11-09-2014, 05:29 AM
NBME (CK)
A 72 yo man is brought to the physician by his wife because of a 6 month hx of difficulty walking, cognitive decline, and urinary incontinence. He has had dysuria or nocturia. His wife says that his short-term memory is decreased and he has had intermittent confusion. On exam, 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 min. 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
A 72 yo man is brought to the physician by his wife because of a 6 month hx of difficulty walking, cognitive decline, and urinary incontinence. He has had dysuria or nocturia. His wife says that his short-term memory is decreased and he has had intermittent confusion. On exam, 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 min. 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