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15 pack smoking history, BPH or Prostate cancer?

3K views 7 replies 6 participants last post by  garygjones 
#1 ·
A 70-year-old man comes to the physician because of nocturia. He states that over the past two years his urinary frequency has increased and he has to strain while passing urine. He also notes dribbling of a few drops of urine at the end of voiding. Sometimes he has to void again within two hours. He has no other symptoms. He has no history of diabetes mellitus, stroke or trauma. He does not take any medication. His father had surgery of the prostate for benign prostatic hyperplasia. He has a 15-pack-years history of cigarette smoking. Rectal examination shows smooth, firm enlargement of the prostate with no induration. Neurological examination shows no abnormalities. Laboratory study shows a serum creatinine at 7 mg/dl.
Which of the following studies is indicated at this time?

A. Blood urea nitrogen
B. Ultrasound of kidney, bladder and ureter
C. Intravenous pyelogram
D. Serum prostate specific antigen
E. Cystoscopy
F. Urinalysis
 
#2 ·
A 70-year-old man comes to the physician because of nocturia. He states that over the past two years his
urinary frequency has increased and he has to strain while passing urine. He also notes dribbling of a few
drops of urine at the end of voiding. Sometimes he has to void again within two hours. He has no other
symptoms. He has no history of diabetes mellitus, stroke or trauma. He does not take any medication. His
father had surgery of the prostate for benign prostatic hyperplasia. He has a 15-pack-years history of
cigarette smoking
. Rectal examination shows smooth, firm enlargement of the prostate with no
induration. Neurological examination shows no abnormalities. Laboratory study shows a serum creatinine a·
0 7 mg/dl W hich of the following studies is indicated at this time?
A. Blood urea nitrogen
B. Ultrasound of kidney, bladder and ureter
C. Intravenous pyelogram
D. Serum prostate specific antigen
E. Cystoscopy
F. Urinalysis
F. Urinalysis
 
#3 · (Edited)
Two best initial test for BOO due to BPH (DRE findings is smooth firm, no induration) is Urinalysis and Creatinine

Urinalysis ...to check if UTI is present from stasis

Creatinine....to see if the BOO has resulted in renal failure

if Creatinine is high next step is....Ultrasound to look for evidence of hydronephrosis,....

In this case Creatinine was done and was normal...so only step left is URINALYSIS!!
 
#6 ·
Why not E ? Bladder ca can present with BOO plus he has smoking history.

Sent from my iPhone using Tapatalk
I have noticed in this exam No heroics..whatever that is not given as a classic presentation of a disease ....we can safely rule that out..

A cystoscopy would be good if he had painless hematuria as his major symptom...once its not a classic presentation ..its best to avoid that option
 
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