[09.23.2023] Updated content, AnKing Overhaul for Step 1 & 2/AnKingMed, ID 712165

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Really wonder where these cards are from… Think we can keep the mention of detrusor hypoactivity here as, according to other edit, overflow incontinence is due to weakened bladder

@anking-maintainers although it isn’t LMN issue, you do have the hypoactivity and resultant overflow, so I think it’s best to just change the explanation in extra rather than remove this component entirely (that was original suggestion). Edited accordingly w/ input from AMBOSS - see here and command+F multiple sclerosis

Please remember to vote on actual suggestion if you support the change :slight_smile:

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agree with @herstein.jacob

The more I read the more confused I get - “LMN” in original is really just referring to sacral nerve root involvement (this is part of PNS, not CNS), which DOES cause overflow incontinence. Unclear to me if MS can affects sacral nerves or not, but according to UW, it generally does not. UpToDate gives a more complete picture, but I think it adds to confusion by making it sound like MS really does affect sacral nerves.

UWorld: “(Choices A and C) Demyelination of the sacral nerve roots can lead to impairment of the lower motor neuron input to the bladder, resulting in detrusor underactivity. Either detrusor underactivity or obstruction of the bladder outlet can lead to urinary retention and overflow incontinence. However, these patients would have a distended bladder and a large (>150 mL) postvoid residual urine volume. In addition, multiple sclerosis affects the CNS, and sacral spinal roots are a part of the peripheral nervous system.”

UpToDate:

Long story short, I have no clue how to deal with this or the other corresponding suggestion

Now I’m confused too

I think we should only include urge incon in the text (it’s HY to know and i don’t think any question will test overflow incon in the setting of MS), and in the extra we can say “as the disease progresses, patients can develop overflow inco…”
This is the conclusion i reached after looking at UW and Amboss Qbank questions related to the topic

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@AnKing-Maintainers

I agree with keeping the hypoactive part in the main text as well as the change in the extra. But since the urge incontinence is more common in MS, I think it might be good to add that fact explicitly somewhere in the card.

Agree with @mohannadkh10, this card has been the bane of my existence for too long