{"id":3222,"date":"2021-09-15T14:59:00","date_gmt":"2021-09-15T14:59:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3222"},"modified":"2025-10-01T11:42:39","modified_gmt":"2025-10-01T19:42:39","slug":"usmle-step-2-ck-question-of-the-day-urgency-incontinence","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-urgency-incontinence","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day: Urgency Incontinence"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-urgency-incontinence\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-urgency-incontinence\/#B_Prescription_of_an_acetylcholine-receptor_antagonist\" >B. Prescription of an acetylcholine-receptor antagonist<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-urgency-incontinence\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-urgency-incontinence\/#A_Prescription_of_an_alpha-receptor_antagonist\" >A. Prescription of an alpha-receptor antagonist<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-urgency-incontinence\/#C_Placement_of_a_vaginal_pessary\" >C. Placement of a vaginal pessary<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-urgency-incontinence\/#D_Initiation_of_intermittent_bladder_catheterization\" >D. Initiation of intermittent bladder catheterization<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-urgency-incontinence\/#E_Referral_for_surgical_repair_of_a_urogenital_tract_fistula\" >E. Referral for surgical repair of a urogenital tract fistula<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-urgency-incontinence\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-urgency-incontinence\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-urgency-incontinence\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>We&#8217;re back with a USMLE\u00ae Step 2 CK Question of the Day!&nbsp;<strong><em>Today&#8217;s case involves a 31-year-old woman with urinary incontinence. Which of the following interventions is used in treating this patient\u2019s condition?<\/em><\/strong><\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 31-year-old woman has come to an outpatient clinic for urinary incontinence over the past week. Since the symptoms began, she reports urinating on herself before having time to reach the bathroom. Past medical history is notable for an episode of transient acute vision loss in her left eye and an episode of left-arm weakness that self-resolved after two weeks. She works as a news reporter and drinks 3-4 cups of coffee per day to stay awake. The patient\u2019s temperature is 37.6\u00b0C (99.7\u00b0F), blood pressure is 115\/79 mmHg, pulse is 67\/min, and respirations are 16\/min. Which of the following interventions is used in treating this patient\u2019s condition?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Prescription of an alpha-receptor antagonist<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Prescription of an acetylcholine-receptor antagonist<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Placement of a vaginal pessary<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Initiation of intermittent bladder catheterization<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Referral for surgical repair of a urogenital tract fistula<\/strong>Scroll down for the correct answer!<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-rich is-provider-embed-handler wp-block-embed-embed-handler wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Osmosis.org at the National University of Rosario in Argentina\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/Be_i7OI168g?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Prescription_of_an_acetylcholine-receptor_antagonist\"><\/span>B. Prescription of an acetylcholine-receptor antagonist<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the\u00a0<strong>Main Explanation<\/strong>, let&#8217;s see why the answer wasn&#8217;t A, C, D, or E. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Today&#8217;s incorrect answers are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Prescription_of_an_alpha-receptor_antagonist\"><\/span>A. Prescription of an alpha-receptor antagonist<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Alpha-antagonists, such as&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Adrenergic_antagonists:_Alpha_blockers\" target=\"_blank\" rel=\"noreferrer noopener\">prazosin or tamsulosin<\/a>, are used in the treatment of overflow incontinence. The condition can be caused by an underactive detrusor muscle and results in urinary retention.&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Multiple_sclerosis\" target=\"_blank\" rel=\"noreferrer noopener\">Multiple sclerosis<\/a>&nbsp;(MS), which may present with transient visual deficits, episodes of urinary incontinence, and focal weakness\/numbness, is a cause of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Urinary_incontinence\" target=\"_blank\" rel=\"noreferrer noopener\">overflow incontinence<\/a>. However, patients with this condition typically present with urinary dribbling that occurs as the bladder starts overflowing.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Placement_of_a_vaginal_pessary\"><\/span>C. Placement of a vaginal pessary<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> <a href=\"https:\/\/www.osmosis.org\/learn\/Urinary_incontinence:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\">Pessaries<\/a>\u00a0are used in the treatment of stress incontinence. The condition presents with loss of urine when intra-abdominal pressure is increased. This patient has none of these symptoms. In contrast, this patient\u2019s history of having sudden urges to urinate and not being able to reach the bathroom in time is more consistent with the presentation of urge incontinence. Pessaries are not effective in treating urge incontinence.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Initiation_of_intermittent_bladder_catheterization\"><\/span>D. Initiation of intermittent bladder catheterization<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Intermittent self-catheterization can be used in patients with overflow incontinence to prevent urinary stasis and infection. However, this patient\u2019s symptoms of sudden urges to void and involuntary loss of urine are most consistent with those of urge incontinence. Patients with urge incontinence are not at increased risk for urinary stasis, and self-catheterization is unnecessary.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Referral_for_surgical_repair_of_a_urogenital_tract_fistula\"><\/span>E. Referral for surgical repair of a urogenital tract fistula<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;A vesicovaginal fistula is an abnormal passageway between the bladder and vagina. As a result, urine from the bladder can pass through the fistula. Surgery is used to treat this condition. Risk factors for developing a vesicovaginal fistula include pelvic radiation and pelvic surgery. The patient in this vignette has none of the aforementioned risk factors, and a vesicovaginal fistula would not explain her previous neurologic symptoms.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient has&nbsp;<strong>urge incontinence<\/strong>, which presents as a&nbsp;<strong>sudden urge to urinate<\/strong>, resulting in involuntary expulsion of urine. Many cases are idiopathic. However, some medical conditions may cause urge incontinence. They can be divided into neurologic conditions (e.g., neuropathy, multiple sclerosis) and non-neurologic conditions (e.g.,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Urinary_tract_infections:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">urinary tract infections<\/a>, bladder stones). The patient in this vignette has a history of transient vision loss and extremity weakness, which suggests that a multiple sclerosis flare-up is the most likely cause of her recent incontinence.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Urge incontinence can be diagnosed based on the history &amp; physical exam. Additional testing, such as urinalysis or bladder ultrasound, can be ordered to identify the underlying cause of the patient\u2019s presentation. Urodynamic studies are not required to make the diagnosis, but if ordered, will show&nbsp;<strong>detrusor hyperactivity<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span style=\"margin: 0px;padding: 0px\">First-line treatment consists of<strong>\u00a0lifestyle modifications,\u00a0<\/strong>including caffeine restriction, Kegel exercises, and bladder training (e.g., developing a timetable that specifies when to urinate).<\/span> In terms of medications,\u00a0<strong>anticholinergic agents<\/strong>, such as\u00a0<a href=\"https:\/\/www.osmosis.org\/learn\/Muscarinic_antagonists\" target=\"_blank\" rel=\"noreferrer noopener\">oxybutynin<\/a>\u00a0and tolterodine, are most commonly used to treat urge incontinence. In cases where non-invasive management has failed, surgical intervention such as sacral nerve stimulation or botulinum toxin injection into the bladder wall can be used to reduce detrusor activity.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Urinary system: Urinary incontinence\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/xpriwfF5bX0?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span><strong>Major Takeaway<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Patients with\u00a0<strong>urge incontinence<\/strong>\u00a0present with<strong>\u00a0sudden urges to urinate\u00a0<\/strong>that result in involuntary expulsion of urine. Most cases are idiopathic, but some cases are secondary to other medical conditions (e.g.,\u00a0<a href=\"https:\/\/www.osmosis.org\/learn\/Multiple_sclerosis\" target=\"_blank\" rel=\"noreferrer noopener\">multiple sclerosis<\/a>, UTI). Treatment includes addressing any underlying causes,\u00a0<strong>lifestyle modifications<\/strong>, and\u00a0<strong>anticholinergic medications<\/strong>. In refractory cases, surgery may be indicated.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span><strong>References<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Callahan, T.L., Caughey, A.B. (2013)&nbsp;<em>Blueprints Obstetrics &amp; Gynecology<\/em>. Lippincott Williams &amp; Wilkins. ISBN: 978-1451117028.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Lin, S.D., Butler, J.E., Boswell-Ruys, C.L., Hoang, P., Jarvis, T., Gandevia, S.C., McCaughey, E.J. (2019) The frequency of bowel and bladder problems in multiple sclerosis and its relation to fatigue: A single centre experience. PLoS One. 14(9), e0222731. Doi:&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/31536557\/\" target=\"_blank\" rel=\"noreferrer noopener\">10.1371\/journal.pone.0222731<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><br><strong>Want more &nbsp;USMLE\u00ae Step 2 CK practice questions?&nbsp;Try Osmosis today! Access your&nbsp;<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>&nbsp;and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_ec36e9.png\" alt=\"Osmosis ad to watch clinical practice videos\" class=\"wp-image-3225\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_ec36e9.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_ec36e9.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>We&#8217;re back with a USMLE\u00ae Step 2 CK Question of the Day!&nbsp;Today&#8217;s case involves a 31-year-old woman with urinary incontinence. Which of the following interventions is used in treating this patient\u2019s condition? A 31-year-old woman has come to an outpatient clinic for urinary incontinence over the past week. Since the symptoms began, she reports urinating [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3224,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,45],"tags":[],"class_list":["post-3222","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-step-2"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 2 CK Question of the Day: Urgency Incontinence - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-urgency-incontinence\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 2 CK Question of the Day: Urgency Incontinence - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"We&#8217;re back with a USMLE\u00ae Step 2 CK Question of the Day!&nbsp;Today&#8217;s case involves a 31-year-old woman with urinary incontinence. Which of the following interventions is used in treating this patient\u2019s condition? A 31-year-old woman has come to an outpatient clinic for urinary incontinence over the past week. 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