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Old 05-28-2015
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USA u world question

q i.d 3481
could anybody tell me the importance of doing urinalysis ( for hematuria and infx) in a patient with BPH ?
uworld later explains that it is mportant to do u/a in patients with prostate cancer!!! in a patient with BPH!!
i am not saeeing the connection here, could anybody elaborate on this?
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Old 05-29-2015
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Quote:
Originally Posted by nadeemhasso View Post
q i.d 3481
could anybody tell me the importance of doing urinalysis ( for hematuria and infx) in a patient with BPH ?
uworld later explains that it is mportant to do u/a in patients with prostate cancer!!! in a patient with BPH!!
i am not saeeing the connection here, could anybody elaborate on this?
basically, from what i understood, in a pt with risk factors, age and etc. you cant rule out other issues that can occur even if he has BPH. so to be safe, do a UA, to screen for hematuria and infection
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Old 05-30-2015
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Default Importance Of Urinalysis

If I am correct you are referring to Q.ID 3481.
The most important fact that they have mentioned is that its the recommendation of American Society of Urologist.
Urinalysis(UA) is usually the most preffered choice for testing for most of the urinary tract complains. The test is least invasive and hence a good choice to do. When being looked at for BPH point of view, it can tell us whether there is superimposed UTI which would change the management from simple addiction of alpha blockers and finastride to addition of antibiotics.
The only significance of UA for cancer is its role in detecting hematuria which could be suggestive of Renal or Bladder cancer.

all the other options require either an UA or a PSA>4 both of which were not available in the question.

My experience with uworld so far has told me, least invasive test first even with cancer. The only exception to this rule is lung cancer.
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Old 05-31-2015
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Exactly.

My general approach was always this:

For every CK question, first ask yourself: What is my working diagnosis?

Don't ever skip that step. If you are unable to make a diagnosis from the vignette, think of your most likely differential. Make sure this is clear in your mind before proceeding. All workup questions will be testing your approach to refining this differential, so make sure you have it in your head before you go to the answer choices. Beyond that:


1) H&P. Anytime history or physical exam is an answer choice, pick it. If you don't, you had better have an EXTREMELY compelling reason.

2) Non-invasive tests first: basic labs, urine, etc. Usually these are given to you because doing them is so routine, but sometimes they won't.

3) Imaging. Order the imaging study that will give you the answer. If you suspect lung cancer, you get a CT scan over an Xray because that will actually answer the question. If you suspect pneumonia, you get a chest xray first. Pick the scan that gives you the answer. Another nice way to test in your mind is to ask what you would do with a positive and negative result on the imaging study you're thinking of. If the answer to both is another imaging study, then THAT is the one to start with (such as with an xray for suspected lung cancer, you will order a CT regardless of whether you see something on the xray or not). With pneumonia, if you see a lobar consolidation, you're done and you treat the PNA; if you see nothing, then you may consider more imaging or you may treat empirically, but if your Dx is correct, the xray is sufficient.

Be careful trying to be too cost effective or non-invasive. I see people I tutor often miss questions because they'll go for the non-invasive or less-expensive distractor when that won't actually answer the question. It's never cost effective to order a cheaper imaging modality that will not answer your clinical question.

3.5) Imaging that diagnoses AND treats. Things like air contrast enema, ERCP, etc -- if it does both, pick it first.

4) Tissue. If tumor is the rumor then tissue is the issue. If the above has been done in the vignette and you're dealing with cancer, you need tissue. Period.
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