USMLEGladiator
2009 & still in race
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40. A 57-year-old man comes to the physician because of intermittent urinary incontinence over the past 6 months. He has loss of small amounts of urine when he coughs or sneezes. He has not had pain or blood with urination. He has a 15-year history of type 2 diabetes mellitus with peripheral neuropathy, retinopathy, and gastroparesis. Current medications include metoclopramide and glyburide. He appears well. Rectal examination shows a normal-sized prostate. Neurologic examination shows decreased sensation in a stocking-glove distribution. Achilles tendon reflexes are absent bilaterally. Test of the stool for occult blood is negative. Urinalysis shows 2+ protein with no leukocytes or erythrocytes. His postvoid residual volume is 500 mL. Which of the following is the most likely mechanism of this patient's incontinence?
A
) Central nervous system disorder
B
) Functional incontinence
C
) Intrinsic sphincter deficiency
D
) Overflow incontinence from acontractile bladder
E
) Overflow incontinence from bladder outlet obstruction
F
) Pelvic floor muscle weakness
G
) Retroperitoneal fibrosis
H
) Retroperitoneal lymphadenopathy
I
) Urinary tract infection
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| liliaeliz
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