NBME 12 BLOCK 2 Q 32- ???Neurogenic bladder or BPH - agboolalai

[ArchivalUser]

The patient's history shows that past medical history is UNREMARKABLE, prostate is moderately and symmetrically enlarged WITHOUT NODULES. Symptoms only started 12hours ago....
Could this be a neurogenic bladder- inability to void urine?

[ArchivalUser]

anyone?

[ArchivalUser]

it is neurogenic bladder cos it is rapid onset, bph would be more insidious in its onset. wish u added the patient's age.

[ArchivalUser]

Hi! I took NBME last weekend. I marked neurogenic bladder but they consider it wrong in the feedback.
Some have the correct answer?

[ArchivalUser]

the patient's age is 75yrs, other options there are BPH, bladder cancer, urolithiasis and RCC.
Someone also claimed to make urolithiasis and got it wrong, I also feel it is neurogenic bladder but crazy4step1 just said it is wrong. pls any suggestion?
Thanks.

[ArchivalUser]

32. A previously healthy 75-year-old man is brought to the emergency department by his wife because of a 12-hour history of confusion. Medical history is otherwise
unremarKable. He is stuporous. Physical examination shows a mar1c.edly distended bladder up to the umbilicus. The prostate gland is moderately and symmetrically
enlarged without nodules. Laboratory evaluation shows a serum creatinine concentration of 10.5 mgfdL and a serum urea nitrogen (BUN) concentration of 130 mgfdL.
Urinalysis shows no abnormalities. Which of the fo llowing is the most likely diagnosis?
o A) Benign prostatic hyperplasia
o B) Bladder malignancy
o C) Neurogenic bladder
o 0) Renal cell carcinoma
o E) Urolith iasis

BPH???

[ArchivalUser]

I took the exam online ...... It is BPH

[ArchivalUser]

is it possible that the BPH has created a vesical globe, which got infected, and created a septic choc? explaining the confusion and the renal insufficiency?

[ArchivalUser]

thanks Sopras I guess in questions like this, it is better to choose the commonest cause of a presentation which in this case is BPH.

[ArchivalUser]

electrolyte imbalance or increased BUN can cause confusion.

Uremia:
Fatigue[3]
Peripheral neuropathy[3]
Decreased mental acuity[3]
Seizures[3]
Anorexia[3]
Nausea[3]
Decreased taste and smell[3]
Cramps[3]
Restless legs,[3] potentially due to decreased muscle membrane potential[3]
Sleep disturbance[3]
Coma[3]