Interesting Case

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Interesting Case

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lucky_doc
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01/22/08 - 10:38 AM

A 21 yo F presents to her OB 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 wks she finds herself continually rushing to the bathroom, "because I feel like I need to go, but I can't" This has never happened to her before, and she has begun wearing pads" just in case". She denies fever or dysuria. She is otherwise healthy, exercise regularly, and takes a multivitamin daily. Her physical exam is normal, as is her UA. Cystometry is performed, and her detrusor contraction to bethanecol chloride is greatly exaggerated. What is the most likely etiology of this woman's urgency?

A Acute Cystitis
B Chronic bladder distention
C Detrusor muscle inflammation
D Multiple Sclerosis
E Pelvic floor damage

Ivonne
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01/22/08 - 11:49 AM

Urge incontinence---------->C

I thought about MS in which it will be called detrussor hyperreflexia in the presence of a neurologic lesion believe to be causative but the Qstem doesn't give more clues for MS.

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bax
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01/22/08 - 12:17 PM

arlete
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01/22/08 - 12:58 PM

C

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kpmle2
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01/22/08 - 01:27 PM

C Detrusor muscle inflammation

Korotkoff
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01/22/08 - 01:36 PM

there won't be fever in detrusor muscle inflammation?
I will go with MS.

cool doctor
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01/22/08 - 02:38 PM

lucky_doc
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01/22/08 - 05:14 PM

The answer is D Multiple Sclerosis!!!!!! Believe it or Not!! wink

kpmle2
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01/22/08 - 05:18 PM

good Q what is the explanation for it?

lucky_doc
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01/22/08 - 05:52 PM

#10

Bethanecol chloride is a parasympathomimetic drug that is used during cystometry to aid in diagnosis. Lack of a contraction to bethanecol chloride suggests detrusor muscle damage and an increase in response suggests upper motor neuron dysfunction. One the presenting symptoms in MS is bladder spasticity and urinary retention. wink

kpmle2
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01/22/08 - 05:56 PM

#11

thanks for the exp lucky doc.

arlete
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01/22/08 - 07:38 PM

#12

Very good question, thanks!

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mildus
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01/23/08 - 09:06 AM

#13

excellent question

neurom
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01/24/08 - 09:40 AM

#14

Ivonne wrote:
Urge incontinence---------->C

I thought about MS in which it will be called detrussor hyperreflexia in the presence of a neurologic lesion believe to be causative but the Qstem doesn't give more clues for MS.

Agree, in this case the question is incomplete. There should be neurologic status abnormalities in order to suspect the diagnosis.

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