DrVirgo
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41. A 65 year old woman is brought to the ER because of lethargy and confusion for 24 hours. She did not fall or injure herself recently. Medications include amitriptyline (150 mg at bedtime) for major depressive disorder and diphengydramine for the past week (50 mg 3 times daily) for a pruritic rash. Her pulse is 100/min and regular, and blood pressure is 135/80 mg Hg. Physical examination shows a palpable mass in the misline extending 5 cm upward from the pubic symphysis. Her serum BUN concentration is 45 mg/dL, and serum creatinine is 2.8 mg/dL. Which of the following best explains the laboratory results?
A. Acute tubular necrosis
B. Bilateral renal artery stenosis
C. Bilateral ureteral obstruction just distal to the renal pelvis
D. Bilateral ureteral obstruction proximal to the bladder
E. Constrictive pericarditis
F. Decreased ability to empty the bladder
G. Interstitial nephritis
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| DrVirgo
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Please explain why and why the other answers are not it. 
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| drkirti79
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patient is on amitryptline (TCA) it has anti cholinergic side effect which is retension of urine . mid line mass is bladder full of urine . correct me if i m wrong
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| reet
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Yes F
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| leen
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agrred F
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| Cedrick
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yeah it is used to treatment nocturnal eneuresis.too
F.-amitriptiline>decreased ability to empty the bladder
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| robin082006
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F
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| DrVirgo
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ok, agreed.
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