A 73-Year-Old Woman Comes to the Clinic Complaining of Acute

question 52

Multiple Choice

A 73-year-old woman comes to the clinic complaining of acute onset of urinary incontinence after recent hospitalization for total knee replacement.  Over the last 3 days, she has had 5-10 episodes of spontaneous urinary leakage daily.  She also has had small, loose bowel movements.  The patient has no urgency, increased frequency, dysuria, hematuria, or involuntary leakage associated with coughing, sneezing, or laughing.  There is no recent history of fever or chills.
Her other medical problems include hypertension, well-controlled type 2 diabetes mellitus with HbA1c of 6.9%, and chronic constipation.  Her medications include metformin, glipizide, lisinopril, amlodipine, docusate, and oxycodone.  She has not changed her diet or increased her caffeine intake.  Her stable routine includes 1or 2 alcoholic beverages each night.  She has 4 children, all of whom were delivered vaginally.
Her vital signs are within normal limits.  The abdomen is distended and mildly tender to palpation in the lower quadrants.  Rectal examination shows hard stool in the rectal vault.  Pelvic examination shows no thinning or pallor of the vaginal mucosa and no evidence of vaginal wall prolapse.
Which of the following is the most appropriate next step in management of this patient?

• A)Ciprofloxacin
• B)Estrogen cream
• C)Oxybutynin
• D)Pelvic muscle exercises
• E)Polyethylene glycol

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Definitions:

Center-To-Center Spacing

The distance measured from the center of one feature (such as a hole or pin) to the center of another, critical for part alignment and assembly.

Intermittent Fillet Weld

A type of weld where continuous fillet welds are interrupted at regular intervals, used to join structural components while saving on material and reducing weight.

Supplementary Symbol

A symbol added to the basic nomenclature or notation in technical drawings, providing additional information about the feature or dimension it accompanies.

Basic Weld

A fundamental welding process where two metal pieces are joined together by melting their adjoining surfaces with or without using a filler material.