Urinary bladder and urethra — MCQs

A 62-year-old man comes to the physician because of increased frequency of urination. He also says that he needs to urinate 4 to 5 times nightly and has difficulty initiating a urinary stream. He has had several episodes of acute cystitis treated with ciprofloxacin during the past year. Digital rectal examination shows a firm, symmetrically enlarged, non-tender prostate. This patient is most likely to develop which of the following complications?

A 72-year-old multiparous woman comes to the physician for the evaluation of episodes of involuntary urine leakage for the past 6 months. She loses small amounts of urine without warning after laughing or sneezing. She also sometimes forgets the names of her grandchildren and friends. She is retired and lives at an assisted-living facility. She has insulin-dependent diabetes mellitus type 2. Her mother received a ventriculoperitoneal shunt around her age. She walks without any problems. Sensation to pinprick and light touch is normal. Which of the following is the primary underlying etiology for this patient's urinary incontinence?

A 63-year-old woman visits her family physician because she has been experiencing difficulty to get her urine stream started in the past 8 months with many occasions needing extra effort to pass the urine. She describes the stream as intermittent and slow, and comments that she needs to go to the restroom again immediately after urinating. Her personal medical history is negative for malignancies, and all of her cytologies have been reported as normal. The only medication she takes is an angiotensin receptor blocker to treat essential hypertension diagnosed 5 years ago. Physical examination is unremarkable except for herniation of the anterior wall of the vagina that goes beyond the hymen. Which of the following types of incontinence is affecting the patient?

A 58-year-old obese male has noticed the gradual development of a soft bulge on his right groin that has been present over the past year and occasionally becomes very tender. He notices that it comes out when he coughs and strains during bowel movements. He is able to push the bulge back in without issue. After examination, you realize that he has an inguinal hernia and recommend open repair with mesh placement. After surgery, the patient returns to clinic and complains of numbness and tingling in the upper part of the scrotum and base of the penis. What nerve was most likely injured during the procedure?

A child is in the nursery one day after birth. A nurse notices a urine-like discharge being expressed through the umbilical stump. What two structures in the embryo are connected by the structure that failed to obliterate during the embryologic development of this child?

A 47-year-old man is brought to the emergency department 1 hour after injuring his genital area when he fell astride his backyard fence. He was trimming a tree from the fence when he lost his balance. His vital signs are within normal limits. Examination shows blood at the urethral meatus, perineal ecchymoses, and a scrotal hematoma. An x-ray of the pelvis shows swelling of the soft tissue but no other abnormalities. Which part of the urinary tract is most likely damaged in this patient?

A 40-year-old sailor is brought to a military treatment facility 20 minutes after being involved in a navy ship collision. He appears ill. He reports a sensation that he needs to urinate but is unable to void. His pulse is 140/min, respirations are 28/min, and blood pressure is 104/70 mm Hg. Pelvic examination shows ecchymoses over the scrotum and perineum. There is tenderness over the suprapubic region and blood at the urethral meatus. Digital rectal examination shows a high-riding prostate. Abdominal ultrasound shows a moderately distended bladder. X-rays of the pelvis show fractures of all four pubic rami. Which of the following is the most likely cause of this patient's symptoms?

A 28-year-old man is brought to the emergency department after being struck by a car an hour ago as he was crossing the street. He did not lose consciousness. He is complaining of pain in his right arm, forehead, and pelvis. He also has the urge to urinate, but has been unable to do so since the accident. He takes no medications. His temperature is 37.1°C (98.9°F), pulse is 72/min, respirations are 18/min, and blood pressure is 118/82 mm Hg. There are abrasions over his scalp and face and a 1x3 cm area of ecchymosis above his right eye. Abdominal examination shows suprapubic tenderness. There is a scant amount of blood at the urethral meatus. There is no cervical spinal tenderness. Musculoskeletal examination shows tenderness and ecchymosis over his right distal forearm. An x-ray of the pelvis shows a fracture of the pelvic ramus. A CT scan of the head and neck show no abnormalities. Which of the following is the best next step in the management of this patient?

A 32-year-old woman comes to the physician because of a 2-week history of involuntary loss of urine. She loses small amounts of urine in the absence of an urge to urinate and for no apparent reason. She also reports that she has an intermittent urinary stream. Two years ago, she was diagnosed with multiple sclerosis. Current medications include glatiramer acetate and a multivitamin. She works as a librarian. She has 2 children who attend middle school. Vital signs are within normal limits. The abdomen is soft and nontender. Pelvic examination shows no abnormalities. Neurologic examination shows a slight hypesthesia in the lower left arm and absent abdominal reflex, but otherwise no abnormalities. Her post-void residual urine volume is 131 mL. Bladder size is normal. Which of the following is the most likely cause of the patient's urinary incontinence?

A 19-year-old man is brought to the emergency department following a high-speed motor vehicle collision in which he was a restrained passenger. He complains of pelvic pain and urinary retention with overflow incontinence, along with associated lower extremity weakness. Examination shows perineal bruising and there is pain with manual compression of the pelvis. Injury to which of the following structures is most likely responsible for this patient's urinary incontinence?