case 8 - pbl

Question 1

what are the two main parts of the smooth muscle bladder chamber

Answer 1

the body
the neck

Question 2

what happens in the body

Answer 2

this is where the urine collects

Question 3

what are features of the neck

Answer 3

funnel shaped and connects with the urethra

Question 4

what is the smooth muscle of the bladder called

Answer 4

the detrusor muscle

Question 5

what is on the posterior wall of the bladder

Answer 5

the trigone

Question 6

what is the trigone mucosa like

Answer 6

mucosa of this is smooth and is folded into rugae

Question 7

where do the two ureters enter the bladder

Answer 7

at the uppermost angles of the trigone

Question 8

name features of the internal sphincter

Answer 8

smooth muscle
involuntary control
parasympathetic

Question 9

name features of the external sphincter

Answer 9

skeletal muscle
voluntary muscle
somatic innervation

Question 10

what is normal urine flow

Answer 10

20-50mls

Question 11

what is the layout of the urinary tract

Answer 11

the kidneys produce urine, the ureters connect the kidney to the bladder, where urine is stored and the urethra is the exit passage way from the bladder

Question 12

what is the prostate

Answer 12

a compound tubuloalveolar exocrine gland

Question 13

what does the prostate secrete

Answer 13

a slightly alkaline fluid that constitutes 30% of the semen volume

Question 14

what does the prostate help to do

Answer 14

neutralise the acidity of the vaginal tract and prolongs the lifespan of the sperm

Question 15

what are the four zones of the prostate

Answer 15

Transition zone
Peripheral zone - 70% of the gland
Central zone
Fibromuscular zone

Question 16

what happens during ejaculation

Answer 16

during ejaculation, sperm is transmitted from the ductus deferent into the make urethra via ejaculatory ducts, which lie within the prostate gland

Question 17

what is PSA excreted from

Answer 17

the prostaste

Question 18

what converts testosterone to DHT

Answer 18

type 5 alpha - reductase

Question 19

what does DHT cause

Answer 19

cell growth and inhibits apoptosis

Question 20

is testosterone or DHT more potent

Answer 20

DHT

Question 21

what are the two main steps of mictruition

Answer 21

The bladder fills until the tension in its walls rises above the threshold level

Elicits a nervous reflex - mictrurition reflex that empties the bladder

Question 22

where does the urine flow from after the collecting ducts

Answer 22

the renal calyces, thus stretching them

Question 23

what does the stretching of these calyces do

Answer 23

This increases pacemaker activity, which in turn initiates peristaltic contractions that spread to the renal pelvis and then downward along the length of the ureter. This forces urine from the renal pelvis to the bladder

Question 24

what are peristaltic contractions of the ureter enhanced by

Answer 24

Peristaltic contractions in the ureter are enhanced by parasympathetic stimulation and inhibited by sympathetic stimulation

Question 25

what is the name of the reflux when the contraction of the bladder does not lead to complete occulsion of the ureter

Answer 25

- urine is propelled backward into the ureter - vesicoureteral reflux

Question 26

what does this cause

Answer 26

renal dysfunction

Question 27

explain and describe the micturition reflex

Answer 27

as the bladder fills, sensory stretch receptors in the wall, initiate a stretch reflex Sensory signals are conducted to the scarab plexus through sensory afferents of the pelvic splanchnic nerves and then reflexively back to the baller through the motor efferent fibres of the same splanchnic nerves When bladder is only partially filled, the contractions usually relax and pressure falls to baseline As it continues to fill, reflexes become more frequent and cause greater contractions of the detrusor muscle This reflex is self-regenerative Causes another reflex to pass through the pudendal nerves to the external sphincter to inhibit it

Question 28

what happens in BPH

Answer 28

the small glands, muscle fibres and connective tissue all enlarge

Question 29

what is the first change seen in BPH

Answer 29

the proliferation of the glandular tissue in the transitional zone

Question 30

what is an important factor in causing BPH

Answer 30

the impairment of apoptosis

Question 31

what happens when epithelial cells multiply excessively

Answer 31

they release an excessive amount of PSA into circulation

Question 32

what is BPH mainly due to

Answer 32

impairment of apoptosis

Question 33

what does this result in

Answer 33

accumulation of senescent cells in the prostate

Question 34

what can androgens such as DHT do

Answer 34

can not only increase proliferation but inhibit cell death

Question 35

what cells are responsible for androgen-dependent prostatic growth and why

Answer 35

Stromal cells are responsible for androgen-dependent prostatic growth because the type 2 5alpha reductase enzyme is only found in the stromal cells

Question 36

what is hydronephrosis

Answer 36

is the dilation of the renal pelvis associated with progressive atrophy in the kidney due to obstruction to the outflow of urine

Question 37

describe the pathology of prostate cancer

Answer 37

growth and multiplication of cells escape from normal control Impairment of apoptosis due to mutation of p53 Occurs in the peripheral zone of the prostate Invades stroma

Question 38

what is the epidemiology of prostate cancer

Answer 38

prostatic carcinoma accounts for 7% of cancer in men 6th most common in the world

Question 39

histologically, what kind of cancer is prostate cancer

Answer 39

adenocarcinoma

Question 40

what is the gene associated with prostate cancer

Answer 40

BRCA I and II

Question 41

what are the features of PSA testing

Answer 41

Interpreted with caution as natural increase in age and with prostatitis Dilemma about screening methods as can lead to over-diagnosing patients who don’t require treatment

Question 42

what is the mechanism of action of tamsulosin

Answer 42

Competitive inhibition for binding site of the alpha1 adrenergic receptors Causes prostate smooth muscle relaxation Reduces urethral occlusion Quick acting May cause a sudden drop in BP - dizziness

Question 43

what is the mechanism of action of finasteride

Answer 43

blocks the enzyme 5 alpha reductase type 2 Slows conversion of testosterone to DHT - slowing down growth of stromal and epithelial cells Promotes apoptosis Slow acting

Question 44

what is transurethral resection of the prostate

Answer 44

- gold standard in reducing symptoms, improving flow rates and decreasing post-voiding residual urine Removes parts or all of the prostate Loss of ability to ejaculate

Question 45

what is inclusion health

Answer 45

Inclusion health is an umbrella term used to describe people who are socially excluded, who typically experience multiple overlapping risk factors for poor health, such as poverty, violence and complex trauma.

Question 46

what services on the NHS are available to asylum seekers

Answer 46

In Scotland and Wales they are entitled to free secondary health care In England they are only offered free secondary health care if they receive section 4;2 support from the home office

Question 47

when can asylum seekers begin to work

Answer 47

People who have claimed asylum in the UK can apply for permission to work if they have been waiting 12 months for a decision, and they are not considered responsible for the delay. If permission is granted, the person will be allowed to take up jobs on the shortage occupation list only.

Question 48

what is PSA required for

Answer 48

liquefying the semen