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Block 4 NBME 4 BLOCK 1-4
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BLOCK 2

Missing Q 1
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This is another stupid judgment call, but fragile X
is unlikely in that child (III, 1) because the
defective gene came from the woman's side
(she's a carrier) not from her husband
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– “Stress Incontinence (Outlet Incompetence).—Urinary stress incontinence, also known as outlet incompetence, is common in
women. Patients describe losses of small volumes of urine with activities that transiently increase the intra-abdominal pressure
(such as coughing, sneezing, running, or laughing). Loss of urine can result from a reduced tone of the internal and the external
urinary sphincter. Although this type of incontinence can occur in men, it is usually limited to those who have had internal
sphincter damage from urologic procedures.
In women, the cause of urinary stress incontinence is usually pelvic relaxation as a result of childbirth and the aging process.
These changes become more pronounced after menopause, when estrogen deficiency allows atrophy of the genitourinary
tissues. Pelvic relaxation, including uterine prolapse and cystocele, allows descent of the normal urethrovesical angle (Fig. 2).
This anatomic distortion allows the urethral sphincter to be more vulnerable to increased intravesical pressure from any activity
that results in increased intra-abdominal pressure. Loss of urine then results.”
(
http://64.233.167.104/search?q=cache:j-naF4dfq10J:www.mayoclinicproceedings.com/inside.asp%3FAID%3D3473%26UID%3D+
%22outlet+incompetence%22+urine&hl=en&ct=clnk&cd=6&gl=us
)
“Cough-induced detrusor overactivity may be confused with stress urinary incontinence when the diagnosis is based on the
symptoms alone. One important differentiating factor is that, with detrusor overactivity, large volumes of urine are passed on
coughing, compared to a relatively small volume leaked with stress urinary incontinence.”
(http://www3.interscience.wiley.com/cgi-bin/fulltext/112695304/PDFSTART)