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NBME 22 Answers

nbme22/Block 2/Question#8 (33.7 difficulty score)
A 73-year-old man has difficulty urinating ...
Area labeled ā€˜Eā€™šŸ”

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submitted by seagull(1170),
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oS aalph asw the renaws so ym uedtfgai inmd ptu Al."w.el." o.dne Yoe'ur ogign ot be a rctdoo. lol

impostersyndromel1000  hope you dont have to write a prescription for me one day lol +3  

submitted by pppro(22),
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aetnitP sha .PBH iGve ahpla oen nntotigsaa ot edrcue sohtom lusmce iontractcon and eelervi iyfdtficul uninagt.ri

d_holles  lol i thought it was some kind of urinary retention problem and put H. +12  
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" +11  
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  

submitted by mamabara(1),

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

submitted by enbeemee(13),
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odlwu an yltsaatsereeclihcnoe boihintri wrko sa llew ot velriee eth mtssop?my tub ustj aeubsce s'eh 7,yo3 'reew puspesod ot mseuas is't edu ot PHB dan ievg na a1 nihibrio?t

yb_26  acetylcholinesterase inhibitors are used in treatment of urinary retention, not urinary frequency +10