bilateral dilation of the renal collecting system...

[babuchuck]

---

Members don't see this ad.

this is a question from nbme 6...

A 70 year old man comes to the physician because of a 2 year history of urinary hesitancy and frequency. He states that he wakes two to three times a night to void, and that during the past year he has had intermittent pain with urination. Physical exam shows no abnormalities. Results of urinalysis are within the reference range. Ultrasonography of the abdomen shows bilateral dilation of the renal collecting system. Which of the following is the most likely diagnosis?

a. adenocarcinoma of the prostate
b. benign prostatic hyperplasia
c. nephroblastoma (wilm's tumor)
d. renal cell carcinoma
e. ureterolithiasis
f. ureteropelvic junction stricture
g. urethral valves
h. urothelial carcinoma of the bladder

have my test in 5 days 😱

 

[RapplixGmed]

Bph.

 

[babuchuck]

couldn't it also be ureteropelvic junction stricture? or is that more in younger patients and since he's 70 it's prob BPH?

 

[RapplixGmed]

couldn't it also be ureteropelvic junction stricture? or is that more in younger patients and since he's 70 it's prob BPH?

Sure, it could be, but all the anatomical problems overwhelmingly occur in babies. Uretopelvic jxn is also upstream of the ureters so they wouldn't be dilated. The differential for urinary urgency/retention in an elderly male is 1. bph, 2. bph, 3. bph.

 

[Step1Hash]

couldn't it also be ureteropelvic junction stricture? or is that more in younger patients and since he's 70 it's prob BPH?

I would less likely to be bilateral if that was the case

 

[medschool86]

Sure, it could be, but all the anatomical problems overwhelmingly occur in babies. Uretopelvic jxn is also upstream of the ureters so they wouldn't be dilated. The differential for urinary urgency/retention in an elderly male is 1. bph, 2. bph, 3. bph.

so is bph not always picked up on physical exam? I wasn't sure since the question said physical exam was normal I didn't choose BPH

 

[Lonely Sol]

so is bph not always picked up on physical exam? I wasn't sure since the question said physical exam was normal I didn't choose BPH

Yea i am confused as well...If physical exam is normal and urine analysis is normal, would it still be BPH...(i thought PSA is increased in BPH and prostate cancer?)

 

[illegallysmooth]

so is bph not always picked up on physical exam? I wasn't sure since the question said physical exam was normal I didn't choose BPH

Have you ever done a DRE? The prostate would have to be huge for you to detect BPH on exam. The enlargement is principally in the periurethral/central zones.

 

[illegallysmooth]

Yea i am confused as well...If physical exam is normal and urine analysis is normal, would it still be BPH...(i thought PSA is increased in BPH and prostate cancer?)

PSA is not part of a urinalysis.

 

[Lonely Sol]

PSA is not part of a urinalysis.

Yeaa...I think I need to take a break now..haha...