nbme ob/gyn - studyboy

[ArchivalUser]

A pt with advanced DM who now has peripheral vasc. disease, charcot jts. and other advanced stages of DM. Now presents with Urinary incontinence, what is it due to?
a) Overflow Acontractile bladder
b) Intrinsic Sphincter def.
c) Detrussor Instability
d) Stress Incontinence
e) Urinary Tract Inf

(hint: remember boards likes to hide things and confuse one with unec. wording)

Since we're on the topic here is one of my own:

24 y/o female is driving long distance on highway, and all of a sudden she has an extreme urge to urinate. She has to pull over in the next exit and find the closest gas station to relieve herself. She states that she has expierienced this feeling before and finally wants to do something about it. Normal Hx. What does she have and how to treat?

a)Urge Incon
b)Stress Incon
c)Overlow Acontractile Bladder
d)Intrinsic Sphincter def

[ArchivalUser]

1.a - the residual volum after urinating would increase?
2.a?

[ArchivalUser]

1- A
2- A

[ArchivalUser]

Yes, Yes. Good April and cs. Don't let them fool you. The name we study is Overflow incontinence, but they call it Overflow acontractile bladder ( due to nerve damage in dm, tumors or stones that cause a backup of urine and higher res volume.)


Urge Incontinence
If you lose urine for no apparent reason while suddenly feeling the need or urge to urinate, you may have urge incontinence. The most common cause of urge incontinence is inappropriate bladder contractions

Involuntary actions of bladder muscles can occur because of damage to the nerves of the bladder, to the nervous system (spinal cord and brain), or to the muscles themselves. Multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke, and injury”including injury that occurs during surgery”all can harm bladder nerves or muscles.

I don't know what they meant about int. sphincter def

However, you forgot to give me the treament - Very fair game on USMLE.

[ArchivalUser]

treatment of urge incontinence is muscle relaxants and anti-cholinergics and also nsaids... though not sure of how nsaids work.
treatment of overflow incontinence is firstly- regular timely voiding.. if that doesn't work then cholinergics like bethanechol and finally if nothing works... intermittent catherization.
correct me if i'm wrong... thanks

[ArchivalUser]

Yes ver good cs. Tolterodine is an option for anti-cholinerigs. I think bethanocol can be used too.

[ArchivalUser]

bethanechol is a cholinomimetic drug..... used for overflow incontinence

[ArchivalUser]

thanks