Urinary Incontinence Questions

64 Questions

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Urinary System Quizzes & Trivia

Questions and Answers
  • 1. 
    ________ oxybutin is associated with __________ published rates of dry mouth and constipation but the incidence of skin reaction to patch is ~15%.
    • A. 

      Topical; lowest

    • B. 

      IV; lowest

    • C. 

      Topical; highest

    • D. 

      IV; highest

  • 2. 
    ________ is better with ________ formulations especially in patients who are already taking multiple daily medications.
    • A. 

      Compliance; once daily

    • B. 

      Tolerance; twice daily

    • C. 

      Efficacy; once daily

    • D. 

      Efficacy; three times daily

  • 3. 
    Which of the following statements is false?
    • A. 

      Major age-related changes in the bladder include increased involuntary contractions

    • B. 

      Urinary incontinence can be attributed to detrusor overactivity alone

    • C. 

      Diminished detrusor contractile strength is a major age-related change

    • D. 

      Urethral closure pressure decreases with age

  • 4. 
    In women, mechanical urethral obstruction is usually due to:
    • A. 

      Pelvic organ prolapse

    • B. 

      Prior surgery

    • C. 

      Prostate disease

    • D. 

      A and B only

  • 5. 
    The major age-related changes in bladder pathophysiology include:
    • A. 

      Decreased involuntary contractions

    • B. 

      Increased voided volume

    • C. 

      Decreased detrusor contractile strength

    • D. 

      All of the above

  • 6. 
    The major age-related changes in urethral pathophysiology
    • A. 

      Increased urethral closing pressure

    • B. 

      The number but NOT density of striated fibers decreases

    • C. 

      Prostate-induced mechanical urethral obstruction is common in females

    • D. 

      None of the above

  • 7. 
    Which is not a predominate factor in drug selection?
    • A. 

      Differences in the incidence of ADEs

    • B. 

      Formulation and manufacturer of the drug

    • C. 

      Avoidance of ADEs to which the patient may be susceptible

    • D. 

      Additional patient-based issues that may complicate the use of the drug

  • 8. 
    Which agent is currently available as a generic medication?
    • A. 

      Oxybutynin

    • B. 

      Solifenacin

    • C. 

      Darifenacin

    • D. 

      Fesoterodine

  • 9. 
    Drug selection for urinary incontinence is primarily based on which of the following:
    • A. 

      Incidences of ADE’s

    • B. 

      Oxybutynin is always the primary choice

    • C. 

      There is no difference between drug choices

    • D. 

      Patient age

  • 10. 
    Which of the following adverse effects of anti-muscarinics is incorrect:
    • A. 

      Dry mouth

    • B. 

      Constipation

    • C. 

      Alopecia

    • D. 

      Altered cognition

  • 11. 
    Older populations tend to have all of the following characteristics that lead to urinary incontinence EXCEPT:
    • A. 

      Smaller voided volumes

    • B. 

      Higher urine flow rate

    • C. 

      Smaller bladder capacity

    • D. 

      Increased post-voiding residual volume

  • 12. 
    Possible causes in women that cause a decrease in urethral closure pressure includes all of the following except:
    • A. 

      Alterations in the mucosal and submucosal layers

    • B. 

      Alterations in smooth muscle membranes

    • C. 

      Decreased vascular density

    • D. 

      Decreased blood flow

  • 13. 
    • A. 

      Alpha –Blockers and 5-ARI’s used in men with LUT symptoms from BPH are not very effective in reducing UI or urgency

    • B. 

      Anticholinergic drugs are neither less efficacious nor significantly more likely to cause urinary retention

    • C. 

      Desmopressin acetate is inappropriate for nocturia in older persons because of the risk of hyponatremic

    • D. 

      Amitriptyline has robust evidence of efficacy and is supported by its anticholinergic effects

  • 14. 
    The correct brand name match for the following generics (tolterodine, solifenacin, darifenacin and fesoterodine) in order are:
    • A. 

      Detrol, Vesicare, Enablex, Toviaz

    • B. 

      Sanctura, Vesicare, Toviaz, Enablex

    • C. 

      Detrol, Enablex, Toviaz, Vesicare

    • D. 

      Sanctura, Oxytrol, Enablex, Evista

  • 15. 
    Which pharmalogical intervention below do you think would be the BEST treatment of urinary incontinence?
    • A. 

      Estrogen

    • B. 

      Duloxetine

    • C. 

      Amitriptyline

    • D. 

      Oxybutynin

  • 16. 
    Solitenacin and darifenacin act primarily by:
    • A. 

      Increasing bladder capacity

    • B. 

      Acting at the level of the sacral cord to facilitate sphincter contraction

    • C. 

      Ablating detursor overactivity

    • D. 

      Facilitate sphincter contraction through smooth muscle α-1A receptors

  • 17. 
    • A. 

      Tolterodine

    • B. 

      Darifenacin

    • C. 

      Oxybutynin

    • D. 

      Fesoterodine

  • 18. 
    Which of the antimuscarinic agents is not metabolized by CYP450 enzymes?
    • A. 

      Solifenacin

    • B. 

      Trospium

    • C. 

      Oxybutynin

    • D. 

      Fesoterodine

  • 19. 
    Which of the following may improve urinary incontinence?
    • A. 

      Correcting comorbid disease states

    • B. 

      Correcting functional impairments

    • C. 

      Optimizing medication therapy

    • D. 

      All of the above

  • 20. 
    Which of the following is not associated with UI in elderly patients?
    • A. 

      Elderly patients are at risk for developing adverse effects of UI medications

    • B. 

      Etiology is usually a specific condition of the lower urinary tract

    • C. 

      Concurrent medications should be considered for the cause of UI

    • D. 

      UI is associated with an increase in fall risk

  • 21. 
    The major age related changes in the bladder include the following EXCEPT?
    • A. 

      Detrusor overactivity

    • B. 

      Diminished detrusor contractile strength

    • C. 

      Increased number and density of striated and smooth muscle

    • D. 

      Small bladder capacity

  • 22. 
    What is a possible cause of decreased urethral closure pressure? 
    • A. 

      Increased vascular density and blood flow

    • B. 

      Diminished detrusor contractile strength

    • C. 

      Alterations in the mucosal and submucosal layers

    • D. 

      "ultra-close abutments" in smooth muscle cells to facilitate

  • 23. 
    Urethral closure pressure decreases with ____________.
    • A. 

      Gender

    • B. 

      Age

    • C. 

      Physical activity

    • D. 

      Caffeine

  • 24. 
    Which of these is NOT a major age related related change in the bladder?
    • A. 

      Increased involuntary contractions

    • B. 

      Detrusor overactivity

    • C. 

      Decreased involuntary contractions

    • D. 

      Diminished detrusor contractile strength

  • 25. 
    Which of the following about bladder biopsies from older person with normal urodynamic tests is correct?
    • A. 

      Elevated caveolae

    • B. 

      “dense bands” in smooth muscle membranes

    • C. 

      Tight spaces between muscle cells

    • D. 

      None of the above

  • 26. 
    Which of the following antimuscarinic agents is NOT metabolized by CYP450?
    • A. 

      Trospium

    • B. 

      Darifenacin

    • C. 

      Oxybutinin

    • D. 

      Solifenacin

  • 27. 
    Which of the following UI therapies had the lowest tolerance for dry mouth?
    • A. 

      Tolterodine

    • B. 

      Oxybutynin

    • C. 

      Darifenacin

    • D. 

      Solifenacin

  • 28. 
    Which of the following UI therapies has been shown to be the most efficacious?
    • A. 

      Oxybutynin

    • B. 

      Tolterodine

    • C. 

      Solifenacin

    • D. 

      There is no difference in efficacy among UI therapies

  • 29. 
    What type of leakage is characterized by an increase in intra-abdominal pressure and is associated with impaired urethral sphincter support?
    • A. 

      Urge UI

    • B. 

      Stress UI

    • C. 

      Explosive UI

    • D. 

      Bladder UI

  • 30. 
    Which of the following medication class is not associated with causing or worsening incontinence?
    • A. 

      NSAIDS

    • B. 

      Estrogens

    • C. 

      Statins

    • D. 

      TCAs

  • 31. 
    Which of the following agents with an indication for stress UI does NOT have robust evidence?
    • A. 

      Duloxetine

    • B. 

      Oxybutynin

    • C. 

      Tolterodine

    • D. 

      Darifenacin

  • 32. 
    Which one of the following statements are FALSE about antimuscarinic:
    • A. 

      All antimuscarinics are metabolized by CYP-450 enzymes

    • B. 

      During antimuscarinic therapy with older adults a major drug related ADE of concern is cognitive impairment

    • C. 

      Currently there is insufficient evidence that one agent with in this class is "safer" for all older patients

    • D. 

      Agents within this class prescribed for UI may be associated with drug-disease interactions ie advance diabetes, and parkison's disease

  • 33. 
    Older persons tend to have smaller bladder capacity, lower urine flow rate, and which of the following?
    • A. 

      Decreased post-voiding residual volume

    • B. 

      Increased post-voiding residual volume

    • C. 

      Decreased nocturia

    • D. 

      Increased detrusor contractile strength

  • 34. 
    What cellular mechanisms are likely responsible for age-related changes in the bladder?
    • A. 

      “dense bands” in smooth muscle

    • B. 

      Decreased axon sensitivity

    • C. 

      Narrowing of spaces between muscle cells

    • D. 

      Acetylcholine accumulation

  • 35. 
    Stress UI is a leakage that is associated with all of the following features EXCEPT:
    • A. 

      Increased intra-abdominal pressure

    • B. 

      Sphincter damage impairing closure

    • C. 

      Detrusor overactivity

    • D. 

      Impaired uretheral support

  • 36. 
    Urge UI is thought to be caused by:
    • A. 

      Detrusor overactivity

    • B. 

      Impaired compensatory mechanisms

    • C. 

      Bladder outlet obstruction

    • D. 

      A and B only

  • 37. 
    Stress UI is leakage that occurs with ­­­________ in intra-abdominal pressure and is associated with ­­­________ urethral sphincter support.
    • A. 

      An increase; impaired

    • B. 

      A decrease; impaired

    • C. 

      An increase; improved

    • D. 

      A decrease; improved

  • 38. 
    The major age-related changes in the bladder included increased involuntary contractions of what?
    • A. 

      Detrusor overactivity (DO)

    • B. 

      Detrusor underactivity (DU)

    • C. 

      Pyloric sphincter overactivity (PO)

    • D. 

      None of the above

  • 39. 
    The possible causes in urethral closure (resting) pressure decreases with age in women are:
    • A. 

      Alterations in the mucosal and sub-mucosal layers

    • B. 

      Decreased vascular density and blood flow

    • C. 

      Both A and B

    • D. 

      None of the above

  • 40. 
    All of the following are factors to consider when selecting an antimuscarinic agent for an older patient with UI EXCEPT:
    • A. 

      ADEs

    • B. 

      Patient-based factors

    • C. 

      Efficacy

    • D. 

      Issues that may complicate use of a drug

  • 41. 
    Urethral closure (resting) pressure decreases with age possible cause(s) in women include:
    • A. 

      Alterations in the mucosal and sub-mucosal layers

    • B. 

      Increased vascular density

    • C. 

      Decreased blood flow

    • D. 

      A and C only

  • 42. 
    The major age-related change(s) in the bladder for men and women include:
    • A. 

      Detrusor overactivity (DO)

    • B. 

      Diminished detrusor contractile strength

    • C. 

      Obstruction due to the prostate

    • D. 

      A and B

  • 43. 
    The major age-related changes in the bladder include all of the following EXCEPT:
    • A. 

      Increased involuntary contractions

    • B. 

      Diminished destructor contractile strength

    • C. 

      Destructor overactivity

    • D. 

      Bladder changes only identified in women

  • 44. 
    Which one of the following antimuscarinic agents failed to show a difference from placebo in reduction in urge UI episodes, but was superior for patient-based outcomes (e.g., quality of life)?
    • A. 

      Oxybutynin

    • B. 

      Tolterodine

    • C. 

      Solifenacin

    • D. 

      Darifenacin

  • 45. 
    Which one of the following has been proven to be the most effective in older persons?
    • A. 

      Oxybutynin

    • B. 

      Tolterodine

    • C. 

      Darifenacin

    • D. 

      None of the above

  • 46. 
    If a patient is using antimuscarinic medications to reduce urge UI, what must a patient experience for therapy to be considered as resulting in "cure"?
    • A. 

      50% reduction in leakage over a period of 3 months

    • B. 

      No leakage recorded in a 3-5 day bladder diary

    • C. 

      No leakage recorded in a 3 month bladder diary

    • D. 

      50% reduction in leakage over a period of 1 month

  • 47. 
    In persons age >50, tolterodine IR 2mg BID has been shown to produce similar effects to ___________ with respect to reduction in urge UI and frequency, but was tolerated significantly better with respect to ADE's (dry mouth and need for dose reduction).
    • A. 

      Solifenacin

    • B. 

      Darifenacin

    • C. 

      Oxybutinin

    • D. 

      None of the above

  • 48. 
    Based on efficacy, which of the following is an appropriate antimuscarinic drug for the treatment of UI in an elderly patient?
    • A. 

      Ditropan

    • B. 

      Detrol

    • C. 

      Diprivan

    • D. 

      A and B

  • 49. 
    Which formulation of oxybutynin has the lowest published rate of dry mouth and constipation?
    • A. 

      Oral syrup

    • B. 

      Gelnique 400mg/gm

    • C. 

      Oral tablet

    • D. 

      Transdermal jelly 100mg/gm

  • 50. 
    Desmopressin acetate should not be used for nocturia in older persons because of the risk of:
    • A. 

      Hypokalemia

    • B. 

      Hypocalcemia

    • C. 

      Hyponatremia

    • D. 

      Hypoalbuminemia

  • 51. 
    Current pharmacological agents for urinary incontinence target:
    • A. 

      Alpha adrenergic receptors

    • B. 

      Beta adrenergic agonists

    • C. 

      Serotonergic receptors

    • D. 

      Muscarinic receptors

  • 52. 
    According to a number of secondary analysis and randomized controlled trials about the efficacy of pharmacological agents for UI, including Oxybutynin, Tolterodine, Solifenacin, Darifenacin; which of the following statements are true?
    • A. 

      Some agents are more effective than others

    • B. 

      All agents are equally effective in older persons

    • C. 

      It is unclear whether these agents are equally effective, or more or less so, in older persons

    • D. 

      No agents are particularly effective, they work by placebo effect

  • 53. 
    Which of the following antimuscarinic drugs has shown higher efficacy rates in reducing urge UI and resulting in cure
    • A. 

      Oxybutynin

    • B. 

      Tolterodine

    • C. 

      Darifenacin

    • D. 

      All of the above have similar efficacies in reducing urge UI and resulting in cure

  • 54. 
    Which antimuscarinc agent for urge incontinence does not come in an extended-release formulation?
    • A. 

      Oxybutynin

    • B. 

      Tolterodine

    • C. 

      Solifenacin

    • D. 

      Tropsium

  • 55. 
    Which medication is available in a topical patch formulation?
    • A. 

      Vesicare

    • B. 

      Enablex

    • C. 

      Oxybutynin

    • D. 

      Sanctura

  • 56. 
    Tricyclic antidepressants for urinary incontinence are limited by which adverse effect?
    • A. 

      Diarrhea

    • B. 

      Anticholinergic effects

    • C. 

      Nausea and vomiting

    • D. 

      Constipation

  • 57. 
    Which if the following was associated with more urinary retention and an increase incidence of discontinuation due to ADE’s?
    • A. 

      Detrol LA 2mg

    • B. 

      Solifenacin 10 mg

    • C. 

      Oxybutynin 5mg

    • D. 

      Solifenacin 5 mg

  • 58. 
    Which of the following showed decrease urgency with UI when administered in addition to behavioral treatment?
    • A. 

      Solefenacin

    • B. 

      Darifenacin

    • C. 

      Detrol LA

    • D. 

      Oxybutynin IR

  • 59. 
    The major age-related changes in the bladder included increased involuntary contractions of what?
    • A. 

      Detrusor overactivity (DO)

    • B. 

      Detrusor underactivity (DU)

    • C. 

      Pyloric sphincter overactivity (PO)

    • D. 

      None of the above

  • 60. 
    The possible causes in urethral closure (resting) pressure decreases with age in women are:
    • A. 

      Alterations in the mucosal and sub-mucosal layers

    • B. 

      Decreased vascular density and blood flow

    • C. 

      Both A and B

    • D. 

      None of the above

  • 61. 
    Urethral age-related changes in men/women can be attributed to?
    • A. 

      Decrease in density of striated and smooth muscle

    • B. 

      Prior surgery

    • C. 

      Increased involuntary contractions due to detrusor overactivity

    • D. 

      Pelvic organ prolapse

  • 62. 
    One study has shown that _______ decreases the frequency of UI when administered in addition to behavioral treatment in nursing-home residents, as measured by “wet checks”?
    • A. 

      Tolerodine

    • B. 

      Oxybutynin

    • C. 

      Darlfenacin

    • D. 

      Solifenacin

  • 63. 
    Which of the following is the most concerning antimuscarinic drug-related ADE for older adults in the treatment of urinary incontinence?
    • A. 

      Constipation

    • B. 

      Cognitive impairment

    • C. 

      Diarrhea

    • D. 

      UTI

  • 64. 
    Which dose of salifenacin was assoicated with urinary retention and discontinuation ?
    • A. 

      5 mg

    • B. 

      10 mg

    • C. 

      4 mg

    • D. 

      15 mg