Benign Prostatic Hyperplasia (BPH) and Urinary Incontinence are common urological disorders that significantly impact the quality of life, particularly in aging men. There is a direct link between BPH-induced bladder outlet obstruction and the development of overflow and urge incontinence. As detailed in the “Urological Disorders” module of the Patient Care 5 curriculum, the management of these interconnected conditions requires a thorough understanding of pharmacotherapy, from fast-acting alpha-blockers to prostate-shrinking 5-alpha reductase inhibitors. This quiz will test your knowledge on the comprehensive management of BPH and related incontinence.
1. A patient complains of urinary hesitancy, a weak stream, and straining to urinate. These are primarily classified as what type of BPH symptoms?
- a. Irritative symptoms
- b. Obstructive symptoms
- c. Systemic symptoms
- d. Inflammatory symptoms
Answer: b. Obstructive symptoms
2. Alpha-1 adrenergic antagonists, such as tamsulosin, provide rapid relief of BPH symptoms by:
- a. Shrinking the prostate gland.
- b. Relaxing smooth muscle in the prostate and bladder neck.
- c. Inhibiting the conversion of testosterone to DHT.
- d. Blocking muscarinic receptors on the bladder.
Answer: b. Relaxing the smooth muscle in the prostate and bladder neck.
3. A patient with an overdistended bladder due to BPH experiences constant dribbling of urine. This is characteristic of which type of incontinence?
- a. Stress incontinence
- b. Urge incontinence
- c. Overflow incontinence
- d. Functional incontinence
Answer: c. Overflow incontinence
4. 5-alpha reductase inhibitors, like finasteride, work by:
- a. Relaxing the detrusor muscle.
- b. Blocking the conversion of testosterone to dihydrotestosterone (DHT), thereby shrinking the prostate.
- c. Antagonizing alpha-1 receptors.
- d. Increasing urine production.
Answer: b. Blocking the conversion of testosterone to dihydrotestosterone (DHT), thereby shrinking the prostate.
5. Which class of medication for overactive bladder must be used with caution in men with BPH due to the risk of worsening urinary retention?
- a. Alpha-blockers
- b. Beta-3 agonists
- c. Anticholinergic agents
- d. 5-alpha reductase inhibitors
Answer: c. Anticholinergic agents
6. The “Management of Benign Prostatic Hyperplasia” is a specific lecture in which course?
- a. PHA5787C Patient Care 5
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5787C Patient Care 5
7. A patient starting a non-selective alpha-blocker like doxazosin should be counseled to take the first dose at bedtime to minimize the risk of:
- a. Insomnia
- b. Orthostatic hypotension and dizziness
- c. Nausea
- d. A severe headache
Answer: b. Orthostatic hypotension and dizziness
8. How long does it typically take to see the maximal effect of a 5-alpha reductase inhibitor on prostate size and symptoms?
- a. 24-48 hours
- b. 1-2 weeks
- c. At least 6 months
- d. 2 years
Answer: c. At least 6 months
9. Which of the following is NOT a typical “irritative” symptom of BPH?
- a. Frequency
- b. Urgency
- c. Nocturia
- d. Incomplete emptying
Answer: d. Incomplete emptying
10. Tadalafil, a PDE-5 inhibitor, is also FDA-approved to treat:
- a. Overflow incontinence
- b. Stress incontinence
- c. The signs and symptoms of BPH
- d. Chronic prostatitis
Answer: c. The signs and symptoms of BPH
11. The management of urinary incontinence is a topic within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
12. Which alpha-blocker is considered “uroselective,” with less effect on blood pressure compared to non-selective agents?
- a. Terazosin
- b. Doxazosin
- c. Tamsulosin
- d. Prazosin
Answer: c. Tamsulosin
13. A patient scheduled for cataract surgery should be advised to inform their surgeon if they are taking tamsulosin due to the risk of:
- a. Intraoperative Floppy Iris Syndrome (IFIS).
- b. Severe hypertension during the procedure.
- c. An interaction with the anesthetic.
- d. Post-operative infection.
Answer: a. Intraoperative Floppy Iris Syndrome (IFIS).
14. Combination therapy with an alpha-blocker and a 5-alpha reductase inhibitor is most appropriate for:
- a. All patients with BPH.
- b. Patients with mild BPH symptoms.
- c. Patients with a significantly enlarged prostate and moderate-to-severe symptoms.
- d. Patients with co-existing erectile dysfunction.
Answer: c. Patients with a significantly enlarged prostate and moderate-to-severe symptoms.
15. A patient with urge incontinence experiences leakage associated with:
- a. Coughing or sneezing.
- b. A sudden, compelling desire to void.
- c. A full bladder that cannot empty.
- d. Cognitive impairment.
Answer: b. A sudden, compelling desire to void.
16. “Introduction to Urological Disorders” is a lecture within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
17. What is the primary cause of overflow incontinence?
- a. An overactive detrusor muscle.
- b. A weak pelvic floor.
- c. Bladder outlet obstruction or an underactive detrusor muscle.
- d. Stress.
Answer: c. Bladder outlet obstruction or an underactive detrusor muscle.
18. A common side effect of 5-alpha reductase inhibitors is:
- a. Increased libido and erectile dysfunction
- b. Decreased libido and erectile dysfunction
- c. Tachycardia
- d. Dizziness
Answer: b. Decreased libido and erectile dysfunction
19. A pharmacist counseling a patient starting an alpha-blocker for BPH should mention that:
- a. The medication will shrink the prostate.
- b. Symptom relief is typically rapid, within days to weeks.
- c. It will take at least 6 months to work.
- d. It has no side effects.
Answer: b. Symptom relief is typically rapid, within days to weeks.
20. An active learning session on urological disorders is part of the Patient Care 5 course.
- a. True
- b. False
Answer: a. True
21. Which lifestyle modification can help with irritative BPH symptoms like nocturia?
- a. Increasing caffeine intake in the evening.
- b. Restricting fluids, especially before bedtime.
- c. Taking an over-the-counter decongestant at night.
- d. A high-sodium diet.
Answer: b. Restricting fluids, especially before bedtime.
22. The American Urological Association (AUA) Symptom Score is used to:
- a. Diagnose prostate cancer.
- b. Quantify the severity of BPH symptoms.
- c. Determine the appropriate dose of an alpha-blocker.
- d. Measure post-void residual volume.
Answer: b. Quantify the severity of BPH symptoms.
23. The “dynamic” component of BPH symptoms is primarily addressed by which drug class?
- a. 5-alpha reductase inhibitors
- b. Anticholinergics
- c. Alpha-1 blockers
- d. PDE-5 inhibitors
Answer: c. Alpha-1 blockers
24. An active learning session on men’s health is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
25. A pharmacist’s role in managing BPH and incontinence includes:
- a. Differentiating between types of incontinence.
- b. Recommending appropriate therapy based on symptoms and comorbidities.
- c. Counseling on medication side effects and onset of action.
- d. All of the above.
Answer: d. All of the above.
26. The “static” component of BPH symptoms is primarily addressed by which drug class?
- a. 5-alpha reductase inhibitors
- b. Anticholinergics
- c. Alpha-1 blockers
- d. PDE-5 inhibitors
Answer: a. 5-alpha reductase inhibitors
27. Dutasteride differs from finasteride in that it inhibits:
- a. Only Type 1 5-alpha reductase.
- b. Only Type 2 5-alpha reductase.
- c. Both Type 1 and Type 2 5-alpha reductase.
- d. It does not inhibit 5-alpha reductase.
Answer: c. Both Type 1 and Type 2 5-alpha reductase.
28. An active learning session on urological disorders is part of which course module?
- a. Module 8: Urological Disorders
- b. Module 1: Diabetes Mellitus
- c. Module 3: Women’s Health
- d. Module 6: Geriatrics
Answer: a. Module 8: Urological Disorders
29. The use of which medication class can worsen BPH symptoms by increasing smooth muscle tone in the prostate?
- a. Decongestants like pseudoephedrine
- b. Benzodiazepines
- c. NSAIDs
- d. Statins
Answer: a. Decongestants like pseudoephedrine
30. The management of BPH and incontinence is a lecture within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
31. First-line, non-pharmacologic management for stress urinary incontinence is:
- a. A pessary
- b. Fluid restriction
- c. Pelvic floor muscle exercises (Kegels)
- d. Bladder training
Answer: c. Pelvic floor muscle exercises (Kegels)
32. The pathophysiology of BPH involves the proliferation of what types of cells in the prostate?
- a. Epithelial and stromal cells
- b. Only muscle cells
- c. Only nerve cells
- d. Cancerous cells
Answer: a. Epithelial and stromal cells
33. What is a key counseling point for a patient taking a 5-alpha reductase inhibitor?
- a. It provides immediate symptom relief.
- b. It may take up to 6 months for the prostate to shrink and symptoms to improve.
- c. It will increase their libido.
- d. It must be taken on an empty stomach.
Answer: b. It may take up to 6 months for the prostate to shrink and symptoms to improve.
34. The primary goal of managing BPH is to:
- a. Cure the condition.
- b. Prevent prostate cancer.
- c. Improve the patient’s quality of life by reducing lower urinary tract symptoms (LUTS).
- d. Eliminate the need for all medications.
Answer: c. Improve the patient’s quality of life by reducing lower urinary tract symptoms (LUTS).
35. A female patient complains of leaking urine when she coughs. The pharmacist should recognize this as:
- a. Urge incontinence
- b. Overflow incontinence
- c. Stress incontinence
- d. BPH
Answer: c. Stress incontinence
36. A patient with BPH who also has hypertension might benefit from which agent that can treat both conditions?
- a. Tamsulosin
- b. Finasteride
- c. A non-selective alpha-blocker like doxazosin or terazosin.
- d. Tadalafil
Answer: c. A non-selective alpha-blocker like doxazosin or terazosin.
37. A patient taking finasteride should be aware that it will:
- a. Falsely elevate their PSA level.
- b. Falsely lower their PSA level by about 50%.
- c. Have no effect on their PSA level.
- d. Eliminate the need for PSA screening.
Answer: b. Falsely lower their PSA level by about 50%.
38. The lecture “Management of BPH” is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
39. A patient is taking an anticholinergic for OAB and complains of severe dry mouth. What could the pharmacist recommend?
- a. Discontinue the medication immediately.
- b. Suggest trying sugar-free hard candies, sips of water, or discussing an extended-release formulation with their doctor.
- c. Double the dose of the medication.
- d. Add a diuretic to the regimen.
Answer: b. Suggest trying sugar-free hard candies, sips of water, or discussing an extended-release formulation with their doctor.
40. An active learning session covering urological disorders is part of which course?
- a. PHA5787C Patient care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
41. Which of the following is NOT a risk factor for BPH?
- a. Advancing age
- b. The presence of androgens
- c. A family history
- d. Regular, vigorous exercise
Answer: d. Regular, vigorous exercise
42. The term “nocturia” refers to:
- a. Inability to urinate.
- b. Painful urination.
- c. Waking up at night to urinate.
- d. Leaking urine during the day.
Answer: c. Waking up at night to urinate.
43. A pharmacist’s role includes identifying medications that can worsen incontinence, such as:
- a. Diuretics
- b. Alpha-blockers (can worsen stress UI)
- c. Anticholinergics (can cause urinary retention and overflow UI)
- d. All of the above
Answer: d. All of the above
44. What is a key difference in onset of action between alpha-blockers and 5-ARIs for BPH?
- a. 5-ARIs work faster.
- b. Alpha-blockers provide more rapid symptom relief.
- c. Both have the same onset of action.
- d. Neither provides rapid relief.
Answer: b. Alpha-blockers provide more rapid symptom relief.
45. Which of the following is a non-pharmacologic intervention for UI?
- a. Bladder training
- b. Pelvic floor muscle exercises
- c. Fluid management
- d. All of the above
Answer: d. All of the above
46. Finasteride is teratogenic and pregnant women should not handle crushed or broken tablets.
- a. True
- b. False
Answer: a. True
47. The management of urinary incontinence is a lecture in the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
48. An active learning session on urological disorders is part of which course module?
- a. Module 8: Urological Disorders
- b. Module 1: Diabetes Mellitus
- c. Module 4: Medication Safety
- d. Module 6: Geriatrics
Answer: a. Module 8: Urological Disorders
49. The overall management of BPH and associated incontinence requires:
- a. A “one-size-fits-all” approach.
- b. An individualized plan based on symptom severity, prostate size, and patient comorbidities.
- c. Starting with surgery for all patients.
- d. Using only 5-alpha reductase inhibitors.
Answer: b. An individualized plan based on symptom severity, prostate size, and patient comorbidities.
50. The ultimate goal of learning about the management of BPH and incontinence is to:
- a. Be able to recommend safe and effective therapies to improve a patient’s quality of life.
- b. Memorize the AUA symptom score questions.
- c. Pass the final exam.
- d. Convince all men over 50 to take tamsulosin.
Answer: a. Be able to recommend safe and effective therapies to improve a patient’s quality of life.