A 68-year-old man comes to the doctor because of an episode of blood in urine. He has been previously healthy. He takes only two times a cheap viagra as a medication. Laboratory exams shows hematuria and proteinuria. The patient has no pain. The physical examination is normal.
Which is the next step?
a. Pelvic CT scan
b. Renal angiogram
c. Cystoscopy
d. Trimethoprim-sulfamethoxazole
e. Biopsy of prostate
The next step is cystoscopy. (C)
ReplyDeleteHematuria may be caused by disorders such as tumors, urethritis, cystitis or prostatitis. The best way to narrow the differential is by direct visualization of the bladder and urethra with cystoscopy. This is relatively non-invasive and painless and is the fastest option.
A CT scan may be helpful for detecting a renal tumor, pelvic abscess or mass. But the chances of missing a small lesion in the urological system are high and a cystoscopy must be completed first.
A course of trimethoprim-sulfamethoxazole is used to treat urinary tract infections and prostatitis. Urinary tract infections are generally not painless.
A renal angiogram would be needed to evaluate hypertension or worsening renal function in order to detect ailments such as renal artery stenosis.
A biopsy of prostate may be needed if prostate cancer is suspected. Certainly the patient has the risk factor of increased age. However, with no history of urinary retention, this can be deferred until the cystoscopy.
But a cystoscopy cannot detect the cause of the proteinuria he has which normally has a renal cause.
ReplyDeleteIt's either A or B but I admit I don't know which one I'd choose.
Anyway I'd get a blood sample first to see what his GFR, creatinine levels, proteinemia etc. look like.
Ok, I go with A, pelvic CT scan
ReplyDeletegoccountogle a
ReplyDeleteIs this site dead?
ReplyDeleteHi guys,
ReplyDeleteThe correct answer is a, because of proteinuria we must have a renal cause
Louis congratulation
Thank you for sharing the right answer.
ReplyDeletePelvic CT scan
ReplyDeleteI agree with Dr.Sathya that is the right answer.
ReplyDeleteWell;
ReplyDeleteand the answer is