Internal Medicine Question (6) for USMLE, MCCEE, PLAB, FCPS, PDMC,MRCP………

A 68-year-old woman presents to her physician with a complaint of urinary incontinence. She is a nursing home resident and her staff tells you that the patient feels desire to void but she cannot hold it to the restroom. She has no pain, dysuria or hematuria. She has a long history of hypertension and she takes metoprolol and hydrochlorothiazide.

Which of the following is the most appropriate first step of management?

A-Discontinue metoprolol

B-Discontinue hydrochlorothiazide

C-Try timed voiding

D-Prescribe tolterodine therapy

E-Refer to a urologist


This is a classic case of overactive bladder with urgency incontinence. Timed voiding, which means to encourage the patient to use the restroom every 2 hours or so, should be recommended to avoid urgent voiding. There is no evidence that discontinuation of metoprolol or hydrochlorothiazide will improve this condition. Tolterodine is effective in cases of overactive bladder but non-pharmacologic treatment should be applied first. This is a case of primary care physician but if the treatment failed or complications occur then, she should be referred to a urologist.

The correct answer is C

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