hgheith
Forum Elite
Topics: 39
Posts: 268
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I just finished listening to the lectures on nephro, and the Dr. says first best test for stones is U/A for hematuria. I also got a Q on UW and it says that spiral CT is the best test for Dx and that a U/A should only be done if coexisting UTI is suspected. So what is the first best test?
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| cool doctor
Forum Junior
Topics: 1
Posts: 226
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I think its echo or UA
but spiral is defenitly not the first.
but still the best
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| hgheith
Forum Elite
Topics: 39
Posts: 268
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I agree cool doctor, but I just did this Q on UW and chose u/a and got it wrong, it was spiral ct...? What source is to be trusted UW or kaplan videos?
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| me007
Forum Guru
Topics: 72
Posts: 803
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if you could post that q with choices.
But suspecting kidney problem and not doing U/A first???
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| hgheith
Forum Elite
Topics: 39
Posts: 268
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34 yo man complains of sever abdominal pain, sharp and unberable in LLQ that radiates to the perineum. He vomitted 2X since the pain began. He denys dysuria. On exam he is afebrile, and connot sit still due to his discomfort. Mucus membranes slightly dry. Lungs cta, heart norm, abd soft and nontender. Extremities show no cyanosis, clubbing or edema. Which one of the following is best to diagnose this pt's condition?
A. Abd and Pelvic xray
B-Abd ct scan
C. Urinealysis and urine culture
D. colonoscopy
E. Abd U/S
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| doyoudig
Forum Guru
Topics: 144
Posts: 613
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A. Abd and Pelvic xray -- best initial for Pt w/ recurrent stone problems, if opaque
B-Abd ct scan -- spiral ct best test to dx radiolucent or opaque for Pt w/ 1st time stone problem
C. Urinealysis and urine culture -- best initial test always....
D. colonoscopy -- not needed
E. Abd U/S
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| doyoudig
Forum Guru
Topics: 144
Posts: 613
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UA and culture is always done initially to give u a clue and r/o other causes, but the best test in a Pt w/ 1st time stone problem is spiral ct in (nonpreg) and ultrasound in (preg). If u on the other hand know that pt has a Hx of stones, n stones are opaque then the cheaper test is X ray....rather than spiral ct...
this is from uw and kaplan videos....
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| me007
Forum Guru
Topics: 72
Posts: 803
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i checked in FA and Step Up also, the answer is U/A.
- look for microhematuria and altered urine pH. (15% do not have hematuria)
Urine culture - if infection is suspected.
than goes X-ray/US, CT and IVP
Spiral CT - most sensitive test for detecting stones
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| mytime
Kick my butt!
Topics: 39
Posts: 3,173
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The q...... was "BEST WAY to diagnose" not what's the first best thing.........so SPIRAL CT is correct. If it were, what's the next step / or first test....or....... then U?A was correct. 
READ THE LAST LINE FIRST but don't forget to HIGHLIGHT the main point of q.s o u can read it again at the END!!
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| me007
Forum Guru
Topics: 72
Posts: 803
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thanks, mytime.
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| hgheith
Forum Elite
Topics: 39
Posts: 268
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I agree mytime, but the explanation for not choosing u/a was because there was no suspition of an infection, not because ct was a better diagnostic tool, that is where my confusion is.
But thank you all for the great explanations!
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| epica
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Oh, guys .
Nice to see this Q again.
MYTIME, u r right, 100%
Good luck to u all.
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