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☕️ Which of the following is the most appropriate next step in management?
☕️ Morning Quiz 111
Dr. Shoaib Ahmad Baig
March 18, 2025
Morning Quiz ☕️
A 7-year-old boy presents with:
1-month history of urinary incontinence both day and night time
And Occasional hard, painful stools
No dysuria, fever, or changes in appetite.
No new stressors at home or school.
Physical Exam: Normal.
Urinalysis: Normal.
Growth: 25th percentile for height/weight, 35th percentile for BMI
Which of the following is the most appropriate next step in management?
A) Administration of an osmotic laxative
B) Desmopressin therapy
C) Recommendation for use of a bed-wetting alarm
D) Renal ultrasonography
E) Reassurance that this is normal behavior
Correct Answer 🎯: A) Administration of osmotic laxative
⚙️
Inadequate fluid intake or dietary fiber
⬇
Hard, Painful Stools (Constipation) 🪨
⬇
Rectal Distension 🎈 (Like a balloon filling up)
⬇
Compression of the Bladder 🎈(Balloon pressing on another balloon)
⬇
↓ Bladder Capacity 🚽 (Smaller container for urine)
Frequent small-volume voiding or inability to hold urine (like a leaky faucet 🚰).
⬇
Urinary Incontinence (Daytime Enuresis) 💧
⬇
Overflow Incontinence
⬇
Nocturnal Enuresis (Bed-Wetting) 🌙💧 (Overflowing at night)
⚙ Mechanism: Osmotic laxatives (e.g., polyethylene glycol) soften stools by drawing water into the intestines (like adding water to dry cement 🧱💧).
Effect
Relieves constipation 🪨⬇
⬇
Reduces rectal distension 🎈⬇
⬇
Decompresses the bladder 🎈⬆
⬇
Restores bladder capacity 🚽⬆
⬇
Resolves urinary incontinence and enuresis 💧⬇
Differential Table ⚖️
Differential ⚖️ | Mechanism ⚙️ | Why Incorrect? 🔴 |
|---|---|---|
B) Desmopressin Therapy | Targets ↓ nocturnal ADH secretion 🌙⬇ → ↑ Urine production 💧⬆ → Bed-wetting 🌙💧 | 🔍 Patient’s enuresis is secondary to constipation, not ADH-related. |
C) Bed-Wetting Alarm | Used for primary enuresis due to poor arousal response 🛌💧 | 🔍 Patient’s enuresis is secondary to constipation, not arousal-related. |
D) Renal Ultrasonography | Rules out structural abnormalities (e.g., hydronephrosis, stones) 🏚 | 🔍 No signs of structural issues (normal urinalysis, no pain with urination). |
E) Reassurance | Assumes symptoms are normal behavior 🧠 | 🔍 Symptoms are pathological (constipation-induced bladder compression). |
Practice Questions ⏳️
Most Importantly Solve UWorld Questions with IDs:
10962, 11820, 11464, 11038
Stay Hungry, Stay Curious!
Your Brother in This Struggle
Dr. Shoaib Ahmad
