1
Q
Urinary incontinence (UI) prevelance is 20-30%.
A
False
It can be as high as 70-80%
2
Q
UI is a normal consequence of aging
A
False
It is always pathological
3
Q
UI does not affect QoL
A
False
It has very negative effects on QoL
4
Q
List the causes of age-related anatomic chanfes in the lower urinary tract in women.
A
- Weakening of pelvic floor muscles (leads to stress incontinence)
- Shortening of urethra
- Urogenital atrophy due to lack of estrogen
- Increasing risk of pelvic prolapse
5
Q
There is no specific screening recommendations for UI
A
True
6
Q
Screening for UI is not done for older adults
A
False
All older adults should be screened
7
Q
All frail older adults should be screened for UI
A
True
8
Q
A physical exam of UI should include DRE
A
True
9
Q
Further evaluation is only needed if a patient fails to respond to treatment.
A
False.
It is one of several reasons, but not the only one.
10
Q
A post-void residual (PVR) volume of 150 ml is considered an automatic trigger for further evaluation.
A
False.
The slide specifies an abnormal PVR as more than 200 ml.
11
Q
The presence of unexplained blood in the urine (hematuria) is a key reason for a more detailed investigation.
A
True
12
Q
If a patient reports symptoms of stress incontinence (SUI) but the in-office stress test is negative, no further evaluation is necessary.
A
False.
This discrepancy between symptoms and test results is an indication that further evaluation is needed.
13
Q
A patient should undergo further, more detailed evaluation before a surgical intervention for UI is considered.
A
True
14
Q
A suspected neurogenic bladder can be managed adequately with just a basic evaluation.
A
False
A suspected neurogenic bladder is a specific indication for further evaluation.
15
Q
A history of previous pelvic surgery or radiation therapy is a significant factor that calls for a more detailed UI evaluation.
A
True
16
Q
A patient with pelvic organ prolapse that is not causing any symptoms automatically requires further evaluation for their urinary incontinence.
A
False
Must be symptomatic
17
Q
UI that is associated with recurrent UTIs can be managed with basic evaluation and does not require a deeper investigation.
A
False
Incontinence associated with recurrent UTIs as a reason for further evaluation.
18
Q
A patient who reports persistent difficulty emptying their bladder is a candidate for further evaluation.
A
True
19
Q
Neurologic conditions, such as a past stroke or Parkinson’s disease, are considered comorbidities that necessitate a further evaluation of a patient’s UI.
A
True
20
Q
The suspicion of a fistula is a clear indication for a more advanced workup.
A
True
21
Q
The mainstay treatment option for UI is pharmocological
A
False
Mainstay treatment option for UI is conservative, which include lifestule interventions and behavioural intercentions
22
Q
Obesity is associated with stress UI
A
True
23
Q
Lifestyle interventions are primarily recommended for overflow incontinence.
A
False
To be considered in urgency, stress, or mixed UI
24
Q
The ideal candidates for lifestyle interventions are frail, non-ambulatory older adults with cognitive impairment.
A
False
The target population is ambulatory, cognitively-intact older people.
25
The main goal of these lifestyle changes is to reduce incontinence episodes without causing significant side effects.
True
26
There is extensive scientific data proving lifestyle interventions are effective specifically in the frail elderly population.
False
here is no specific data available in the frail older person
27
Managing chronic constipation and weight are considered important lifestyle interventions for UI.
True
28
Patient education is a core component of implementing these lifestyle changes.
True
29
Timed voiding can be implemented in oatients with cognitive impairment
True
30
What is the first line treatement for stress UI in women
Pelvic floor muscle training
31
Bladder training is the first line treatment in any type of UI for at least a short period of time
True
32
Before considering other treatment options, minimum 2 weeks of bladder training are advised in women with urgency or mixed UI
False
Minimum of 6 weeks
33
Weight reduction is recommended as a universally safe and appropriate lifestyle intervention for all older adults, including the frail.
False.
The slide explicitly states that weight reduction "May be inappropriate in the frail elderly."
34
When managing fluid intake, older adults with incontinence should always be advised to restrict their fluids.
False
The slide advises to "Only modify if excessive intake."
34
Pelvic floor muscle training is primarily advised for managing urge urinary incontinence.
False. The slide states it is "Advised in stress urinary incontinence."
35
Timed voiding is a behavioral technique that can be used for older adults with or without cognitive impairment.
True
36
Bladder training is a versatile intervention that can be used for any type of urinary incontinence.
True
37
Prompted voiding is considered the gold standard of care for independent, cognitively intact older adults living at home.
False.
It is the "Golden standard in care dependent people residing in nursing homes."
38
Medications should be considered the first-line treatment for urinary incontinence, to be started immediately upon diagnosis.
False
Pharmacological treatment should only be undertaken after at least 3 months of non-pharmacological therapy has been attempted.
39
Once a patient begins taking medication for UI, non-pharmacological treatments like lifestyle changes can be discontinued.
False
The slide states that non-pharmacological treatments "should be continued" after starting medication.
40
Most medications available for UI have been shown to be primarily effective for treating stress incontinence.
False. Most pharmacological interventions are effective on urge incontinence.
41
There is a large body of evidence confirming the effectiveness of UI medications specifically in the frail older population.
False. The slide indicates that evidence of effectiveness in frail older people is "relatively scant."
42
What drug is the first line therpy for urge incontinence or overactive bladder?
Antimuscarnins (fesoterodine).
Note that it should be used with caution especially in older frail patients
43
Drugs used for BPH?
5-alpha reductase inhibitor and alpha-adrenergic antagonists
44
T or F: topical estrogen is effective in incontience of any type in women
True
45
Internal devices are useful in women with bad manual dexterity.
False
Women with good manual dexterity are candiates for intravaginal support devices or urethral occlusion inserts
45
What drugs are mainly used for stress incontience?
Duloxetine and Topical estrogens
46
Internal devices offer the option of temprary or occasional use and are suitable for patients with excercise induced SUI
True
47
Absorbent aids should be used in combination with a holistic continence management plan and should never be the only solution.
True
48
What does absorbant aid depend on?
1. Choosing right product for the specofoc need of patient
2. Correct cleaning and skincare routine
49
Most surgical interventions are auitable for frail older patients
False
49
The effects of Botulinum toxin injections for overactive bladder are permanent.
False
he slide states the durability is for 6-12 months.
50
Nerve stimulation (like PTNS or SNS) is considered a third-line treatment for overactive bladder that has not responded to other therapies.
True
51
Tension-free vaginal tape procedures are an effective treatment for stress urinary incontinence, with no increased risks for older patients.
False.
While they have good results, the slide notes that problems with bladder emptying "may occur more frequently in the older persons."
52
Periurethral injections of bulking agents provide a long-term solution for stress incontinence symptoms.
False
he slide specifies that they allow for "short-term improvement."
53
Augmentation cystoplasty is a common and frequently used surgical option for older patients with overactive bladder.
False.
The slide states this procedure is "rarely used in older patients."
54
List the 5 geriatric giants.
1. instability
2. incontience
3. immobility
4. intellectual impairment
5. iatrogenic illness
55
What is the gold standard for the diagnosis and management of frailty?
Comprehensive geriatric assessment, which is carried out by an MDT together with its associated interventions
55
What is frailty physically characterized by? (6)
1. low excercise tolerance and consequential low physical activity
2. slow gait speed
3. involuntary weight loss (sarcopenia)
4. muscle weakness due to sarcopenia
5. easily exhausted
6. sedentary behaviour
56
Frailty can never be reversed
False
it can be reversed if due to 1 medical condition, but is very difficuly if due to multiple conditions
57
According to this geriatrician's classification, a 65-year-old person is considered 'old
False
A person aged 60 to 79 is classified as 'young old'.
58
individuals aged 80 and over are potentially frail.
True
59
This classification considers a person aged 59 to be a pediatric case
True.
The "under 60 years" category is labeled "paediatrics."
60
The term "A geriatrician's delight" is used to describe the 'young old' age group
False.
It is used to describe the "80 years and over" or 'old old' group.
61
Depression maybe masked with demintia
True
62
The "Get up and Go" test starts with the patient standing up from a lying position.
False.
The test begins with the patient standing up from a chair.
63
In the Get up and Go test, the patient is required to walk a distance of 3 meters during the test.
True
63
Timing the "Get up and Go" test is not a required part of the assessment
False
Shoould be timed
64
The Get up and Go test concludes when the patient walks back to the chair and stands next to it.
False.
The test ends when the patient walks back and sits down again.
65
The Get up and Go test is considered to provide a lot of information about a patient's gait and balance.
True
66
Write dows the principal points for managing frailty.
1. Screening frail older adults in clinical practice (this will involve a complete clinical examination and history: must pay special attentiom to 1) hygiene 2) the skin for pressure sores and dehydration 3) the mouth to assess oral hygiene and candida 4) feet and footwear 5) nutritional status by assessing their weight 6) gait and balance (use get up and go test)
2. look for causes of their frailty
3. proposing strong and long-term useful interventions. this includes:
- excercise
- nutrition (analyze using mini nutrition assessment aswell)
- cognitive training
- comprehension geriatric assessment and management
- rehabilitation
67
In terms of electrolyte imbalance, what are
SE of ace-i and loop diuretics?
Loops diuretics --> hypokalemia
ACE-i --> hyperkalemia (peak t-wave and prolonged PR segment)
68
Who is at the greatest risk of having a stroke?
Stroke survivors. They are likely to get a 2nd stroke within 30 days of their first stroke
69
What are the main risk factors ro stroke?
1. Cardiovascular conditons (eg. hypercholesterolemia, MI)
2. Age (>65yo)
3. Stress
4. Depression
5. HTN
6. AF
7. Migranies and varciella zoster virus may also be stroke risk factors
70
True or False:
Strokes on the dominant hemisphere usually affect speech and language abilities, whereas strokes on the non-dominant hemisphere tend to cause spatial neglect or lack of awareness of the affected side.
True
71
T or F:
Strokes on the non-dominant side are more likely to lead to more significant functional impairments, such as difficulty with hand movements in right-handed individuals.
False
Strokes on the dominant side are also more likely to lead to more significant functional impairments as ex: hand movements with right hand will no longer be easy so more functional impairment in right-handed individuals.
72
True or False: Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel or dipyridamole may be used in some stroke patients.
true
73
True or False: Aspirin or clopidogrel monotherapy is generally safer than DAPT because it carries a lower risk of bleeding.
true
74
True or False: DAPT should be reserved for patients at higher risk of recurrent events rather than used routinely.
True
75
T or F: Having a past TIA increases tour risk of stroke by 7 times
true
76
What should we do when someone has an TIA?
Immediatly strat aspirin 300mg daily and we then assess their stroke risk and address any risk factors
77
T or F: In the ABCD score, 1 point is given for age ≥60 years.
True
78
T or F: A patient receives 1 point in the ABCD score if their blood pressure is normal during acute evaluation.
False
They get one point for hypertension at the acute evaluation
79
T or F: In the clinical features category of the ABCD score, focal weakness is given 2 points, while speech disturbance without weakness is given 1 point.
True
80
For symptom duration, 1 point is given for 10–59 minutes and 2 points for ≥60 minutes.
True
81
The ABCD score is used to assess the prognosis and future stroke risk after a transient ischaemic attack (TIA).
False
ABCD score to assess the
prognosis of those who suffer from a TIA. They are considered to be at a high risk of stroke if they have an ABCD score of 4 or more. These high risk patients need specialist assessment within 24h, while those with an ABCD score of 3 and below can have specialist assessment within a week.
82
Patients with an ABCD score of 4 or more are at high risk of stroke and should be assessed by a specialist within 24 hours.
True
83
Patients with an ABCD score of 3 or below can safely have specialist assessment within one week.
True
84
How do we distinguish between the types of strokes (ischemic and hemorrhagic)?
Using a Cranial CT (CCT), which will realiably show if hemorrhagic CT is present. An ischemic CT does NOT typically show. (unless within 2 hours - unrealiable)
85
What is the treatment of acute ischemic stroke?
Alteplase (a thrombolytic agent), which has to be given less than 4.5 hours from symptoms onset, and BP is less than 185/110mmhg
86
After a patient has been given alteplase, we may consider conducting cerebral
angioplasty and stenting with physical removal of large blood clots. But this must be done within 6h of stroke symptom onset, and may only be done after the patient has been given alteplase.
True
87
T/F: bladder dysfunction from a stroke is usually persistent
False
It usually resolves within a month
88
What is the most frequent infective complication in stroke patients?
UTIs. Mostly iatrogenic due to catheterization
89
List the complications of stroke and how to manage them.
MD4 Semster 1
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