Quiz 3: Evaluation

Which of the following test is not indicated in the basic evaluation of urinary incontinence:
1. Urine cytology
2. Urea and creatinine
3. Glucose
4. Calcium and potassium
5. Urinalysis
When evaluating patients with urinary incontinence, the rectal exam is least useful for:
1. Detecting stool impaction
2. Evaluating for rectal mass or polyp
3. Diagnosing a large prostate causing urinary retention
4. Detecting a hard nodule suspicious for prostate cancer
5. Testing the bulbo-cavernosus relex
The class of medication least likely to affect detrusor function is:
1. Diuretics
2. Alpha blockers
3. Cholinesterase inhibitors
4. Hormones
5. Antibiotics
A 3 day voiding diary can be helpful in the management of urinary incontinence because:
1. It can record the frequency of incontinent events
2. It can diagnose the mechanism of incontinence better than a urodynamic test
3. It can document the timing of incontinence episodes
4. a and b
5. a and c
During pelvic examination, all but one neurological testing maneuver are useful:
1. Testing perineal and peri-anal sensations
2. Provoking the Barrington third reflex
3. Asking for a voluntary anal squeeze contraction
4. Eliciting the anocutaneous reflex by perineal prick
5. Squeezing the glans penis or clitoris to assess for the bulbocavernosus reflex
All the following statements are true about the cough stress test, except:
1. It is done with a full or an empty bladder
2. It is only performed in standing position
3. It should reproduce the symptoms of stress urinary incontinence
4. It must be positive to consider surgical therapy
5. It can separate stress from urge incontinence when the leakage is seen occurring at the time of the stressful effort (cough, strain, laugh)
Additional tests are sometimes needed to characterize the mechanism of urinary incontinence, except one:
1. Standing voiding cystourethrogram
2. Uroflow and post-void residual
3. Lasix renal scan
4. Cystoscopy
5. Urodynamic testing
Referral to a Female Pelvic Medicine and Reconstructive Surgery (FPMRS) specialist is recommended in all but one of the following situations:
1. Elderly patient unable to reach the bathroom on time due to gait imbalance
2. Patient with a large bladder prolapse noted on examination who is at risk of secondary incontinence after prolapse repair
3. Elderly patient otherwise healthy in whom the etiology of incontinence remains uncertain despite a thorough evaluation
4. Older woman with evidence of inadequate bladder emptying
5. Older woman with persistent urge incontinence despite initial empiric intervention including behavioral therapy and anticholinergic medication