For Student

A 70-year-old woman with a history of congestive heart failure and diabetes mellitus is seen in
your clinic because of frequent episodes of incontinence. She says that these episodes happen
without warning, usually in the context of coughing or sneezing.

Tasks:
1. What is the possible mechanism of patient’s incontinence
2. Which of these interventions is most likely to help with her incontinence?
Student’s name
For examiner
Task 1 (5.0) Task 2 (5.0) This patient has stress incontinence, which has been shown to be more
responsive to behavioral interventions, like pelvic muscle exercises, than drug treatments such as
topical estrogen. Estrogen, in fact, has shown little efficacy in clinical trials. Tolterodine is helpful
in urge, not stress incontinence. Alpha blockers such as tamsulosin have a very limited role in
women. Augmentation cystoplasty is a surgical treatment for patients with diminished bladder
capacity.

Final score: