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4 A 21-year-old woman presents to her obstetrician - highsky
#1
A 21-year-old woman presents to her obstetrician
for urinary problems. She states that she
has been stressed because she is working hard
to do well on her finals at college. Over the last
2 weeks she finds herself continually rushing to
the bathroom, œbecause I feel like I need to go,
but I can™t. This has never happened to her
before, and she has begun wearing pads œjust
in case. She denies fevers and dysuria. She is
otherwise healthy, exercises regularly, and
takes a multivitamin daily. Her physical examination
is normal, as is her urinalysis. Cystometry
is performed, and her detrusor contraction
to bethanechol chloride is greatly exaggerated.
What is the most likely etiology of this
woman™s urinary urgency?
(A) Acute cystitis
(B) Chronic bladder distention
© Detrusor muscle inflammation
(D) Multiple sclerosis
(E) Pelvic floor damage
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#2
dd?
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#3
cc
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#4
DD-
Overflow incontinence seen in multiple sclerosis.
the bladder is denervated.
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#5
bb or cc.
go with BBB,
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#6
The correct answer is D. Bethanechol chloride
is a parasympathomimetic drug that is
used during cystometry to aid in diagnosis.
Lack of a contraction to bethanechol chloride
suggests detrusor muscle damage and an increased
response suggests upper motor neuron
dysfunction. Multiple sclerosis is an autoimmune
disease that is the result of central nervous
system demyelination. It most commonly
affects young women and can be exacerbated
by stress. Bladder spasticity and urinary retention
can be the presenting symptoms.
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#7
thanks for the good qs, highsky.
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