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Female LUTS, Neurology, Chronic Pelvic Pain Master

Total questions: 100

Worksheet time: 50mins

Name
Class
Date
1.

Which of the following is a storage symptom?

a)

Hesitancy

b)

Straining

c)

Frequency

d)

Weak stream

2.

Which neurotransmitter is primarily involved in detrusor contraction?

a)

GABA

b)

Serotonin

c)

Acetylcholine

d)

Dopamine

3.

Which nerve controls voluntary control of micturition?

a)

Hypogastric

b)

Pelvic

c)

Pudendal

d)

Vagus

4.

The most common cause of chronic pelvic pain in women is:

a)

Pelvic inflammatory disease

b)

Endometriosis

c)

Interstitial cystitis

d)

Pelvic organ prolapse

5.

What is the typical bladder finding in interstitial cystitis with Hunner lesion?

a)

Bladder diverticulum

b)

Normal bladder mucosa

c)

Mucosal ulcer

d)

Trabeculated bladder

6.

Which drug is approved for stress urinary incontinence in women in Europe?

a)

Solifenacin

b)

Oxybutynin

c)

Duloxetine

d)

Desmopressin

7.

The most sensitive and specific urine marker for IC/BPS is:

a)

Beta-2 microglobulin

b)

Antiproliferative factor

c)

NMP22

d)

Tamm-Horsfall protein

8.

In women with neurogenic bladder, which urodynamic finding is most concerning?

a)

Low compliance

b)

High flow rate

c)

Reduced post-void residual

d)

Large bladder capacity

9.

Which of the following is NOT part of the UPOINT system for chronic pelvic pain?

a)

Urinary

b)

Organ specific

c)

Neurologic

d)

Psychosocial

10.

The primary innervation of the detrusor muscle is via:

a)

Hypogastric nerve

b)

Pelvic splanchnic nerve

c)

Pudendal nerve

d)

Iliohypogastric nerve

11.

First-line conservative treatment for overactive bladder includes:

a)

Intravesical Botox

b)

Sacral neuromodulation

c)

Behavioral therapy

d)

Midurethral sling

12.

Which imaging is preferred for ruling out upper tract damage in neurogenic bladder?

a)

CT urography

b)

Renal ultrasound

c)

Intravenous pyelogram

d)

MRI

13.

High-tone pelvic floor dysfunction is commonly seen in:

a)

Urethral diverticulum

b)

IC/BPS

c)

Cystocele

d)

Vesicoureteral reflux

14.

Sacral neuromodulation is approved for all of the following EXCEPT:

a)

Refractory urgency incontinence

b)

Fecal incontinence

c)

IC/BPS with frequency

d)

Acute urinary retention

15.

Which is a voiding symptom?

a)

Nocturia

b)

Intermittency

c)

Frequency

d)

Urgency

16.

Urethral hypermobility can be evaluated with:

a)

Q-tip test

b)

Post-void residual

c)

Uroflowmetry

d)

Cystometry

17.

Which finding is most typical in urodynamic detrusor overactivity?

a)

Low detrusor pressure during filling

b)

Sustained contraction during filling

c)

Delayed sensation

d)

Normal compliance

18.

Which medication is a M3 receptor antagonist used in OAB?

a)

Solifenacin

b)

Duloxetine

c)

Mirabegron

d)

Finasteride

19.

Which pelvic organ condition frequently overlaps with IC/BPS?

a)

Urethral stricture

b)

Endometriosis

c)

Pelvic fracture

d)

Rectocele

20.

Most effective conservative therapy for stress urinary incontinence:

a)

Pelvic floor muscle training

b)

Mirabegron

c)

Oxybutynin

d)

Antibiotics

21.

A 40-year-old woman has urgency, frequency, and pelvic pain relieved by voiding. What is the most likely diagnosis?

a)

Overactive bladder

b)

Interstitial cystitis

c)

Urinary tract infection

d)

Detrusor-sphincter dyssynergia

22.

The afferent limb of the micturition reflex is carried by:

a)

Pudendal nerve

b)

Pelvic nerve

c)

Hypogastric nerve

d)

Ilioinguinal nerve

23.

Which receptor is targeted by Mirabegron in overactive bladder therapy?

a)

M2

b)

M3

c)

β2

d)

β3

24.

First-line pharmacologic therapy for detrusor overactivity is:

a)

Finasteride

b)

Solifenacin

c)

Duloxetine

d)

Tamsulosin

25.

Which finding suggests poor bladder compliance on cystometry?

a)

High capacity with low pressure

b)

Low capacity with high pressure

c)

Detrusor overactivity

d)

Low post-void residual

26.

Which test best distinguishes stress from urge incontinence?

a)

Bladder diary

b)

Cystoscopy

c)

Urodynamic study

d)

Voiding cystourethrogram

27.

In detrusor sphincter dyssynergia (DSD), what happens during voiding?

a)

Relaxed sphincter with strong detrusor contraction

b)

Coordinated detrusor-sphincter relaxation

c)

External sphincter contracts during detrusor contraction

d)

Detrusor contracts without outlet resistance

28.

The primary sympathetic nerve supply to the bladder is via:

a)

Pudendal nerve

b)

Pelvic nerve

c)

Hypogastric nerve

d)

Genitofemoral nerve

29.

What is the most common etiology of neurogenic bladder in women?

a)

Spinal cord injury

b)

Multiple sclerosis

c)

Stroke

d)

Diabetes mellitus

30.

In the urodynamic filling phase, the detrusor pressure should:

a)

Increase rapidly

b)

Remain stable and low

c)

Oscillate intermittently

d)

Remain high and constant

31.

What condition is most associated with levator ani spasm?

a)

Stress incontinence

b)

Interstitial cystitis

c)

Pelvic organ prolapse

d)

Urethral diverticulum

32.

What is the mechanism of action of Botox in the bladder?

a)

Cholinesterase inhibition

b)

M2 receptor blockade

c)

α-receptor antagonism

d)

Inhibits acetylcholine release at neuromuscular junction

33.

Which test helps diagnose urethral diverticulum?

a)

Pelvic ultrasound

b)

Retrograde urethrogram

c)

VCUG

d)

MRI pelvis

34.

A woman with OAB symptoms and normal cystometry most likely has:

a)

Stress incontinence

b)

Bladder cancer

c)

Sensory urgency

d)

Detrusor areflexia

35.

What is the expected leak point pressure in genuine stress incontinence?

a)

>100 cm H₂O

b)

<60 cm H₂O

c)

70-90 cm H₂O

d)

120-150 cm H₂O

36.

Anticholinergic drugs are contraindicated in:

a)

Elderly with urgency

b)

Patients with narrow-angle glaucoma

c)

Detrusor overactivity

d)

Postpartum patients

37.

What is the most reliable test to assess urethral function?

a)

Urethral pressure profile

b)

Bladder scan

c)

Q-tip test

d)

Uroflowmetry

38.

Which neuromodulation target is used for percutaneous tibial nerve stimulation?

a)

S3

b)

L1

c)

T12

d)

S2

39.

What is a long-term risk of chronic high bladder pressure?

a)

Bladder cancer

b)

Vesicoureteral reflux

c)

Diabetes insipidus

d)

Pyelonephritis

40.

The hallmark urodynamic feature of underactive detrusor is:

a)

High flow with low pressure

b)

Low flow with high pressure

c)

Low flow with low pressure

d)

Normal compliance with DO

41.

Which of the following is NOT an antimuscarinic drug?

a)

Oxybutynin

b)

Solifenacin

c)

Tolterodine

d)

Mirabegron

42.

What is the action of sacral neuromodulation in OAB treatment?

a)

Inhibits detrusor contractions

b)

Stimulates α-receptors in bladder neck

c)

Increases urethral resistance

d)

Reduces pelvic floor tone

43.

What is the role of the hypogastric nerve in bladder control?

a)

Stimulates detrusor contraction

b)

Relaxes external sphincter

c)

Inhibits detrusor contraction and contracts bladder neck

d)

Controls pelvic floor muscles

44.

What test is most useful to diagnose functional bladder outlet obstruction in women?

a)

MRI

b)

Urodynamics with EMG

c)

Q-tip test

d)

Cystoscopy

45.

Which of the following symptoms is NOT included in IC/BPS diagnosis per AUA guidelines?

a)

Frequency

b)

Pelvic pain

c)

Dysuria

d)

Incontinence

46.

What finding is consistent with sensory urgency?

a)

Low compliance

b)

High bladder pressure

c)

Early first sensation with no detrusor contraction

d)

Sustained detrusor contraction during filling

47.

A 55-year-old woman with urgency and frequency, failed oral meds. Next step?

a)

Midurethral sling

b)

Sacral neuromodulation

c)

Methenamine

d)

Bladder augmentation

48.

Which neuromodulation is non-invasive and office-based?

a)

Sacral

b)

Pudendal

c)

Tibial

d)

Pelvic

49.

What is a potential complication of Botox for OAB?

a)

Urethral diverticulum

b)

Retention

c)

Stone formation

d)

Fistula

50.

What is the mechanism of duloxetine for stress incontinence?

a)

α-agonist

b)

SNRI

c)

Cholinergic agonist

d)

Dopamine anta

51.

x for OAB?

a)

Urethral diverticulum

b)

Retention

c)

Stone formation

d)

Fistula

52.

What is the mechanism of duloxetine for stress incontinence?

a)

α-agonist

b)

SNRI

c)

Cholinergic agonist

d)

Dopamine antagonist

53.

The voiding diary is most useful for evaluating:

a)

Bladder compliance

b)

Urethral hypermobility

c)

Frequency and urgency patterns

d)

Urethral diverticulum

54.

Which drug is β3-selective agonist for OAB?

a)

Mirabegron

b)

Tamsulosin

c)

Finasteride

d)

Desmopressin

55.

Which feature differentiates urge incontinence from stress incontinence?

a)

Leakage only during cough

b)

Leakage preceded by urgency

c)

Leakage while supine

d)

Leakage with physical exertion

56.

Which feature best characterizes neurogenic detrusor overactivity?

a)

Low flow with low detrusor pressure

b)

High pressure with spontaneous contractions

c)

Early sensation with full voiding

d)

Detrusor inactivity on filling phase

57.

Chronic pelvic pain is defined as pain >3 months in absence of:

a)

Urodynamic abnormality

b)

Positive urine culture

c)

Structural pathology

d)

Neurogenic bladder

58.

The spinal cord segment responsible for detrusor contraction is:

a)

T12-L2

b)

L1-L3

c)

S2-S4

d)

L4-S1

59.

What is the effect of estrogen on LUTS in postmenopausal women?

a)

Increases detrusor tone

b)

Improves urethral mucosa and continence

c)

Decreases bladder capacity

d)

Causes urethral obstruction

60.

Which agent is a non-anticholinergic alternative for OAB?

a)

Trospium

b)

Mirabegron

c)

Solifenacin

d)

Tolterodine

61.

A 62-year-old woman has high PVR, poor flow, and detrusor underactivity. Best treatment:

a)

Anticholinergic

b)

Intermittent catheterization

c)

Midurethral sling

d)

Botox

62.

What is the effect of α-blockers in female bladder outlet obstruction?

a)

Stimulate detrusor contraction

b)

Improve urethral resistance

c)

Relax smooth muscle in bladder neck

d)

Increase sphincter tone

63.

Which is the most common cause of female bladder outlet obstruction?

a)

Urethral stricture

b)

Primary bladder neck obstruction

c)

Dysfunctional voiding

d)

Urethral diverticulum

64.

A woman with pelvic pain worsened by bladder filling and relieved by voiding likely has:

a)

Urethral stricture

b)

IC/BPS

c)

Detrusor underactivity

d)

Stress incontinence

65.

Which test confirms detrusor underactivity?

a)

Urethral pressure profile

b)

Bladder diary

c)

Pressure-flow study

d)

Post-void residual

66.

Which of the following symptoms is least typical for OAB syndrome?

a)

Frequency

b)

Urgency

c)

Incontinence on coughing

d)

Nocturia

67.

Which structure is primarily responsible for continence at rest in women?

a)

External urethral sphincter

b)

Internal urethral sphincter

c)

Puborectalis muscle

d)

Levator ani

68.

What muscle contracts during stress events to aid continence?

a)

Detrusor

b)

Bulbospongiosus

c)

External urethral sphincter

d)

Internal sphincter

69.

Which medication may worsen cognitive side effects in elderly OAB patients?

a)

Solifenacin

b)

Tolterodine

c)

Oxybutynin

d)

Mirabegron

70.

What is the role of biofeedback in urinary incontinence?

a)

Measures bladder pressure

b)

Trains pelvic floor muscle awareness

c)

Measures urine volume

d)

Inhibits detrusor contractions

71.

Which urodynamic finding suggests outlet obstruction?

a)

Low detrusor pressure with low flow

b)

High detrusor pressure with low flow

c)

Low compliance

d)

Early first sensation

72.

What is the typical bladder capacity in IC/BPS?

a)

>700 mL

b)

400-600 mL

c)

<350 mL

d)

Variable and unpredictable

73.

What is the effect of aging on bladder function?

a)

Increased bladder compliance

b)

Decreased PVR

c)

Increased involuntary contractions

d)

Increased voiding efficiency

74.

Which syndrome includes pelvic pain, urinary symptoms, and myofascial trigger points?

a)

Overactive bladder

b)

Urethral syndrome

c)

Chronic pelvic pain syndrome

d)

Interstitial cystitis

75.

What is the most likely urodynamic pattern in MS patients with LUTS?

a)

Detrusor overactivity

b)

High capacity underactivity

c)

Fixed sphincter tone

d)

Atonic bladder

76.

Which is the most appropriate surgical treatment for genuine stress incontinence?

a)

Colposuspension

b)

Bladder augmentation

c)

Botox injection

d)

Cystectomy

77.

In a patient with neurogenic bladder and reflux, what is the key risk factor for renal damage?

a)

High bladder capacity

b)

High detrusor leak point pressure

c)

High PVR

d)

Bladder trabeculation

78.

What symptom is most specific for stress urinary incontinence?

a)

Frequency

b)

Urgency

c)

Leakage with physical activity

d)

Nocturia

79.

Urethral bulking agents are best used in:

a)

Recurrent UTIs

b)

Pelvic organ prolapse

c)

Intrinsic sphincter deficiency

d)

Detrusor overactivity

80.

Which treatment has the lowest systemic side effects for OAB?

a)

Oxybutynin IR

b)

Tolterodine ER

c)

Solifenacin

d)

Vaginal estrogen

81.

Which type of incontinence improves with pelvic floor muscle training?

a)

Detrusor overactivity

b)

Stress incontinence

c)

Overflow incontinence

d)

Reflex incontinence

82.

Best management for woman with high PVR, low detrusor pressure, and weak stream:

a)

Urethral dilation

b)

Intermittent catheterization

c)

Anticholinergic therapy

d)

Midurethral sling

83.

Which urodynamic value reflects safe storage pressure?

a)

Detrusor pressure >60 cm H₂O

b)

Compliance >30 mL/cm H₂O

c)

Leak point pressure <10 cm H₂O

d)

PVR >100 mL

84.

A woman with detrusor overactivity unresponsive to medication-next step?

a)

Cystectomy

b)

Botox injection

c)

Bladder augmentation

d)

Midurethral sling

85.

Which type of incontinence is best diagnosed by cough stress test?

a)

Urge

b)

Mixed

c)

Overflow

d)

Stress

86.

A woman has urinary frequency and pain that is worsened by eating acidic foods. Likely diagnosis?

a)

UTI

b)

IC/BPS

c)

Overactive bladder

d)

Bladder cancer

87.

What is the normal range for first sensation of bladder filling?

a)

<50 mL

b)

100-150 mL

c)

200-300 mL

d)

>350 mL

88.

Which of the following is a risk factor for underactive bladder?

a)

Pregnancy

b)

Obesity

c)

Diabetes mellitus

d)

High estrogen

89.

What is the expected voided volume per void in normal bladder diaries?

a)

<100 mL

b)

150-350 mL

c)

>600 mL

d)

Variable but >400 mL

90.

What is the function of levator ani in female continence?

a)

Controls detrusor contractions

b)

Stabilizes bladder neck and supports urethra

c)

Innervates the urethral mucosa

d)

Contracts bladder dome

91.

What is the most effective non-pharmacologic therapy for urgency-predominant OAB?

a)

Vaginal estrogen

b)

Bladder training

c)

Midurethral sling

d)

Q-tip test

92.

Which treatment is LEAST appropriate for pure urge incontinence?

a)

Antimuscarinics

b)

β3-agonist

c)

Pelvic floor exercise

d)

Midurethral sling

93.

In bladder filling phase, what finding is ABNORMAL?

a)

Stable detrusor pressure

b)

No urgency until moderate volume

c)

Detrusor overactivity

d)

Good compliance

94.

Urethral hypermobility causes incontinence due to:

a)

Detrusor instability

b)

Weak external sphincter

c)

Absent mucosal seal

d)

Poor anatomic support of urethra

95.

The ideal antimuscarinic for elderly patients is:

a)

Oxybutynin IR

b)

Solifenacin

c)

Trospium

d)

Darifenacin

96.

The predominant neurotransmitter in sympathetic bladder control is:

a)

Acetylcholine

b)

Norepinephrine

c)

Dopamine

d)

Serotonin

97.

Recurrent UTI is defined as ≥ ___ infections in 12 months:

a)

1

b)

2

c)

3

d)

4

98.

Which finding is common in functional bladder outlet obstruction in women?

a)

High flow rate

b)

Normal EMG

c)

Sphincter contraction during voiding

d)

Normal detrusor-sphincter coordination

99.

Which treatment option is NOT supported for first-line OAB management?

a)

Bladder training

b)

Antimuscarinics

c)

Sacral neuromodulation

d)

Pelvic flo

100.

Which treatment option is NOT supported for first-line OAB management?

a)

Bladder training

b)

Antimuscarinics

c)

Sacral neuromodulation

d)

Pelvic floor exercise

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