Interstitial Cystitis/Painful Bladder Syndrome — MCQs
Increased permeability in acute inflammation is due to all except?
A 50-year old woman complains of leakage of urine. Other than genuine stress urinary incontinence, the most common cause of urinary leakage is ?
A patient 45 years of age, non diabetic, presents with chronic pelvic pain of 1 year duration. She also complains of frequency, urgency and a sense of incomplete evacuation since 1 year without any significant finding on her past ultrasounds, urine examination and urine and high vaginal swab cultures. On pelvic examination there is no significant vaginal discharge. Cystoscopy is normal. Most probable diagnosis is
Michaelis-Gutmann bodies are seen in
An elderly female presented with dribbling of urine only on coughing and straining. What type of urinary incontinence is she suffering from
Bead cystogram is used for the diagnosis of:
A multiparous woman with a history of LSCS presents with cyclical hematuria and normal menstruation. The most likely diagnosis is:
What is the drug of choice for most forms of interstitial lung disease?
Pine-tree bladder is a sign of.
A woman, who is in the reproductively active age group, presents with a history of greenish and frothy vaginal discharge. On examination, she has multiple punctuate strawberry-like spots. What is the likely diagnosis?
Interstitial Cystitis/Painful Bladder Syndrome Indian Medical PG Practice Questions and MCQs
Question 1: Increased permeability in acute inflammation is due to all except?
- A. Lytic enzymes (Correct Answer)
- B. Cytokines
- C. Endothelial cell contraction
- D. Endothelial injury
Explanation: ***Lytic enzymes*** - **Lytic enzymes** play a role in the breakdown of tissue and are not primarily responsible for increased vascular permeability in acute inflammation [2]. - They are more involved in tissue destruction rather than facilitating permeability changes [2]. *Cytokines* - **Cytokines** are crucial mediators in the inflammatory response and increase vascular permeability by affecting endothelial function. - They promote the expression of adhesion molecules and induce other inflammatory mediators, contributing to permeability. *Endothelial injury* - **Endothelial injury** directly contributes to increased permeability by damaging the endothelial barrier, allowing fluid and proteins to leak into tissues. - It often occurs due to various insults, such as infections, toxins, and mechanical stress during inflammation. *Cell contraction* - **Cell contraction** refers to the retraction of endothelial cells, which leads to increased gaps in the endothelium and enhances permeability [1]. - This mechanism is induced by inflammatory mediators like histamine and contributes significantly to acute inflammation [1,2]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 187-189. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, p. 101.
Question 2: A 50-year old woman complains of leakage of urine. Other than genuine stress urinary incontinence, the most common cause of urinary leakage is ?
- A. Vesico vaginal fistula
- B. Overflow incontinence
- C. Detrusor dyssynergia
- D. Urge incontinence (Correct Answer)
Explanation: ***Urge incontinence*** - **Urge incontinence**, characterized by an **involuntary leakage of urine accompanied or immediately preceded by urgency**, is the most common form of urinary incontinence after stress urinary incontinence, especially in older women [1]. - It results from **detrusor overactivity**, leading to sudden, strong urges to void that are difficult to defer. *Vesico vaginal fistula* - A **vesicovaginal fistula** involves an abnormal connection between the bladder and the vagina, leading to continuous and spontaneous leakage of urine into the vagina, which would present differently from typical urge symptoms [1]. - While it causes leakage, it's a relatively rare cause compared to urge incontinence and is often associated with prior surgery or radiation. *Overflow incontinence* - **Overflow incontinence** occurs when the bladder is overfilled and unable to empty properly, leading to continuous leakage of small amounts of urine due to retention [1]. - This is often caused by **bladder outlet obstruction** or **neurogenic bladder**, and the patient might report difficulty voiding or a sensation of incomplete emptying [1]. *Detrusor dyssynergia* - **Detrusor dyssynergia** describes a lack of coordination between the detrusor muscle contraction and external urethral sphincter relaxation, typically seen in neurological disorders [2]. - This condition is a specific type of voiding dysfunction that can lead to incontinence but is not the most common cause of leakage after stress incontinence in the general population.
Question 3: A patient 45 years of age, non diabetic, presents with chronic pelvic pain of 1 year duration. She also complains of frequency, urgency and a sense of incomplete evacuation since 1 year without any significant finding on her past ultrasounds, urine examination and urine and high vaginal swab cultures. On pelvic examination there is no significant vaginal discharge. Cystoscopy is normal. Most probable diagnosis is
- A. Asymptomatic bacteriuria
- B. Cystitis
- C. Urethral syndrome (Correct Answer)
- D. Vulvovaginitis
Explanation: ***Urethral syndrome*** - The patient presents with classic symptoms of **urethral syndrome**, including chronic pelvic pain, frequency, urgency, and incomplete evacuation despite negative urine cultures and normal cystoscopy [1]. - This diagnosis is also supported by the absence of significant findings on ultrasound, urine examination, and vaginal cultures, ruling out common infectious or structural causes [1]. *Asymptomatic bacteriuria* - This condition involves the presence of bacteria in the urine without any associated symptoms and would not explain the patient's **chronic pelvic pain**, frequency, and urgency. - While urine cultures would be positive, the absence of symptoms differentiates it from the patient's presentation. *Cystitis* - **Cystitis**, or bladder inflammation, typically presents with similar symptoms to the patient, but would usually show signs of inflammation or infection in urine analysis (e.g., pyuria) or cystoscopy, which are absent here. - Her negative urine cultures also effectively rule out **bacterial cystitis**. *Vulvovaginitis* - **Vulvovaginitis** is an inflammation of the vulva and vagina, usually presenting with vaginal discharge, itching, or irritation, which is conspicuously absent in this patient [2]. - The patient's symptoms are primarily urinary and pain-related, not genitally localized to the vulva or vagina.
Question 4: Michaelis-Gutmann bodies are seen in
- A. Malacoplakia (Correct Answer)
- B. Thimble Bladder
- C. Transitional cell carcinoma of bladder
- D. Interstitial cystitis
Explanation: ***Malacoplakia*** - **Michaelis-Gutmann bodies** are pathognomonic, spherical, intracytoplasmic or extracellular concretions that stain positive with **Perls' Prussian blue stain** (due to their iron content). - Malacoplakia is a specific type of **granulomatous inflammation** [2] that most commonly affects the urinary tract, particularly the bladder. *Thimble Bladder* - This term refers to a **small, contracted bladder** often seen in end-stage **tuberculosis** [3] or interstitial cystitis [1], but it is not characterized by Michaelis-Gutmann bodies. - It describes a morphological feature rather than a specific microscopic inclusion [4]. *Transitional cell carcinoma of bladder* - This is a common **malignant tumor** of the bladder lining, characterized by atypical transitional epithelial cells, not Michaelis-Gutmann bodies. - Diagnosis involves histopathological examination revealing **dysplastic urothelial cells** with varying degrees of invasion. *Interstitial cystitis* - Characterized by **chronic bladder pain** and urinary frequency without infection, often associated with submucosal hemorrhages (glomerulations) and sometimes **Hunner's ulcers** [1]. - It is a diagnosis of exclusion and does not involve the formation of Michaelis-Gutmann bodies. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 966-967. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 198-200. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 494-495. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 972-973.
Question 5: An elderly female presented with dribbling of urine only on coughing and straining. What type of urinary incontinence is she suffering from
- A. Overflow incontinence
- B. Stress incontinence (Correct Answer)
- C. Urge incontinence
- D. Neurogenic bladder
Explanation: ***Stress incontinence*** - **Dribbling of urine** specifically with activities that increase intra-abdominal pressure like **coughing or straining** is the hallmark of stress incontinence. - This type of incontinence results from **weakness of the pelvic floor muscles** and/or intrinsic urethral sphincter deficiency. *Overflow incontinence* - This occurs when the bladder is **overfilled and unable to empty**, leading to constant dribbling or leakage. - Patients typically experience a **poor stream**, hesitancy, and a feeling of incomplete emptying, which are not described here. *Urge incontinence* - Characterized by a **sudden, strong urge to urinate** that is difficult to defer, often leading to involuntary leakage before reaching the toilet. - It is caused by **involuntary contractions of the detrusor muscle** and is not directly related to physical exertion like coughing. *Neurogenic bladder* - This refers to bladder dysfunction due to a **neurological condition** affecting bladder control, such as spinal cord injury or multiple sclerosis. - Symptoms can vary broadly (flaccid or spastic bladder) and are not limited to leakage with coughing alone.
Question 6: Bead cystogram is used for the diagnosis of:
- A. Thimble bladder
- B. Diverticulum
- C. Stress incontinence (Correct Answer)
- D. Ca bladder
Explanation: ***Stress incontinence*** - A **bead cystogram** is a diagnostic test specifically designed to evaluate the **urethral vesical angle** and assess for bladder neck descent during stress maneuvers, which are characteristic of **stress incontinence**. - The procedure involves placing a metal bead chain within the urethra and bladder, and then taking X-rays to visualize the relative positions of the bladder neck and urethra during changes in intra-abdominal pressure. *Thimble bladder* - A **thimble bladder** is a small, contracted bladder, often seen in conditions like **tuberculosis** or interstitial cystitis. - While cystography might reveal a small bladder, a bead cystogram is not specifically used to diagnose the size or capacity of the bladder. *Diverticulum* - A **diverticulum** is an outpouching of the bladder wall, which would be visualized as an abnormal projection during a standard cystogram. - A bead cystogram's primary purpose is to assess urethral and bladder neck morphology, not to identify diverticula. *Ca bladder* - **Bladder cancer (Ca bladder)** is typically diagnosed through **cystoscopy with biopsy**, urine cytology, or imaging techniques like CT scans or MRI, which look for masses or wall thickening. - A bead cystogram is not a primary diagnostic tool for bladder cancer and does not provide information about malignant lesions.
Question 7: A multiparous woman with a history of LSCS presents with cyclical hematuria and normal menstruation. The most likely diagnosis is:
- A. Bladder endometriosis (Correct Answer)
- B. Vesicouterine fistula
- C. Urinary tract infection
- D. Both bladder endometriosis and vesicouterine fistula
Explanation: ***Bladder endometriosis*** - This is the **correct diagnosis** given the presentation of **cyclical hematuria with normal menstruation**. - **Bladder endometriosis** involves endometrial tissue growing in the bladder wall, which responds to hormonal changes during the menstrual cycle. - It leads to **cyclical hematuria concurrent with menstruation**, while the patient continues to have normal vaginal menstrual bleeding. - **Risk factors** include previous pelvic surgery such as LSCS, which can lead to endometrial tissue implantation. *Vesicouterine fistula* - A **vesicouterine fistula** (Youssef syndrome) is an abnormal communication between the bladder and uterus, often a complication of uterine surgery like LSCS. - It presents with **menouria** - cyclical hematuria with **amenorrhea** (absence of vaginal menstruation), as menstrual blood drains directly into the bladder. - This patient has **normal menstruation**, which rules out vesicouterine fistula. *Both bladder endometriosis and vesicouterine fistula* - While both can occur after LSCS, they are **distinguished by the presence or absence of menstruation**. - The presence of **normal menstruation** in this case points specifically to bladder endometriosis, not both conditions. *Urinary tract infection* - While UTIs can cause hematuria, it is typically **non-cyclical** and often accompanied by symptoms like dysuria, frequency, and urgency. - The key differentiating factor here is the **cyclical nature** of the hematuria synchronized with the menstrual cycle, which is not characteristic of UTI.
Question 8: What is the drug of choice for most forms of interstitial lung disease?
- A. Antibiotics
- B. Bronchodilators
- C. Aspirin
- D. Corticosteroids (Correct Answer)
Explanation: ***Corticosteroids*** - **Corticosteroids** are the **drug of choice** for many forms of **interstitial lung disease (ILD)** due to their potent **anti-inflammatory** and **immunosuppressive properties**, which help reduce lung inflammation and prevent fibrosis. - They are particularly effective in inflammatory ILDs such as **sarcoidosis**, **hypersensitivity pneumonitis**, and some **connective tissue disease-associated ILDs**. *Antibiotics* - **Antibiotics** are primarily used to treat bacterial and other microbial infections and are **not effective** against the **inflammatory and fibrotic processes** characteristic of most ILDs. - They might be used if there's a **secondary bacterial infection** complicating ILD, but not as primary treatment for the ILD itself. *Bronchodilators* - **Bronchodilators** work by relaxing the muscles around the airways, making them wider and easier to breathe through, which is beneficial in conditions like **asthma** or **COPD**. - They are **not primarily used** in ILD as the main problem is **inflammation and scarring of the lung tissue**, not reversible airway constriction. *Aspirin* - **Aspirin** is an **NSAID** with **anti-inflammatory**, **anti-platelet**, and **analgesic properties**, commonly used for pain relief, fever reduction, and cardiovascular protection. - It has **no established role** in the primary treatment of **interstitial lung disease**, as its anti-inflammatory effects are typically insufficient for the severe inflammation seen in ILD.
Question 9: Pine-tree bladder is a sign of.
- A. Pelvic abscess
- B. Bilharziasis (Correct Answer)
- C. Intraperitoneal bladder rupture
- D. Neurogenic bladder
Explanation: ***Bilharziasis*** - The "pine-tree bladder" appearance on a retrograde cystogram is characteristic of **chronic bilharzial cystitis**, also known as **schistosomiasis of the bladder**. - This appearance results from **fibrosis**, **granulomas**, and **calcification** of the bladder wall leading to multiple irregular diverticula and trabeculations, which resemble pine-tree branches. *Pelvic abscess* - A pelvic abscess causes an **extrinsic compression** on the bladder, leading to mass effect or displacement, rather than intrinsic wall changes. - It would typically present with symptoms of infection, such as fever and localized pain, and imaging would show a fluid collection. *Intraperitoneal bladder rupture* - An intraperitoneal bladder rupture would lead to extravasation of urine into the peritoneal cavity, which would be visible on imaging as **free fluid** around abdominal organs. - The bladder itself would appear flaccid and potentially collapsed, without the characteristic "pine-tree" appearance. *Neurogenic bladder* - Neurogenic bladder is characterized by **detrusor-sphincter dyssynergia** or loss of bladder sensation, leading to features like **trabeculation**, cellules, and diverticula due to high intravesical pressure. - While it can cause some bladder wall changes, the specific "pine-tree" pattern is not its hallmark, and it is usually associated with neurological deficits.
Question 10: A woman, who is in the reproductively active age group, presents with a history of greenish and frothy vaginal discharge. On examination, she has multiple punctuate strawberry-like spots. What is the likely diagnosis?
- A. Chlamydia infection
- B. Gonococcal vaginitis
- C. Candidiasis
- D. Trichomoniasis (Correct Answer)
Explanation: ***Trichomoniasis*** - The classic presentation of **greenish, frothy vaginal discharge** coupled with **strawberry cervix (multiple punctate spots)** is highly characteristic of trichomoniasis, caused by the parasite *Trichomonas vaginalis*. - This infection often causes **vaginal itching, irritation**, and dyspareunia. *Chlamydia infection* - Chlamydia often presents with **mucopurulent cervical discharge** and can be **asymptomatic**, but typically does not cause frothy, green discharge or strawberry cervix. - It is more commonly associated with symptoms like **dysuria** or **post-coital bleeding** when symptomatic. *Gonococcal vaginitis* - Gonorrhea typically causes **purulent discharge** that may be yellowish or greenish, but it is not typically frothy. - It is also associated with **dysuria** and pelvic pain, but the strawberry cervix is not a common finding. *Candidiasis* - Candidiasis (yeast infection) typically presents with a **thick, white, curd-like vaginal discharge**, often described as cottage cheese-like. - It is associated with **intense vulvovaginal itching and burning**, but not a frothy discharge or strawberry cervix.
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