01-14-2012, 05:56 AM
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 36.9°C (98.4°F), 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
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