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* nbme 23 q
 #646829  
  dpgc - 01/14/12 09:56
 
  A 61-year-old woman comes to the office because of a 3-month history of urinary incontinence. You have been providing care for her and her husband since they moved to your area 2 years ago. She has a history of diabetes mellitus that was first diagnosed 2 years ago and has been very well managed by diet alone. She currently takes lorazepam at night for sleep and calcium and vitamin D supplements to prevent osteoporosis. She has declined hormone replacement therapy in the past because of a concern about breast cancer. She denies dysuria or problems with incontinence after sneezing or laughing, but she says, "When I try to pass urine, there usually isn't much, but I have to go again a few minutes later. And then, at other times, I just lose control and wet myself. I recently saw a television program on this and I think I have stress incontinence." Vital signs are: temperature 36.9C (98.4F), pulse 64/min, respirations 16/min and blood pressure 158/72 mm Hg. She weighs 93 kg (205 lb) and is 163 cm (5 ft 4 in) tall. Physical examination is normal except for moderate vaginal mucosal atrophy. Urinalysis done in the office shows no signs of infection.

Item 1 of 3

23. Which of the following factors in this patient's history or physical examination suggests a diagnosis other than stress incontinence as the cause for this patient's symptoms?

A

) Absence of dysuria

B

) Diabetes mellitus

C

) Increased body mass index

D

) Pattern of urination

E

) Vaginal mucosal atrophy

Item 2 of 3

24. The most appropriate next step in management is to suggest which of the following?

A

) Increased fluid consumption at night

B

) Referral for bladder ultrasonography

C

) Replacement of lorazepam with diphenhydramine at night for sleep

D

) Scheduled voiding

E

) Use of a pessary

 
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* Re:nbme 23 q
#2565485
  oldhakim - 01/14/12 15:13
 
  B&D  
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* Re:nbme 23 q
#2565492
  flower11 - 01/14/12 15:23
 
  e and d  
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* Re:nbme 23 q
#2565576
  drguirand - 01/14/12 17:28
 
  Answer E
Answer D
 
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* Re:nbme 23 q
#2565632
  dpgc - 01/14/12 18:54
 
  don't we decide based on pattern of urination..what type of incontinenece it is  
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* Re:nbme 23 q
#2565656
  kickoff - 01/14/12 20:33
 
  B and D  
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* Re:nbme 23 q
#2565889
  drguirand - 01/15/12 11:01
 
  Answer D
Answer D

I don't know what happen to me on my previous post...May be I was too tired!...Sorry guys for adding to your confusion ... sometimes your mind is right but your hands just go wrong!
 
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* Re:nbme 23 q
#2565903
  dpgc - 01/15/12 11:49
 
  thanks drguirand...yeah i was surprised to see vaginal atrophy as the cause....anyway hanks for participation.  
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* Re:nbme 23 q
#2565911
  cell - 01/15/12 12:04
 
  ans are d,b  
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* Re:nbme 23 q
#3384980
  vcampech2 - 10/15/19 13:37
 
  https://www.youtube.com/watch?v=yzC23BHQ7i8&feature=push-lbss&attr_tag=mvKpH2B...-TMF-eM%3A6  
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