USMLE forum
 
USMLE Forum
Step 1
Step 2 CK
Step 2 CS
Matching & Residency
Step 3
Classifieds
 
Archives
 
 
  <<   < *  Step 2 CK   *  >   >>  

* NBME 4 clarification-- please help
 #442317  
  chris783 - 08/29/09 14:18
 
  I finished taking the NBME 4 with the feedback. Funnily enough, the questions I had mistakes revolved around a common theme: urinary incontinence. Please, kindly explain to me your thought process behind your answer.

1. 72-year-old man is brought to the physician by his wife because of a 6-month history of difficulty walking, cognitive decline, and urinary incontinence. He has not had dysuria or nocturia. His wife says that his short-term memory is decreased and he has intermittent confusion. On examination, 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 minutes. Which explains his urinary incontinence.

a. bladder neck dyssynergia
b. chronic bladder inflammation
c. detrusor-sphincter dyssynergia
d. failure of bladder closure
e. failure to inhibit the voiding reflex

82-year-old woman comes to the physician because of a 9-month history of progressive urinary incontinence. At least once daily, she has a strong urge to void, is unable to reach a bathroom in time, and spontaneously passes a large amount of urine. She had a mild cerebral infarction 2 years ago with no residual weakness. She has severe arthritis of her knees and hips, which severely limits her mobility. Current medications include lovastatin and aspirin. Examination, including pelvic examination, shows no abnormalities. Which of the following is the most likely explanation for this patient's incontinence?

a. detrusor hyperactivity
b. intrinsic weakness of urethral sphincter
c. outflow obstruction
d. poor pelvic support
e. upper motoneuron disease

14. 37-year-old woman comes to the physician because of a 4-month history of numbness, burning, and tingling of the toes and soles of her feet. She has a 3-year history of recurrent mouth sores. She takes no medications. Examination shows numerous oral aphthous ulcers, genital ulcers, and several 2.5-cm red lesions over the left anterior tibial region. She has photophobia. Ankes reflexes are absent. Proprioception and sensation to pinprick and vibration are decreased in a distal gradient patter over the lower extremities. Diagnosis?

a. Behcet syndrome
b. dermatomyositis
c. pemphigus vulgaris
d. polyarteritis nodosa
e. SLE
f. wegener granulomatosis
 
Report Abuse

 
 

* Re:NBME 4 clarification-- please help
#1858524
  targetresidency09 - 08/29/09 14:35
 
  1. for the 72 year old man..he is having NPH..so the tracts leading to urinary reflex are damaged.so i think answer should be E>failure to inhibit the voiding reflex
2.the 82 year old lady is having urge incontinence..."At least once daily, she has a strong urge to void, is unable to reach a bathroom in time, and spontaneously passes a large amount of urine."
choices only choice a) goes with the diagnosis of urge incontinence
3.behcets disease.clue is she is having genital and oral ulcers both.its a common disease in the middle east,i think kaplan q bank had a similar q
 
Report Abuse

* Re:NBME 4 clarification-- please help
#1858538
  chris783 - 08/29/09 14:47
 
  thank you so much, target! if you have any doubts about other questions on nbme 4, let me know if i can return the favor.  
Report Abuse

* Re:NBME 4 clarification-- please help
#1858542
  targetresidency09 - 08/29/09 14:49
 
  thats great!im doing the NBMEs now,so ill be posting the questions on here...please do reply if u have some time

thanx
 
Report Abuse

          Page 1 of 1          

[<<First]   [<Prev]  ... Message ...  [Next >]   [Last >>]

 
Logon to post a new Message/Reply
 
 
 
 

 

 

Google
  Web USMLEforum.com
 

Step 1 Step 2 CK Step 2 CS Matching & Residency Step 3 Classifieds
LoginUSMLE LinksHome