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NBME 22 Answers

nbme22/Block 2/Question#8

A 73-year-old man has difficulty urinating and ...

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 +4  upvote downvote
submitted by pppro(14),

Patient has BPH. Give alpha one antagonist to reduce smooth muscle contraction and relieve difficulty urinating.

d_holles  lol i thought it was some kind of urinary retention problem and put H. +8  
sbryant6  How is H wrong? Oxybutinin or tolterodine treat urinary incontinence by blocking M3 muscarinic acetylcholine receptors --> urinary retention. We're just supposed to assume they are talking about BPH here because he is old? +  
jaxx  I agree. I picked "H" for that same logic. Does anyone know where we should have come to the conclusion that this was BPH? +  
forerofore  they are telling you he's having "difficulty urinating", one of the clinical criteria for BPH is reduced urinary flow rate. this is not incontinence because they are not telling you he leaks at all, just that he pees "a lot" +6  
drzed  Even if he was urinating too much, anticholinergics are contraindicated in the elderly (Beers criteria) +2  
pathogen7  @drzed tI mean techinically alpha-1 blockers are on the Criteria too ... +1  

 +4  upvote downvote
submitted by seagull(714),

So alpha was the answer so my fatigued mind put "A"...well done. You're going to be a doctor. lol

impostersyndromel1000  hope you dont have to write a prescription for me one day lol +  

 +1  upvote downvote
submitted by mamabara(1),

I believe the drug they are talking about here is tamulosin, which is an a1-antagonist

 +1  upvote downvote
submitted by enbeemee(9),

would an acetylcholinesterase inhibitor work as well to relieve the symptoms? but just because he's 73yo, we're supposed to assume it's due to BPH and give an a1 inhibitor?

yb_26  acetylcholinesterase inhibitors are used in treatment of urinary retention, not urinary frequency +3