Hidronephrosis?

[skinyballs]

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A 65-year-old woman is admitted to the hospital for constant, severe abdominal pain that has worsened over the prior week. She has no other associated symptoms, such as nausea or vomiting, but has noticed that her daily urine output has sharply decreased. She has had a constant desire to urinate, but, when she tries, only a small amount of bloody urine is discharged. The patient is a long-time smoker, having smoked three packs per day for more than 45 years, although she claims to have quit 2 days ago. A bladder ultrasound in the emergency department reveals a mass consistent with bladder cancer, as well as significant urinary retention. Which of the following is most likely to be detected upon imaging the patient's genitourinary system?

A. Bilateral hydronephrosis
B. Bladder dilation
C. Bladder dyskinesis
D. Unilateral hydronephrosis
E. Ureteral dilation

I found free questions at:
www. u s m l e p a c k.blogspot.com

 

[raidermedic]

If I had to guess I would say B.

 

[chocomorsel]

Wouldn't A B and E all be correct? You would think the bladder mass would be obstructing the bladder outlet, causing bladder distention, then bilateral ureteral dilation and hydronephrosis since this seems to be more of a chronic and not an acute problem. That's a tough one. what's the answer?

 

[BillyWitchDoctr]

I agree that it sounds like bladder outlet obstruction...I don't think it would be E since this is bladder cancer and the obstruction is more proximal than the ureter. Otherwise, I can't rule out either bladder distention or bilateral hydronephrosis...but if I had to guess I would say bladder distention since I think hydronephrosis takes some time to develop. To me the question implies that her oliguria is a relatively acute problem.

 

[werd]

i don't think this is really a question for us to answer; rather, it seems like an advertisement for the website listed at the bottom of the post. there are multiple answers which seem correct, probably because they want more of us to go to said website and check it out.

 

[Terpskins99]

Was going to go with E with this one.

Patient has feelings of urgency, so the bladder is definitely full and distended. But dilated? I think the ureter would start to expand further just because of relative thickness.