Urinary incontinence Quiz: Ace Your Exams

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A 55 year-old female comes to her outpatient physician because of urinary incontinence. The patient reports a sense of fullness in the bladder and continuous dribbling of urine over the past two months. Past medical history is notable for type 2 diabetes mellitus and hypertension. However, the patient reports being inconsistent in taking her medications. Her temperature is 37.1°C (98.8°F), blood pressure is 158/91 mmHg, and pulse is 75/min. Physical exam reveals decreased sensation to soft touch and pinprick in the distal arms and legs. Laboratory results are as follows:

Laboratory value Result
Glucose 167 mg/dL
HbA1c 8.1%
Postvoid residual volume 170 ml

Which of the following best describes the pathophysiology of this patient’s symptoms?

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Impaired parasympathetic innervation of the bladder

Impaired sympathetic innervation of the bladder

Abnormal connection between the bladder and vagina

Pelvic floor musculature weakness causing hypermobile urethra

Peripheral vascular disease causing reduced blood supply to the urethra

Laboratory value	Result
Glucose	167 mg/dL
HbA1c	8.1%
Postvoid residual volume	170 ml