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Kaplan Qbank USMLE



Author9 Posts
  #1

14. An 82-year-old woman with a 20-year history of urinary incontinence has had a mild exacerbation of her symptoms over the past 3 months. Urine loss generally occurs when she is carrying out daily activities such as shopping or driving and is not affected by coughing or sneezing. She underwent appendectomy at the age of 24 years. She has one daughter. She takes no medications. Pelvic examination shows an atrophic cervix without a palpable uterus or an adnexal mass. Laboratory studies show:

Hemoglobin 13 g/dL
Serum
Na+ 140 mEq/L
Cl– 105 mEq/L
K+ 4.5 mEq/L
HCO3– 25 mEq/L
Urea nitrogen (BUN) 15 mg/dL
Glucose 120 mg/dL
Creatinine 1.1 mg/dL
Urine
Epithelial cells 5–10
Glucose negative
WBC 0–1/hpf
Bacteria occasional

Which of the following is the most likely cause of this patient’s urinary incontinence?

A ) Detrusor instability

B ) Hyperglycemia

C ) Neurogenic bladder

D ) Obstructive uropathy

E ) Urinary tract infection


  #2

Detrusor instability

  #3

? Neurogenic bladder.

  #4

A) Detrusor instability


  #5

can u all explain how u reach to ur ans... i ll go wid nerogenic bladder as there can be pudendal n damage


  #6

The option for neurologic is ruled out,coz of no clear history of neurological probs in past,no spinal cord injuries etc..

Autonomic neuropathy due to hyperglycemia is also ruled out,coz her BS is not that high to cause a urinary incontinence..

UTI:- normal WBC, contaminated with bacteria.--ruled out

OB.URO:- clearly mentions no adnexal masses to produce pressure effects..

The only left out is detrusor instabilty(and DETRUSOR INSTABILTY is the MCC of urinary incontinence in ELDERLY)

So i am going for-------->A..

Edited by Aashi on 01/15/07 - 12:25 PM

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  #7

excellent!

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  #8

hi,Aashi,
how can a high bs cause incontinence, is it diabetic neurogenic incontinence?

  #9

webjeee wrote:
hi,Aashi,
how can a high bs cause incontinence, is it diabetic neurogenic incontinence?

I guess there is no strong evidence for DM.
(A)

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