06-26-2009, 06:05 PM
The response options for the next two items are the same. You will be required to select one answer
for each item in the set.
For each patient with urinary incontinence, select the most likely cause.
A ) Detrusor instability
B ) Interstitial cystitis
C ) Overflow incontinence
D ) Stress incontinence
E ) Urethra diverticulum
F ) Urinary fistula
7. A previously healthy 44-year-old woman, gravida 4, para 4, comes to the physician because of a
9-month history of progressive loss of small amounts of urine while running; she now has to wear
an absorbent pad. Examination shows a second-degree cystourethrocele.
For each patient with urinary incontinence, select the most likely cause.
A ) Detrusor instability
B ) Interstitial cystitis
C ) Overflow incontinence
D ) Stress incontinence
E ) Urethra diverticulum
F ) Urinary fistula
8. One day after an uncomplicated spontaneous vaginal delivery, a 23-year-old woman, gravida 1,
para 1, has the onset of loss of small amounts of urine. She received epidural anesthesia during
labor and delivery. Examination shows an episiotomy without evidence of hematoma. She is voiding 50 to 75 mL of urine at a time. Postvoid residual volume is 300 mL.
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
17. A 72-year-old woman comes to the physician because of increasing episodes of urinary incontinence over the past 6 months. Her incontinence usually occurs at night, she feels no sensation to urinate prior to the episodes. The episodes are less frequent if she schedules her trips to the bathroom and restricts liquid intake several hours prior to bedtime. She has a 20-year history of type 2 diabetes mellitus. Current medications include metformin and glyburide. Funduscopic examination shows mild retinopathy. Pelvic examination shows normal vaginal mucosa. Sensation to pinprick is decreased in a stocking-glove distribution. Urinalysis shows 1 + protein and no leukocyte esterase or nitrites. Which of the following is the most likely cause of this patient's urinary symptoms?
O A) Functional incontinence
O B) Hypersensitivity of the detrusor muscle
O C) Overflow of urine from large residual volumes
O D) Urethral atrophywith loss of urethrovesical angle
O E) Normal aging
A 72 yo man is brought to the physician by his wife because of a 6 month hx of difficulty walking, cognitive decline, and urinary incontinence. He has had dysuria or nocturia. His wife says that his short-term memory is decreased and he has had intermittent confusion. On exam, 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 min. WHich of the following is the most likely explanation for the patient's urinary incontinence?
A. Bladder neck dyssynergia
B. Chronic bladder inflammation
C. Detrusor-sphincter dyssynergia
D. Failure of bladder neck closure
E. Failure to inhibit the voiding reflex.
A 63-year-old man is evaluated for urinary incontinence characterized by leaking, dribbling urine, occurring throughout the day and requiring him to wear pads. His symptoms of incontinence began after he underwent radical prostatectomy 3 years ago for prostate cancer, and they have persisted since then. Treatment with tolterodine has not been helpful. He works as a businessman and travels frequently and states that his symptoms are beginning to interfere with performance of his daily activities. His medical history also includes depression, for which takes sertraline.
On physical examination, there are no palpable prostatic or rectal masses. The remainder of the physical examination is normal. The serum prostate-specific antigen level is undetectable.
Which of the following is the most appropriate next step in treatment?
A Discontinue sertraline
B Begin oxybutynin
C Institute behavioral therapy
D Perform bulbourethral sling procedure
NBME form3 block3, question: 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 carring 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 take no medications. Pelvic examination shows an atrophic cervix without a palpable uterus or an adnexal mass. CBC and urinalysis are no abnormalities.
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
for each item in the set.
For each patient with urinary incontinence, select the most likely cause.
A ) Detrusor instability
B ) Interstitial cystitis
C ) Overflow incontinence
D ) Stress incontinence
E ) Urethra diverticulum
F ) Urinary fistula
7. A previously healthy 44-year-old woman, gravida 4, para 4, comes to the physician because of a
9-month history of progressive loss of small amounts of urine while running; she now has to wear
an absorbent pad. Examination shows a second-degree cystourethrocele.
For each patient with urinary incontinence, select the most likely cause.
A ) Detrusor instability
B ) Interstitial cystitis
C ) Overflow incontinence
D ) Stress incontinence
E ) Urethra diverticulum
F ) Urinary fistula
8. One day after an uncomplicated spontaneous vaginal delivery, a 23-year-old woman, gravida 1,
para 1, has the onset of loss of small amounts of urine. She received epidural anesthesia during
labor and delivery. Examination shows an episiotomy without evidence of hematoma. She is voiding 50 to 75 mL of urine at a time. Postvoid residual volume is 300 mL.
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
17. A 72-year-old woman comes to the physician because of increasing episodes of urinary incontinence over the past 6 months. Her incontinence usually occurs at night, she feels no sensation to urinate prior to the episodes. The episodes are less frequent if she schedules her trips to the bathroom and restricts liquid intake several hours prior to bedtime. She has a 20-year history of type 2 diabetes mellitus. Current medications include metformin and glyburide. Funduscopic examination shows mild retinopathy. Pelvic examination shows normal vaginal mucosa. Sensation to pinprick is decreased in a stocking-glove distribution. Urinalysis shows 1 + protein and no leukocyte esterase or nitrites. Which of the following is the most likely cause of this patient's urinary symptoms?
O A) Functional incontinence
O B) Hypersensitivity of the detrusor muscle
O C) Overflow of urine from large residual volumes
O D) Urethral atrophywith loss of urethrovesical angle
O E) Normal aging
A 72 yo man is brought to the physician by his wife because of a 6 month hx of difficulty walking, cognitive decline, and urinary incontinence. He has had dysuria or nocturia. His wife says that his short-term memory is decreased and he has had intermittent confusion. On exam, 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 min. WHich of the following is the most likely explanation for the patient's urinary incontinence?
A. Bladder neck dyssynergia
B. Chronic bladder inflammation
C. Detrusor-sphincter dyssynergia
D. Failure of bladder neck closure
E. Failure to inhibit the voiding reflex.
A 63-year-old man is evaluated for urinary incontinence characterized by leaking, dribbling urine, occurring throughout the day and requiring him to wear pads. His symptoms of incontinence began after he underwent radical prostatectomy 3 years ago for prostate cancer, and they have persisted since then. Treatment with tolterodine has not been helpful. He works as a businessman and travels frequently and states that his symptoms are beginning to interfere with performance of his daily activities. His medical history also includes depression, for which takes sertraline.
On physical examination, there are no palpable prostatic or rectal masses. The remainder of the physical examination is normal. The serum prostate-specific antigen level is undetectable.
Which of the following is the most appropriate next step in treatment?
A Discontinue sertraline
B Begin oxybutynin
C Institute behavioral therapy
D Perform bulbourethral sling procedure
NBME form3 block3, question: 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 carring 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 take no medications. Pelvic examination shows an atrophic cervix without a palpable uterus or an adnexal mass. CBC and urinalysis are no abnormalities.
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