renal help

[ddw2013]

nbme 13 q:
A 70 year old woman comes to the physician because of several episodes of burning pain with urination during the past year, Physical examination shows uterine prolapsed. Urinalysis shows a mild increase in leukocytes. Ultrasonography of the abdomen shows bilateral dilation of the renal collecting system. The patient is at great risk for which of the following?
A) Cervical Carcinoma
B) Pyelonephritis
C) Renal cell carcinoma
D) Ureterolithiasis
E) Urothelial Carcinoma
So why D is wrong? What is her dx? Does this patient already have ureterolithiasis? Thanks~

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[dyspareunia]

Patient presentations sound so much cooler with the current SDN lingo.

 

[ArmyTiger]

Sounds like uretral obstruction (from the uterine prolapse) and a UTI. So ascending infection --> pyelonephritis.

 

[Robotic Dock]

To me, it's like a ureterovesical reflux. Since the uterine prolapse causes ascending UTI.= pyelonephritis

 

[ddw2013]

Sounds like uretral obstruction (from the uterine prolapse) and a UTI. So ascending infection --> pyelonephritis.

so you think it is uretal obstruction but not necessary caused only by renal stone?

To me, it's like a ureterovesical reflux. Since the uterine prolapse causes ascending UTI.= pyelonephritis

I thought VUR is more common in kids and younger patients.

 

[notbobtrustme]

pyelo -> she has WBCs in her urine.

 

[Bancrofti]

so you think it is uretal obstruction but not necessary caused only by renal stone?

I thought VUR is more common in kids and younger patients.

You needed to appreciate the fact that she had uterine prolapse and BILATERAL dilation.

The prolapse is likely what is causing the obstruction, given the mention of that physical exam finding and the fact that it is bilateral. It's very unlikely for you to have stones in both ureters. Further, the question asked what is a sequelae of her presentation, not what is causing it. So even if she had stones that isn't the answer.

The addition of the fact that she has had repeated infections within the last year also points you to the most likely outcome.

 

[ddw2013]

You needed to appreciate the fact that she had uterine prolapse and BILATERAL dilation.

The prolapse is likely what is causing the obstruction, given the mention of that physical exam finding and the fact that it is bilateral. It's very unlikely for you to have stones in both ureters. Further, the question asked what is a sequelae of her presentation, not what is causing it. So even if she had stones that isn't the answer.

The addition of the fact that she has had repeated infections within the last year also points you to the most likely outcome.

cleared, thanks~