Rosh Emergency Medicine Practice Test

What would indicate a patient with urinary incontinence requires prompt intervention?

1. Normal bowel movements

2. Severe back pain

3. Decreased sensation in the lower extremities

4. Urgency to urinate

The correct answer is: Severe back pain

Prompt intervention is particularly crucial when there are severe back pain symptoms, as this can signal potential serious underlying conditions such as spinal cord compression or cauda equina syndrome. In such scenarios, the risk of permanent neurological damage increases if intervention is delayed. Severe back pain associated with urinary incontinence may suggest a neurologic compromise that requires immediate evaluation and management. The other signs, while they might indicate a need for further evaluation, generally do not present the same level of immediate risk as severe back pain would. Normal bowel movements and urgency to urinate do not typically warrant urgent intervention, as they can occur in many benign situations. Decreased sensation in the lower extremities can indicate a neurological issue, but if it is not accompanied by other concerning symptoms such as back pain, it may not require the same prompt response. Therefore, severe back pain in a patient with urinary incontinence serves as a critical indicator for needing immediate action.