USMLE Forum Archives - USMLE Step 3 - bph
bph
bingousmle - 07-13-10 01:39
A 76-year-old man comes to the clinic because of "urine problems". He tells you that he has "trouble with his urinary stream," that over the past month it has been progressively decreasing in force. He also has the urgency to urinate and he finds himself running to the bathroom, but can only pass a small amount of urine. The trips to the bathroom have increased in frequency over the past couple of days and he has started to leak urine. The leakage is only in small amounts, but can occur at any time. His abdominal examination reveals a smooth, round suprapubic mass. Percussion of this mass is dull and causes the patient to leak urine per urethra. Penile examination is normal. Rectal examination reveals good sphincter tone with a moderately enlarged, smooth prostate (also unchanged from prior exams). Urine dipstick in the office is negative for glucose, RBC, WBC, and nitrites. You explain to the patient that the most likely primary cause of his incontinence is
A. abnormal bladder sensation
B. obstructing prostate
C. uninhibited bladder contractions
D. vesicocutaneous fistula
E. weakened pelvic floor muscles
bingousmle - 07-13-10 01:39
A 76-year-old man comes to the clinic because of "urine problems". He tells you that he has "trouble with his urinary stream," that over the past month it has been progressively decreasing in force. He also has the urgency to urinate and he finds himself running to the bathroom, but can only pass a small amount of urine. The trips to the bathroom have increased in frequency over the past couple of days and he has started to leak urine. The leakage is only in small amounts, but can occur at any time. His abdominal examination reveals a smooth, round suprapubic mass. Percussion of this mass is dull and causes the patient to leak urine per urethra. Penile examination is normal. Rectal examination reveals good sphincter tone with a moderately enlarged, smooth prostate (also unchanged from prior exams). Urine dipstick in the office is negative for glucose, RBC, WBC, and nitrites. You explain to the patient that the most likely primary cause of his incontinence is
A. abnormal bladder sensation
B. obstructing prostate
C. uninhibited bladder contractions
D. vesicocutaneous fistula
E. weakened pelvic floor muscles
The correct answer and explanation will be available after you answer.
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#1
Re: bph babbu5508 - 07-13-10 09:43 My answer is: b.
When sufficiently large, the nodules compress the urethral canal to cause partial, or sometimes virtually complete, obstruction of the urethra, which interferes the normal flow of urine. It leads to symptoms of urinary hesitancy, frequent urination, dysuria , increased risk of urinary tract infections, and urinary retention.
#2
Re: bph
bingousmle - 07-14-10 03:31 My answer is: b.
the suprapubic mass here actually is nothing but the distended bladder which cannotempty due to the enlarged prostate
#9
Re: bph mansour - 10-10-10 12:23 My answer is: b.
Urine stream which is decreasing in force.
Moderately enlarged, smooth prostate.
Leaking urine, as a result of over distended bladder due to obstructive prostate (overflow incontinence)
Good rectal sphincter tone, which rules out weakened pelvic floor muscles.
Vesicocutaneous fistula will cause the urine to leak from opening in the skin and won't cause overdistended bladder.
Uninhibited bladder contractions and abnormal bladder sensation will cause urine leakage, but won't affect urinary stream and the fact that the prostate is enlarged points out more to obstruction due to prostate enlargement
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