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+--- Thread: q13. 72yo man w/ difficulty walking, urin incontin - monicab (/showthread.php?tid=626460)
q13. 72yo man w/ difficulty walking, urin incontin - monicab - ArchivalUser - 10-29-2011
n4b1q13
13. A 72-year-old man is brought to the physician by his wife because of a 6-month history of difficulty walking, cognitive decline, and urinary incontinence. He has not had dysuria or nocturia. His wife says that his short-term memory is decreased and he has had intermittent confusion. On examination, he has a broad-based, short-stepped gait with some reduction of step height. He is oriented to person and place but not to time. He learns four words with some difficulty and recalls zero after 3 minutes. Which of the following is the most likely explanation for the patient's urinary incontinence?
A) Bladder neck dyssynergia
B) Chronic bladder inflammation
C) Detrusor-sphincter dyssynergia
D) Failure of bladder neck closure
E) Failure to inhibit the voiding reflex
4 - ArchivalUser - 10-29-2011
(E)
0 - ArchivalUser - 10-29-2011
please explain your answer
0 - ArchivalUser - 10-29-2011
E) Failure to inhibit the voiding reflex
Normal Pressure Hydrocephalus
The classic clinical triad of normal pressure hydrocephalus (NPH) is
Dementia, Gait apraxia, and Urinary incontinence.
Urinary incontinence appears late in the illness, and is found to be of the spastic hyperreflexic, increased-urgency type associated with decreased inhibition of voiding reflex, there is a lack of concern for micturition due to the severe frontal lobe cognitive impairment. This is also known as "frontal lobe incontinence", where the patient becomes indifferent to their recurrent urinary symptoms
0 - ArchivalUser - 10-22-2012
Great!
0 - ArchivalUser - 10-22-2012
good qs, good explanation thx