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  #1  
Old 07-21-2012
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Question 15 pack smoking history, BPH or Prostate cancer?

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
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Old 07-21-2012
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Originally Posted by tyagee View Post
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
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Old 07-21-2012
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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!!

Last edited by stfidel; 07-21-2012 at 08:17 PM.
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Old 07-21-2012
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F. Urinalysis to rule out UTI
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Old 07-22-2012
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Why not E ? Bladder ca can present with BOO plus he has smoking history.


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Last edited by tyagee; 07-22-2012 at 03:16 AM.
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Old 07-22-2012
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Why not E ? Bladder ca can present with BOO plus he has smoking history.


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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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Old 07-24-2012
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Quote:
Originally Posted by stfidel View Post
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!!
THE CREATININE IS 7mg/dl which is NOT NORMAL ..THE answer is USG for hydronephrosis.
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Old 08-12-2012
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That would be F. urinalysis.
B. Ultrasound of kidney, bladder and ureter - might be a secondary part
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