Free floating echodense object in the left renal pelvis - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 08-03-2011
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 512
Threads: 57
Thanked 319 Times in 163 Posts
Reputation: 329
Kidney Free floating echodense object in the left renal pelvis

A 55-year-old man has had dysuria for the past week. Over the past 2 days he has experienced shaking chills. On physical examination his temperature is 39.3 C.. A urinalysis shows sp gr 1.016, pH 6, 1+ glucose, 1+ blood, no ketones, and no protein. Urine microscopic examination shows numerous WBCs and WBC casts. His serum creatinine is 1.5 mg/dL and glucose 155 mg/dL with hemoglobin A1C 8.7%. A renal ultrasound scan shows a 0.3 cm free floating echodense object in the left renal pelvis. Which of the following complications has this man most likely developed?

A Acute tubular necrosis
B Aspergillus fungus ball
C Cystine calculus
D Hematoma
E Papillary necrosis
F Renal cell carcinoma
G Urothelial carcinoma
Reply With Quote Quick reply to this message
The above post was thanked by:
usmlemydream (08-04-2011)



  #2  
Old 08-03-2011
bebix's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,357
Threads: 194
Thanked 3,269 Times in 881 Posts
Reputation: 3279
Default

E Papillary necrosis
Reply With Quote Quick reply to this message
The above post was thanked by:
madeeha shafqat (08-03-2011)
  #3  
Old 08-03-2011
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 2
Threads: 0
Thanked 0 Times in 0 Posts
Reputation: 10
Default

papillary necrosis
Reply With Quote Quick reply to this message
 
  #4  
Old 08-03-2011
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 32
Threads: 7
Thanked 9 Times in 5 Posts
Reputation: 19
Default

Can u please explain why? The picture seems fit for an infection WID proteus resulting in a cysteine stone. Supporting it is the fact tat ph is acidic and his hba1c too is high. So he is a diabetic with a not-so-good glycemic control n more prone to urinary tract infections. And plus he has got an infection wid all the chills n rigor. Cud be awfully wrong though...
Reply With Quote Quick reply to this message
  #5  
Old 08-03-2011
bebix's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,357
Threads: 194
Thanked 3,269 Times in 881 Posts
Reputation: 3279
Default

Quote:
Originally Posted by liaison4fun View Post
Can u please explain why? The picture seems fit for an infection WID proteus resulting in a cysteine stone. Supporting it is the fact tat ph is acidic and his hba1c too is high. So he is a diabetic with a not-so-good glycemic control n more prone to urinary tract infections. And plus he has got an infection wid all the chills n rigor. Cud be awfully wrong though...
If you have free floating echodense object...this is not a "stone"

This is a diabetic patient with an acute pyelonephritis => MC complication = Papillary necrosis
Reply With Quote Quick reply to this message
The above post was thanked by:
drhnis (08-03-2011), liaison4fun (08-03-2011), usmlemydream (08-04-2011), zohra (08-03-2011)
  #6  
Old 08-03-2011
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 46
Threads: 8
Thanked 36 Times in 18 Posts
Reputation: 46
Default

Papillary necrosis
Reply With Quote Quick reply to this message
  #7  
Old 08-03-2011
qurat21's Avatar
USMLE Forums Master
 
Steps History: 1 + CK
Posts: 623
Threads: 62
Thanked 289 Times in 186 Posts
Reputation: 299
Default

papillary necrosis
Reply With Quote Quick reply to this message
  #8  
Old 08-03-2011
akua's Avatar
USMLE Forums Addict
 
Steps History: Not yet
Posts: 167
Threads: 0
Thanked 31 Times in 31 Posts
Reputation: 41
Default

E.papillary necrosis
Reply With Quote Quick reply to this message
  #9  
Old 08-04-2011
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 512
Threads: 57
Thanked 319 Times in 163 Posts
Reputation: 329
Default Explanation

(E) CORRECT. Papillary necrosis is a renal complication of diabetes mellitus, as in this case. Papillary necrosis may also be seen with analgesic abuse nephropathy, with sickle cell anemia, and with a severe acute pyelonephritis.

(A) Incorrect. Acute tubular necrosis may produce renal tubular casts, not WBC casts, and tissue should not slough into the collecting system.

(C) Incorrect. A calculus may form as a consequence of infection, but such stones are typically formed of magnesium ammonium phosphate.

(D) Incorrect. Hematomas are unlikely in and around the kidney expect with severe trauma

(F) Incorrect. Renal cell carcinoma will produce a mass lesion; it does not slough into the collecting system. Diabetes mellitus is not a risk for renal cell carcinoma.

(G) Incorrect. Urothelial carcinoma typically does not slough. Diabetes mellitus and infection is not a risk for urothelial carcinoma.
Reply With Quote Quick reply to this message
The above post was thanked by:
usmlemydream (08-04-2011)



Reply

Tags
Pathology-, Radiology-, Renal-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
USMLE Free Practice Materials (Free 150) Sabio General Topics Recommended Threads 6 04-18-2017 04:08 AM
Pain in the left eye? Prepping123 USMLE Step 1 Forum 15 01-23-2013 12:01 PM
Floating out and dilated pupils, which substance abuse! INCOGNITO USMLE Step 1 Forum 4 04-18-2012 06:29 PM
1.5 months left b.abid USMLE Step 2 CK Forum 1 05-24-2011 06:10 PM
Advice 2 weeks left mpz013 USMLE Step 1 Forum 3 11-01-2010 02:13 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)