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nbme 4 1 3 - zoh
#1
3. A 27-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 gaitwith 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 ofthe following is
the most likely explanation for the patient's urinary incontinence?
O A) Bladder neck dyssynergia
O B) Chronic bladder inflammation
O C) Detrusor-sphincter dyssynergia
O D) Failure of bladder neck closure
O E) Failure to inhibitthe voiding reflex
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#2
e - i think he has dementis due to normal pressure hydrocephaly
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#3
yea its NPH .. but i dont know the mechanism what happens ..

and can anyone give the disease for each option pls ??????
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#4
c----------------While incontinence can result secondarily from gait disturbance or dementia, detrusor overactivity mostly underlies urinary urgency/frequency and incontinence in iNPH.
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#5
sure trice ?
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#6
yeah guys NPH leading to hydrocephalus--as hydrocephalus increases size of the ventricle increases so is the pressure on the brain matter i mean cortex so we end up wit loss of upper motor function leading to - Failure to inhibit the voiding reflex

Had similar question in uw of step 1
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