Hotobhaga
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Topics: 41
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And people what do you think of this:
38) A 74-year-old man complains of lower abdominal pain. He has become aware of a periumbilical mass during that time. His past medical history is significant for hypertension and type 2 diabetes. He has a history of diverticulitis 1 year ago. On physical examination, he is afebrile and appears mildly uncomfortable. On abdominal examination, there is a palpable mass extending from the pubic ramus to the umbilicus with a smooth contour. Laboratory results reveal a BUN of 14 mg/dL and a creatinine of 1.8 mg/dL. Which of the following is the most appropriate next step in the management of this patient?
A. Masturbation
B. Ureteral catheterization
C. Abdominal sonogram
D. Abdominal and pelvic CT scan
E. Percutaneous nephrostomy
Explanation:
The correct answer is
B. This elderly man has an acute onset of a "lower abdominal mass" and discomfort. Its location and contour suggest that it may be a distended bladder. The modest increase in BUN and creatinine is probably secondary to the impairment to urine production produced by bladder obstruction, with resulting back pressure on the kidney tubules. This probably occurred as a result of benign prostatic hypertrophy. The first order of business would be a ureteral catheterization, which would probably allow the disappearance of the "abdominal mass," which is in fact his distended bladder. This should be performed before any imaging such as sonogram (choice C) or CT scan (choice D).
Masturbation (choice A) would not decompress the bladder.
Percutaneous nephrostomies (choice E) are invasive procedures that are done if there is a unilateral or bilateral hydronephrosis. This would never take precedence over the initial attempt at decompression with a urethral catheter.
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USMLE preparation is all about discovery. Discovery of your own capabilities....Julia Perch MD (iprep)
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| arlete
Forum Fanatic
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You mean "urethral catheterization" when you state "ureteral catheterization"?
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| cirus
Forum Guru
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The ttt now has to be a urethral catheter to empty the bladder
Edited by cirus on 06/29/07 - 11:21 AM
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| Hotobhaga
Forum Elite
Topics: 41
Posts: 180
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The point I was making is ..this is what the q-bank states. Verbatim. That is why I chose USG. But they obviously meant urethral....somebody is not checking
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USMLE preparation is all about discovery. Discovery of your own capabilities....Julia Perch MD (iprep)
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