NBME incontinence

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NBME incontinence

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7 Posts

DrAlex_76
Forum Guru

Topics: 120
Posts: 410

09/21/08 - 12:06 PM

. 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
HC03 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?
O A) Detrusor instability
O B) Hyperglycemia
O C) Neurogenic bladder
O D) Obstructive uropathy
O E) Urinary tract infection

DrAlex_76
Forum Guru

Topics: 120
Posts: 410

09/21/08 - 12:07 PM

is it Urge incontince ?

ngaybinhyen
Forum Guru

Topics: 23
Posts: 657

09/21/08 - 03:57 PM

I think it's A by exclusion

And here it is

"Future Directions

Defining the basic abnormalities that cause detrusor hyperactivity, including the role of sensory afferent innervation, is a crucial goal. New drugs and drug delivery systems to treat detrusor hyperactivity but minimize bothersome anticholinergic side effects will have a major impact on the treatment of urinary incontinence in the geriatric population."

Eagle_303
Forum Guru

Topics: 77
Posts: 655

09/21/08 - 04:15 PM

First most common cause in females = stress incontinence
Second most common cause in females = urge incontinence (detrursor instability )

It is utmost important to differentiate because

in No 1 Anticholinergic are contraindicated
in No 2 Anticholinergic are indicated

ngaybinhyen
Forum Guru

Topics: 23
Posts: 657

09/21/08 - 04:23 PM

Thanks, Eagle

Eagle_303
Forum Guru

Topics: 77
Posts: 655

09/21/08 - 04:29 PM

Welcome dear brother

nightflight1945
banned

Topics: 32
Posts: 920

09/21/08 - 04:48 PM

Agree , although I think the question is somehow defective in defining the patient's exact symptoms

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