men with issues before 45
For $ 100 each, name 5 treatments other than meds which are used for BPH.
TURP
Laser
Urolift
Rezum (Water vapor therapy
Prostatic artery embolization
Optimum (balloon dilatation and cell growth inhibitor