NBME 3 block 3 qs 45 - stalinmbbs - Printable Version +- USMLE Forum - Largest USMLE Community (https://www.usmleforum.com) +-- Forum: USMLE Forum (https://www.usmleforum.com/forumdisplay.php?fid=1) +--- Forum: Step 2 CK (https://www.usmleforum.com/forumdisplay.php?fid=3) +--- Thread: NBME 3 block 3 qs 45 - stalinmbbs (/showthread.php?tid=573408)

NBME 3 block 3 qs 45 - stalinmbbs - ArchivalUser - 03-12-2011 45. An 82-year-old woman with a 20-year history of urinary incontinence has had a mild exacerbation of her symptoms over the past 3 months. Urine loss generally occurs when she is carrying out daily activities such as shopping or driving and is not affected by coughing or sneezing. She underwent appendectomy at the age of 24 years. She has one daughter. She takes no medications. Pelvic examination shows an atrophic cervix without a palpable uterus or an adnexal mass. Laboratory studies show: Hemoglobin 13 g/dL Serum Na* 140 mEq/L Cl- 105 mEq/L K+ 4.5 mEq/L HC03 25 mEq/L Urea nitrogen (BUN) 15 mg/dL Glucose 120 mg/dL Creatinine 1.1 mg/dL Urine Epithelial cells 5-10 Glucose negative WBC 0-1/hpf Bacteria occasional Which of the following is the most likely cause of this patient's urinary incontinence? O A) Detrusor instability O B) Hyperglycemia O C) Neurogenic bladder O D) Obstructive uropathy O E) Urinary tract infection 0 - ArchivalUser - 03-12-2011 Its A. DETRUSOR INSTABILITY or URGE INCONTINENCE. OTHER CHOICES : B , C,:common in diabetics , multiple sclerosis ,stroke pts.[bladdar gets No innervation for contraction.]All will lead to overflow incontinence. D.Obstructive uropathy:It will cause overflow incontinence.urine will be dribbling throughout the day. e.urine examination is fine.No symptoms. 0 - ArchivalUser - 03-12-2011 HII stalin.. plz share right ANS .. 0 - ArchivalUser - 03-12-2011 case seems PREVIUOS stress incontinence and now exaggerated symptoms are due to superimposed UTI.. urine exam may be normal even in UTI ,IT is not ,MUST thing to make diagnosis of UTI. The main symptom of stress incontinence is involuntary loss of urine. It may occur when: Coughing Sneezing Standing Exercising Engaging in other physical activity Engaging in sexual intercourse... 0 - ArchivalUser - 03-12-2011 AA is the answer given in key thanks nija 0 - ArchivalUser - 03-12-2011 thanks sheeom 0 - ArchivalUser - 03-12-2011 thanks stalin and nija ..