A 4-Year-Old Boy Is Brought to the Office Due to Bedwetting

question 56

Multiple Choice

A 4-year-old boy is brought to the office due to bedwetting.  Toilet-training was initiated at age 2 when he learned the words "pee" and "poop."  His parents are concerned that the boy still urinates in his bed at least 1 night a week despite avoiding fluid intake 2 hours prior to bedtime.  The patient's older sisters were toilet-trained during the day and night by age 3.  He has a soft bowel movement in the toilet every day.  The boy is active and plays outside for at least an hour a day.  He has no medical problems and takes no medications.  Physical examination shows a well-nourished, talkative boy.  There is no sacral dimple or hair tuft.  Testes are descended bilaterally, and the urethral meatus is at the tip of the glans.  He can hop on each foot for a few seconds.  He identifies the colors of "pee" and "poop" as yellow and brown, respectively.  What is the best next step in management of this patient?

• A)Initiate enuresis alarm therapy
• B)Obtain urinalysis
• C)Order bladder ultrasound
• D)Prescribe desmopressin
• E)Provide reassurance
• F)Recommend family therapy
• G)Restrict play time until bedwetting resolves

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Definitions:

Manufacturing Overhead

Includes all the indirect costs associated with the production process, excluding direct materials and direct labor.

Assembly Division

A department or area within a manufacturing firm that is responsible for assembling the components of a product into a finished good.

Prorated

The allocation or division of amounts or costs proportionally according to a specific rate, size, or timeframe.

WIP

An acronym for Work In Progress, which refers to the materials and products that are in the process of being manufactured but are not yet complete.