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Old 05-21-2012
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Kidney Management of Renal Colic; First Step?

a question from Kaplan Qbook

A 45 yo m comes to the ER c/o severe right flank pain that began abruptly 3 hours ago. The pin comes in waves and radiates down to the ipsilateral testis. The patient is nauseated and extremely restless. His temperature is 37.0 C. Dipstick examination of the urine is positive for hematuria. Urine PH is 5.8. Which of the following is the most appropriate next step in diagnosis?

a.) IVP
b.) plain abdominal x ray
c.) renal ultrasound
d.) serum Ca, P, electrolytes, and uric acid.
e.) urine cultures




I put c because there is no CT choice so i choose the less sensitive test, which is ultrasound. But the q book answer says x-ray. So... the answer is...?
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Old 05-22-2012
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I think,in next step....it's better to look for any small bowel obstruction so thats why > b.) plain abdominal x ray
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Old 05-22-2012
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Quote:
Originally Posted by dryogi View Post
I think,in next step....it's better to look for any small bowel obstruction so thats why > b.) plain abdominal x ray
agree, also remember that most of the renal stones are radio-opaque, so u can simple dx stones by AXR

the most accurate test is abd CT , and mgm depend on size & location
-small and in lower ureter --> hydration & analgesia, it will pass alone
-large or upper ureter --> machine smash (extracoporal ...)
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Old 05-22-2012
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but the presentation is very specific for renal colic, why we need to look for small bowel obstruction?

Thank you!



Quote:
Originally Posted by dryogi View Post
I think,in next step....it's better to look for any small bowel obstruction so thats why > b.) plain abdominal x ray
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Old 05-22-2012
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Quote:
Originally Posted by chienpolska View Post
but the presentation is very specific for renal colic, why we need to look for small bowel obstruction?

Thank you!
renal colic is associated with Ileus (u posted that thead right)

i think AXR is principly for dx and to see if the pt developing Hydronephrosis
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Old 05-22-2012
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Dude, i think qbook information is old, similar thread
Initial imaging choice in suspected renal colic

said that non-contrast CT is the first step (NOW), cuz KUB miss 15% (radio-lucent)

and there's alot of confusion b/w KUB & US

but still KUB is best initial, use US if pregnant or negative KUB
use CT as the BEST
and if all test are mentioned the question stem ??? and the question ask about what is the next step in mgmg (i will pick CT) ?
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Old 05-23-2012
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Quote:
Originally Posted by bisho View Post
Dude, i think qbook information is old, similar thread
Initial imaging choice in suspected renal colic

said that non-contrast CT is the first step (NOW), cuz KUB miss 15% (radio-lucent)

and there's alot of confusion b/w KUB & US

but still KUB is best initial, use US if pregnant or negative KUB
use CT as the BEST
and if all test are mentioned the question stem ??? and the question ask about what is the next step in mgmg (i will pick CT) ?


but sine axr is the best initial test, if the q asks what is the next step in mgmt, if we havent done axr, even though ct is the best, we shall still do acr first, right?
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