1. Examination of urge incontinenece
Physical Exam Assessment
Depending on the particular details of your medical history, your doctor may proceed to any or all of the
following physical evaluations.
Neurologic examination to evaluate strength, sensation and reflexes in your legs.
Pelvic exam to assess whether you have any pelvic relaxation or pelvic organ prolapse.
Pelvic floor assessment,in which your provider will evaluate the strength of your pelvic floor muscles,
particularly your ability to contract and relax the appropriate muscle group.
Postvoid residual urine assessment to measure how much urine remains in your bladder within 15 minutes
of voiding. This test offers an estimation of your bladder's ability to efficiently "empty the tank." The
same urine sample may be analyzed for other factors,such as blood, sugar, crystals or signs of infection.
Such an evaluation can be accomplished with an office urine dipstick or the hospital laboratory's
microscopic urinalysis.
Urine culture if a urine dipstick or urinalysis suggests signs of acute infection. The culture is sent to the
microbiology lab and, in approximately 24 to 48 hours, bacterial growth can be detected and the specific
strain identified.
Cough stress test,in which your bladder is filled with water,and you are asked to cough or strain in the
same manner that would cause you to leak urine. This test can be performed in the office or incorporated
into more elaborate urodynamics testing.
Lab investigation
Urinalysis. A sample of your urine is checked for signs of infection, traces of blood or other
abnormalities.
Bladder diary. For severaldays you record how much you drink, when you urinate, the amount of urine
you produce, whether you had an urge to urinate and the number of incontinence episodes.
Post-void residual measurement. You're asked to urinate (void) into a container that measures urine
output. Then your doctor checks the amount of leftover urine in your bladder using a catheter or
ultrasound test. A large amount of leftover urine in your bladder may mean that you have an obstruction
in your urinary tract or a problem with your bladder nerves or muscles.
Radiologic tests identify upper or lower urinary tract structural abnormalities:
CT scan — A CT scan of the abdomen and pelvis may be performed, in which an X-ray machine takes a
rapid sequence of two-dimensional, thin cross-sections of the body in the area of interest. This exam can
be performed with or without contrast dye; mostly, this depends on what your doctor is looking for. The
X-rays pictures provide great anatomic detail of most of the internal organs.
2. Bendroflumethiazide is a diuretic and cause urge incontinence. increases urine production in kidneys
which will lead to frequent urination, overactive bladder and stress incontinence.
Time to opt for surgery in urge ofincontinence
For some women, symptoms of stress incontinence or overactive bladder don't respond to conservative
treatment. When you've tried conservative measures and urinary incontinence continues to disrupt your
life, surgery might be an option.
Examination of hypogeusia
A complete examination of the oral cavity and nasopharynx is recommended, with particular attention to
signs of previous surgery (e.g.,absent wisdom teeth or tonsils). Evidence of oral mucosal lesions or
gingival and periodontal inflammation may suggest a nutritional deficiency or inflammatory process. The
quantity of oral salivary flow is important because hyposalivation secondary to medications (common),
Sjogren syndrome, or past cancer therapies including radiation therapy may impact saliva production.
Signs of hyposalivation include inflamed mucosa, presence of mucus threads or frothy or bubbly saliva,
and tooth decay or loss.The ears should be examined for evidence of serous otitis (acute and chronic otitis
media) or previous surgery. The eyes should be examined for evidence of dryness (or keratoconjunctivitis
sicca), which may suggest Sjogren syndrome, while nodularity of these glands may suggest neoplasia.
The neck should be assessed for any evidence of previous neck surgery or thyroid enlargement. Parotid
and/or submandibular gland enlargement may suggest Sjogren syndrome. Depending on the clinical
history, a neurologic exam, including assessment of cognitive function, is indicated. This should include a
carefulevaluation of cranial nerve function
Laboratory investigations
Tests may include CBC and peripheral blood smear,serum ferritin, vitamin B12, and folate to exclude an
underlying anemia; serum zinc; serum fasting morning glucose, or an oral glucose tolerance test to
exclude diabetes mellitus; and TSH and T4 assays to exclude hypothyroidism. Tests of renal function
(BUN,creatinine, and serum electrolytes) and liver function may be useful to exclude renal/hepatic
insufficiency. If Sjogren syndrome is suspected,testing for the presence of anti-Ro/SSA and/or anti-
La/SSB antibodies is useful. In myasthenia gravis, an acetylcholine receptor antibody assay may be
indicated. Sialometry and sialochemistry (analysis of saliva) may also be revealing, as they define the
microenvironment of the taste buds.
Imaging
Neurologic imaging: if the history and clinical exam suggest any significant unidentified intracranial
pathology, then cranial CT and MRI exam may be indicated. Cranial CT may show a skull fracture,
intracranial bleeds, or subdural hematoma, and areas of ischemia. In Alzheimer disease, imaging may
show hippocampal volume loss, atrophy of the medial temporal lobe, and posterior cortical atrophy. In
multiple sclerosis, demyelination perpendicular to the lateral ventricles and corpus callosum may be
evident. Intracranial tumors may be seen as an area of hypodensity or hyperdensity on cranial CT, and
MRI may help identify an acoustic neuroma or meningioma. Cranial CT may also be useful to exclude
glomus tumor or other mastoid process abnormalities (e.g.,cholesteatoma). Salivary gland tumors leading
to hyposalivation may also be detected on cranial radiographic studies.
3. Amlodipine causes interference in zinc absorption which will lead to zinc insufficiency. Zinc is an
essential mineral needed by the body for growth, immune system function and catalyzing certain
enzymes. Insufficient dietary zinc or medical conditions that inhibit zinc absorption can result in a
deficiency, with potential health consequences that include taste disturbances such as hypogeusia, or
blunted sense of taste,and dysgeusia, or distorted sense of taste.
Losartan which belongs to ACE inhibitors antagonists, in some patients causes taste disorders but how it
causes is not known
Partial anosmia
Physical examination
The nasal passages should be inspected for swelling, inflammation, discharge, and polyps. Having the
patient breathe through each nostril sequentially (while the other is manually occluded) may help identify
obstruction.A complete neurologic examination, particularly of mental status and cranial nerves, is done.
Lab investigation
Patients should have CT of the head (including sinuses) with contrast to rule out a tumor or unsuspected
fracture of the floor of the anterior cranial fossa. MRI is also used to evaluate intracranial disease and may
be needed as well, particularly in those patients with no nasalor sinus pathology on CT.
Antihypertensive and cardiac medications are known to affect sense of smell. Amlodipine and atenolol
can cause loss of sense of smell.Odors are perceived in part via specific G-protein coupled receptors
(GPCRs) with cAMP or IP3 as the second messenger. Drugs that interact with this signaling cascade are
known to reduce olfactory. Drugs active in the centralnervous system may also interfere with processing
and integration of signals from the 400 distinct olfactory receptors that allow perception of thousands of
odors.
