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Renal-1

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neuroblastoma
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07/03/08 - 04:58 AM

A 56-year-old man comes to the emergency department with severe right flank pain for the past 5 days. He says that the pain started after he returned from a long hiking trip in the Grand Canyon, and despite taking some ibuprofen, it has not improved. Infact, he came to the hospital today because the pain has increased and he now has new onset of nausea and chills. He tells you that he had similar pain several years ago that was diagnosed as uric acid stones. He was treated conservatively and eventually passed all the stones spontaneously. His temperature is 38.1 C (100.6 F), blood pressure is 130/80 mm Hg, and pulse is 115/min. On examination, the patient is unable to lie still because of the pain and has significant right costovertebral tenderness radiating to his right testicle. Leukocyte count is 16,000/mm3 and his creatinine is 2.1 mg/dL. The most appropriate study after starting the patient on intravenous hydration and antibiotics is

A. a CT scan of the abdomen and pelvis

B. a DMSA renal scan

C. an intravenous pyelogram

D. a radiograph of the kidneys, ureters, and bladder

E. a renal ultrasound

Maryjoe
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07/03/08 - 08:32 AM

I think its E, less expensive than CT and he cant have an IVP because of his Creatinine. The xray can miss the stone, depending on its radiolucency.

hero
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07/03/08 - 08:39 AM

mikky
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07/03/08 - 11:29 AM

a??...uric acid stones r radiolucent, rules out x ray...and history is sugestive of uretric stone wh is usually missed by usg

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liliaeliz
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07/03/08 - 12:20 PM

bvenny
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07/03/08 - 01:03 PM

neuroblastoma
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07/03/08 - 06:13 PM

MICKY and Liliaz.. good job guys

yes A. Ct without contrast is the best choice to locate the stones. (uric acid stones)

U/S ---u cannt see ureteric stones,,,only hydronephrosis in kidneys can be seen better and uric acid stone are usualy missed with U/S and KUB
IVP conrasts not done if high serum creatinine renal failure.

Eagle_303
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07/03/08 - 06:39 PM

Thread Extension :
Which stones are not detected by CT scan ?

mikky
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07/04/08 - 02:09 PM

indinavir induced uric acid stones???

@neuroblastoma... grin

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Eagle_303
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07/04/08 - 04:57 PM

#10

mikky wrote:
indinavir induced uric acid stones??? @neuroblastoma... grin

You are right but these are not uric acid stones rather INDINAVIR STONES

mikky
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07/05/08 - 01:48 AM

#11

ok...indinavir stones...thanx eagle...

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mikky
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07/05/08 - 02:10 AM

#12

i have a doubt regarding cysteine stones...robins says ther r radiolucent whr as bailey says they are radioopaque cos of their sulfur content...r they radiolucent or radioopaque??

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Eagle_303
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07/05/08 - 02:36 AM

#13

mikky wrote:
i have a doubt regarding cysteine stones...robins says ther r radiolucent whr as bailey says they are radioopaque cos of their sulfur content...r they radiolucent or radioopaque??

Dear

If you are referring to "Bailey and Love's short practice of Surgery " ,it has written that these are radioopaque.But I could find any statement by Robins in his big version.

Would you please put the exact name of the book ??

Oxford Handbook of general practice :
Radiologyâ€”KUB X-ray (90% renal stones are radio-opaque; only urate and xanthine stones are radio-transluscent); IVP.

Edited by Eagle_303 on 07/05/08 - 02:59 AM

mikky
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07/05/08 - 12:06 PM

#14

yeah eagle..i mean bailey and love..i dont have robins with me now...i will try to check in robins as soon as possible..

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mikky
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07/06/08 - 11:58 AM

#15

hey..i dont have big robins..i checked in robins Q bank 2 nd edition...page no.275 the first explanation itself says uric acid and cysteine stones are radiolucent....

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