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  #1  
Old 08-03-2012
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Question Immediate improvement in BPH management!

A 65-year-old man visits his physician because of increasingly difficult urination. he has trouble initiating a stream and experiences postvoid dribbling. He wakes from sleep 3 times per night to urinate. His baseline creatinine level was 1.0mg/dl , and it is now 1.5mg/dl. Which treatment is most feasible to immediately improve this patient's creatinine level?

A. Administration of fluid boluses
B. Dialysis
C. Placement of a Foley Catheter
D. Treatment with terazosin
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  #2  
Old 08-03-2012
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The question asks "to improve immediately " So I will go with

A. Administration Fluid boluses.
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Old 08-03-2012
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Quote:
Originally Posted by rapiddo View Post
A 65-year-old man visits his physician because of increasingly difficult urination. he has trouble initiating a stream and experiences postvoid dribbling. He wakes from sleep 3 times per night to urinate. His baseline creatinine level was 1.0mg/dl , and it is now 1.5mg/dl. Which treatment is most feasible to immediately improve this patient's creatinine level?

A. Administration of fluid boluses
B. Dialysis
C.Placement of a Foley Catheter
D. Treatment with terazosin
No need for fluid as there's nothing in the hx suggest hypoperfusion.
No need for B as no indication is given as fluid overload, hyperkalemia etc.
Confused btw &C.
D is not for the immediate improvment of creatinine.
Would be C, as the symptoms of BPH causing back pressure on kidney resulting in High creatinine level.
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Old 08-03-2012
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Quote:
Originally Posted by Anders View Post
No need for fluid as there's nothing in the hx suggest hypoperfusion.
No need for B as no indication is given as fluid overload, hyperkalemia etc.
Confused btw &C.
D is not for the immediate improvment of creatinine.
Would be C, as the symptoms of BPH causing back pressure on kidney resulting in High creatinine level.
I wrote C first but then realized that the question is asking for immediate improvement of creatinine , not patient's condition. So i went with A . Someone will confirm the answer.
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Old 08-03-2012
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C. Placement of a Foley Catheter - as BPH is causing obstructive uropathy,

once backpressure on kidneys relieved, creat. should come back to normal.
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Old 08-04-2012
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Quote:
Originally Posted by rapiddo View Post
A 65-year-old man visits his physician because of increasingly difficult urination. he has trouble initiating a stream and experiences postvoid dribbling. He wakes from sleep 3 times per night to urinate. His baseline creatinine level was 1.0mg/dl , and it is now 1.5mg/dl. Which treatment is most feasible to immediately improve this patient's creatinine level?

A. Administration of fluid boluses
B. Dialysis
C.Placement of a Foley Catheter
D. Treatment with terazosin
First deal with immediate step for improvement..........you can do more later!!!
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Old 08-04-2012
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Correct Answer Answer

The Explanation Given:

The correct answer is C. This patient has symptoms consistent with benign prostatic hy-pertrophy, including difficulty initiating a stream, postvoid dribbling, and frequent night-time urination. In this case, the large prostate encasing the prostatic urethra caused urinary
obstruction, leading to a decline in renal func-tion refl ected by an increase in creatinine level. On ultrasound one may be able to see di-lation of the urinary collection system. A well-placed Foley catheter defi nitively relieves the
obstruction.

Answer A is incorrect. Giving fluids would improve renal function if the patient were hypovolemic. The patientís symptoms point to an ob-structive reason for his rise in creatinine level rather than to a prerenal cause.

Answer B is incorrect. Dialysis would be ap-propriate if the patient were in renal failure. However, his creatinine level is not severely el-evated, and he is still making urine. Placing a Foley catheter directly addresses the cause of
the patientís declining renal function.

Answer D is incorrect. Terazosin is an α1-blocker that relaxes prostatic smooth muscle surrounding the prostatic urethra. This does improve the obstruction, but does not have the immediate effect of relieving it.
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