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Urinary and Endocrine problems

Urinary and Endocrine problems.

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Urinary and Endocrine problems

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  1. Urinary and Endocrine problems

  2. Choose the correct statement(s) about microscopic hematuria. A) It is defined as defined as >10 red blood cells per high-power field B) It occurs at a prevalence of ≤2% C) Referral to a nephrologist is indicated if dysmorphic red blood cells are present D) All the above

  3. Answer • C) Referral to a nephrologist is indicated if dysmorphic red blood cells are present

  4. Microscopic hematuria • often present in women with interstitial cystitis (IC) • defined as >3 red blood cells per highpower field from 2 specimens of freshly voided midstream catch urine; prevalence 21%; if benign cause suspected • (eg, menstruation, recent vigorous workout), repeat test within 48 hr • if infection present, do not repeat test for 6 wk to allow persistent mucosal inflammation to subside • if patient has risk factors, eg, smoking, exposure to dyes, history of gross hematuria, age >40 yr, recent or repeated urinary tract infections (UTIs), symptoms of irritative voiding, or analgesic abuse, only one positive result sufficient

  5. Choose the correct statements about interstitial cystitis (IC).It is usually associated with urinary urgency, frequency, and nocturiaPrevalence is 38% to 85% in women with chronic pelvic painIt is rarely associated with other disordersIt is thought to involve activation of pain C-fibers that cause release of substance PThe glycosaminoglycan layer is considered an important component of its etiology A) 2,3,4,5 B) 1,2,4,5 C) 1,2,3,4 D) 1,3,4,5

  6. It is usually associated with urinary urgency, frequency, and nocturiaPrevalence is 38% to 85% in women with chronic pelvic painIt is thought to involve activation of pain C-fibers that cause release of substance PThe glycosaminoglycan layer is considered an important component of its etiology B) 1,2,4,5

  7. Patients with symptoms of IC are found to have cancer at a rate of _______. A) 1% to 2% B) 5% to 10% C) 10% to 15% D) ≈21%

  8. Answer •  A) 1% to 2%

  9. Which of the following statements about the treatment of IC is incorrect? A) Pentosan polysulfate is the only oral agent approved for IC B) Hydroxyzine is helpful in women with IC who suffer from allergies C) Agents that promote alkalinity of urine may help D) Kegel exercises are beneficial

  10. Answer • D) Kegel exercises are beneficial

  11. First-line treatment of IC • avoid foods that exacerbate symptoms; • agents that promote alkalinity of urine may help, eg, calcium glycerophosphate (Prelief) or calcium carbonate • stress management important; exercise (eg, yoga, Pilates

  12. IC • Oral medications: amitriptyline—also used for vulvar pain; • speaker starts at 10 mg and tapers dose upward (improvement seen at 25-50 mg); also helps with nocturia • hydroxyzine —causes sedation; start with 25 mg at bed time and may increase to 50 mg • cimetidine speaker uses infrequently • Pentosan polysulfate: only oral agent approved for IC • Heparin analogue; may help renew GAG lining of bladder • Therapy may take 6 mo (discontinue if no improvement after 1 yr) • side effects—well tolerated • upper gastrointestinal symptoms seen in some patients; discontinue if diarrhea, reversible loss of hair (in <3%), or increase in liver enzymes develops (check every 6 mo and discontinue until normalized, then try lower dose) may cause easy bruising (decrease dose)

  13. The normal capacity of the bladder is ≥200 mL. A) True B) False

  14. Answer • B) False • normal capacity >400 ml

  15. Choose the correct statements about bladder function and urinary incontinence .Stress incontinence is associated with exertionUrinary frequency is usually due to urge incontinenceUrinary frequency is defined as needing to urinate >8 times daily (>10 for older patients)The normal rate of urine production 1 mL/minNocturia is defined as needing to urinate >3 times per night A) 1,3,4,5 B) 2,3,4,5 C) 1,2,3,4 D) 1,2,4,5

  16. Answer • Stress incontinence is associated with exertion • Urinary frequency is usually due to urge incontinence • Urinary frequency is defined as needing to urinate >8 times daily (>10 for older patients) • The normal rate of urine production 1 mL/min • C) 1,2,3,4

  17. normal values • frequency considered as >8 times daily (>10 for older patients) • nocturia defined as >1 per night • normal intake of fluid varies from 50 to 100 oz per day • normal urine production 1 mL/min • postvoid residual volume <100 mL for patients >65 yr of age (<50 mL if younger

  18. Which of the following should be evaluated during physical examination of a woman with urinary incontinence? A) Gait and reflexes B) Contraction of anal sphincter after tapping the clitoris or stroking along the bulbocavernosus C) The strength of a Kegel contraction using only the pelvic floor muscles D) All the above

  19. Answer •  D) All the above

  20. In the Knack procedure, the patient performs a Kegel exercise, then walks to the bathroom with the pelvic floor muscles contracted. A) True B) False

  21. Answer •  A) True

  22. Which of the following options has (have) been shown to be effective for treatment of urge incontinence? A) Posterior tibial nerve stimulation B) OnobotulinumtoxinA C) Sacral nerve stimulation D) All the above 

  23. Answer • D) All the above

  24. Medication • anticholinergic agents— consider trial for overactive bladder symptoms; allow 4 to 6 wk before increasing dose or trying other medication • newer oral agents have greater selectivity for receptors in bladder and cause fewer visual changes, but all may cause some cognitive impairment • May interact with coumadin and digoxin, and prolong QT interval in older patient

  25. Double-blind randomized controlled trials have proven that nonsteroidal anti-inflammatory drugs and antioxidants reduce risk for Alzheimer disease (AD). A) True B) False

  26. Answer •  B) False

  27. Personality and behavior are often preserved in patients with _______, and patients may appear normal on mental status testing. A) AD B) Vascular dementia C) Lewy body dementia D) Frontotemporal dementia

  28. Answer •  B) Vascular dementia

  29. Cholinesterase inhibitors: A) Are typically recommended for severe AD B) Modify the course of AD C) May slow progression of AD D) Should never be used indefinitely

  30. Answer •  C) May slow progression of AD

  31. Double-blind randomized controlled trials have proven that nonsteroidal anti-inflammatory drugs and antioxidants reduce risk for Alzheimer disease (AD). A) True B) False

  32. Answer •  B) False

  33. Personality and behavior are often preserved in patients with _______, and patients may appear normal on mental status testing. A) AD B) Vascular dementia C) Lewy body dementia D) Frontotemporal dementia

  34. Answer • B) Vascular dementia

  35. Cholinesterase inhibitors: A) Are typically recommended for severe AD B) Modify the course of AD C) May slow progression of AD D) Should never be used indefinitely

  36. Answer • C) May slow progression of AD

  37. Memantine: A) Is typically indicated for mild AD B) Is not associated with improved behavioral symptoms C) Is useful in stabilizing nerve cells D) Should not be combined with cholinesterase inhibitors

  38. Answer •  C) Is useful in stabilizing nerve cells

  39.  Which of the following is the least reliable indicator of driving risk? A) Patient's self-report B) Patient's self-restriction C) Score of ≥1 on Clinical Dementia Rating scale D) Adverse rating by caregiver

  40. Answer •  A) Patient's self-report

  41. During the early stage of AD, which of the following should be considered? A) Advance directives and goals of care B) Establishment of surrogate decision maker C) Financial planning D) All the above

  42. Answer • D) All the above

  43. Choose the correct statement about attention-deficit/hyperactivity disorder (ADHD). A) Present at birth B) Symptoms do not present until after age 7 yr C) In adult ADHD, symptoms typically present after age 25 yr D) Symptoms resolve in ≈60% of patients after age 25 yr

  44. Answer • A) Present at birth

  45. All the following are criteria for ADHD in children, except: A) ≥6 hyperactive or inattentive symptoms B) Impairment before age of 7 yr C) Impairment in ≥1 setting D) Symptoms occur often and are clinically significant

  46. Answer • C) Impairment in ≥1 setting

  47. A patient with symptoms of ADHD that occur exclusively during manic, depressive, or psychotic episodes is more likely to have ADHD than another psychiatric disorder. A) True B) False

  48. Answer • B) False

  49. Which of the following can cause hyperactive or inattentive symptoms that can lead to impairment? A) Concussion B) Sleep apnea C) Medications D) All the above

  50. Answer •  D) All the above

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