09-12-2007, 01:31 PM
35. 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
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