LONG EXAM 1- Lower Urinary Tract Disorders, Pelvic Organ Prolapse, Anorectal Dysfunction

Question 1

The effective urethral closure is influenced by several factors which include:

Sympathetic nervous system mediation
Muscle tone and strength
Intraabdominal pressure
Muscle attachment to the pelvic walls

Answer 1

Muscle tone and strength

Question 2

This occurs with increase in abdominal pressure and can be treated with pelvic muscle exercise, vaginal devices, lifestyle changes, and surgery.

Urinary incontinence
Stress urinary incontinence
Urgency urinary incontinence
Mixed urinary incontinence

Answer 2

Stress urinary incontinence

Question 3

The urinary bladder function is mediated primarily by:

Parasympathetic nervous system
Involuntary muscle contractions
Sympathetic nervous system
Micturition reflex

Answer 3

Sympathetic nervous system

Question 4

This is accomplished by voluntary relaxation of the pelvic floor and urethra, accompanied by sustained contraction of the detrusor muscle, leading to complete bladder emptying:

Normal voiding
Micturition reflex
Bladder filling and emptying
Urinary incontinence

Answer 4

Normal voiding

Question 5

The alpha receptors of the sympathetic nervous system are primarily located at which part?

Bladder body
Bladder neck
Detrusor muscle
Brainstem

Answer 5

Bladder neck

Question 6

The pontine micturition center serves as the final common pathway for all bladder motor neurons and transection below this area would lead to this condition:

Urinary frequency
Incontinence
Urinary retention
Detrusor overactivity

Answer 6

Urinary retention

Question 7

This is the involuntary loss of urine associated with urgency and with effort or physical exertion or on sneezing or coughing:

Urgency urinary incontinence
Mixed urinary incontinence
Stress urinary incontinence
Insensible urinary incontinence

Answer 7

Mixed urinary incontinence

Question 8

What is the current most accepted theory of stress urinary incontinence pathogenesis?

Loss of integrity of structures intrinsic to the urethra
Hammock theory
Connective tissue laxity in the vagina and its supporting ligaments
Integral theory

Answer 8

Loss of integrity of structures intrinsic to the urethra

Question 9

What is the pathophysiology of overactive bladder?

Backward direction of the levator plate
Forward direction of the pubococcygeus muscle
There is no known cause that is documented
Abnormality between the micturition center and the bladder

Answer 9

There is no known cause that is documented

Question 10

This condition involves a congenital absence of the anterior vaginal wall and the base of the bladder/urethra:

Urethral diverticuli
Ectopic urethra
Bladder extrophy
Vesicovaginal fistula

Answer 10

Bladder extrophy

Question 11

Which one is a risk factor for urgency urinary incontinence?

Obesity
Advancing age
White women
Parity

Answer 11

Obesity

Question 12

One of the reversible causes of urinary incontinence is:

Depression
Psychiatric cause
Enuresis
Atrophic vaginitis

Answer 12

Atrophic vaginitis

Question 13

This is the amount of urine remaining in the bladder within 10 minutes from voiding and the abnormal threshold level is:

<50 mL
>100 mL
>150 mL
<200 mL

Answer 13

> 150 mL

Question 14

What is the hallmark of advanced bladder testing?

Quality of life measurement
Urodynamic tests
Uroflowmetry
Cystoscopy

Answer 14

Urodynamic tests

Question 15

This type of detrusor overactivity that refers to the involuntary detrusor contractions occurring at cystometric capacity which cannot be suppressed resulting in incontinence and bladder emptying

Neurogenic type
Phasic type
Terminal type
Idiopathic type

Answer 15

Terminal type

Question 16

The difference between urethral pressure and vesical pressure is called:

Urethral closure pressure
Pressure profile
Total urethral pressure
Maximum urethral closure pressure

Answer 16

Urethral closure pressure

Question 17

hat is the normal volume when one has a strong desire to void?

150 mL
200 mL
250 mL
400 mL

Answer 17

250 mL

Question 18

The cut off pressure during a Valsalva leak point pressure measurement is:

> 60 cm of H2O
200 mmHg
100 mmHg
120 cm of H2O

Answer 18

> 60 cm of H2O

Question 19

The flow rate during voiding with detrusor pressure is:

<15 mL/sec
<40 mL/sec
>20 cm H2O
<50 cm H2O

Answer 19

<50 cm H2O

Question 20

Bladder training is one of the nonpharmacologic treatments for which lower urinary tract disorder?

Idiopathic overactive bladder
Stress urinary incontinence
Mixed urinary incontinence
Primary bladder neck dysfunction

Answer 20

Idiopathic overactive bladder

Question 21

Which statement is true regarding pelvic floor muscle training?

it a a method to restore function of pelvic relaxation
it a best done with full bladder
should be done while voiding
done by preventing passage of gas

Answer 21

done by preventing passage of gas

Question 22

Which drug agent that is used for treatment of stress incontinence has the mechanism of action on the bladder to increase its storage?

Oxybutynin
Duloxetine
Tropium chloride
imipramine

Answer 22

Duloxetine

Question 23

This medication is a specific beta 3 receptor agonist that is used to treat urgency urinary incontinence

Mirabegron
Tolterodine
Desmopressin
imipramine

Answer 23

Mirabegron

Question 24

This surgical procedure involves performance through two incision, one around the urethra, and one through the abdomen to gain access around the upper space of Retzius

Burch sling procedure
Pubovaginal sling procedure
Mid-urethral sling procedure
M…

Answer 24

Pubovaginal sling procedure

Question 25

Which statement is true regarding indication and characteristics of mid-urethral retropubic slings? The top-down route may be more effective than bottom up route Fewer adverse events occur with the retropubic approach The retropubic sling is favored in cases of fixed immobile urethra The trans-obturator approach is favored in cases if pelvic relaxation

Answer 25

The retropubic sling is favored in cases of fixed immobile urethra

Question 26

This happens when the desire to void occurs later than previously experienced despite awareness that bladder is filling Increased bladder sensation Reduced bladder sensation Feeling of incomplete bladder emptying Delayed bladder emptying

Answer 26

Reduced bladder sensation

Question 27

The sudden and often painful inability to void despite the sensation of a full bladder and desire to urinate is called Hesitancy Acute urinary retention Intermittency Acute absent bladder sensation

Answer 27

Acute urinary retention

Question 28

What is the term also used to describe bladder atony? Detrusor sphincter dyssenergia Fowler syndrome Idiopathic hypoactive bladder Paralytic bladder syndrome

Answer 28

?

Question 29

What is the recommended management for non-obstructive voiding dysfunction? Beta agonists Calcium channel blockers Neuromodulation Intermittent catheterization

Answer 29

Neuromodulation

Question 30

When should urine cytology be done with bladder pain syndrome? History of smoking Younger women Inflammatory disorders Urethral diverticula

Answer 30

History of smoking

Question 31

This is one of the risk factors of pelvic organ prolapse: Previous cesarean delivery BMI > 35 History of a difficult delivery Menopausal women

Answer 31

BMI > 35

Question 32

Among the support system of the uterus, this pertains to the distal vagina and is made up of the muscles and connective tissue surrounding the distal vagina and perineum: Level 1 Level 2 Level 3 Level 4

Answer 32

Level 3

Question 33

This condition occurs when the pubocervical muscular connective tissue weakens midline or detaches from its lateral or superior connecting points: Rectocele Cystocele uterine prolapse procidentia uteri

Answer 33

Cystocele

Question 34

Which structure is included as the endopelvic connective tissue? Mackenrodt ligaments Acus tendineous Retroperitoneal portion of the uterus Broad ligaments

Answer 34

Retroperitoneal portion of the uterus

Question 35

What happens when there is detachment of the fibromuscular tissue of the vagina from the anterior rectum? Resultant enterocoele Ballooning of the vaginal wall Persistent rectocele Pelvic organs prolapse

Answer 35

Resultant enterocoele

Question 36

This organ corresponds to the middle site (C) in POP-Q measurements: anterior wall of hymen posterior fornix vaginal cuff dependent portion of posterior wall

Answer 36

vaginal cuff

Question 37

What is the stage of pelvic organ prolapse when the most distal portion of the prolapse is less than 1 cm below the plane of the hymen but no further than 2 cm less than the total vagina length: Stage I Stage II Stage III Stage IV

Answer 37

Stage III

Question 38

The one of the goals of a conservative therapy approach to the treatment of mild to moderate prolapse is: Prevent prolapse Decrease the severity of symptoms Support of the pelvic floor musculature Delay surgical intervention

Answer 38

Prevent prolapse murag except ni nga question ai

Question 39

Which one is a possible complication of pessary use? Pain Increase urgency urinary incontinence Menstrual irregularities Hydronephrosis

Answer 39

Hydronephrosis

Question 40

This is a recommended anterior compartment procedure for surgical management of pelvic organ prolapse: Paravaginal repair Traditional colporrhaphy Transanal perineal repair Iliococcygeal vaginal suspension

Answer 40

Paravaginal repair

Question 41

What is the term used for vaginal narrowing or surgical shortening of vaginal canal? Colporrhexis Colpocleisis Culdocentesis Colpopexy

Answer 41

Colpocleisis

Question 42

The colon plays an important role in the absorption and regulation of water and electrolytes, how much water can be absorbed in a day? 2L 3000mL 4L 5000mL

Answer 42

5000mL

Question 43

This occurs as the normally compliant rectal vault relaxes in response to increased volume: Rectoanal inhibitory reflex Accommodation Defecatory reflex Urge to defecate

Answer 43

Accommodation

Question 44

Which muscle is essential for passive continence? Internal sphincter muscle Puborectalis muscle External sphincter muscle Levator ani muscle

Answer 44

Internal sphincter muscle

Question 45

Which statement is true regarding continence mechanism involving innervation or nerve supply? IAS receives its sympathetic supply from S2-4 The autonomic nervous system provides local circuitry The EAS acts through reflex arcs at the spinal cord w/out voluntary control Rich sensory supply is from posterior rectal branch of the pudendal nerve

Answer 45

The autonomic nervous system provides local circuitry

Question 46

Which condition is a risk factor for both fecal incontinence and defecatory dysfunction? Myotonic dystrophy Food allergy Thyroid dse Surgical trauma

Answer 46

Thyroid dse

Question 47

Which one is a central nervous system disorder that causes fecal incontinence and defecatory dysfunction? Parkinsons disease Hirschsprung disease Autonomic neuropathy Pudendal neuropathy

Answer 47

Parkinsons disease

Question 48

What is the cause of constipation in pregnancy? Estrogen hormone Iron supplementation Hyperthyroidism Drug and food allergies

Answer 48

Iron supplementation

Question 49

What is the surgical procedure of choice for the treatment of fecal incontinence? Graciloplasty Sacral nerve root stimulator Artifical sphincter Overlapping Sphincteroplasty

Answer 49

Overlapping Sphincteroplasty

Question 50

This procedure involves separation of the rectal mucosa from the phincter and muscularis propria, followed by resection of the rectal mucosa and plication of the distal rectal wall. Altemeier operation Deforme procedure Ileorectal anastomosis Bruel-Kjaer rectal procedure

Answer 50

Deforme procedure