WBR0565

Author	PageAuthor::Vendhan Ramanujam
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Emergency Room
Sub Category	SubCategory::Genitourinary, SubCategory::Surgery
Prompt	[[Prompt::A 20 year old high school football player is brought to emergency room with the complaint of passing blood in his urine. He developed this complaint three hours after his football match when he got kicked in his left flank. Physical examination does not reveal any significant finding. His vital signs are heart rate 70 beats/min, respiratory rate 16/minute, blood pressure 110/70 mm Hg and oral temperature 36.8 C. The initial diagnostic tests in the emergency room should include which of the following?]]
Answer A	AnswerA::Arteriography
Answer A Explanation	AnswerAExp::'''Incorrect'''-Renal arteriography is not indicated routinely but should be performed to rule out renal pedicle injury when no kidney function is demonstrated by drip infusion pyelography.
Answer B	AnswerB::Intravenous pyelogram
Answer B Explanation	[[AnswerBExp::Correct-In stable patients with suspected genitourinary tract injury, the first urologic study other than a urinalysis should be on intravenous pyelogram. The technique of high-dose drip infusion is desirable because the high concentration of contrast achieved greatly facilitates the interpretation in an unprepared patient.]]
Answer C	AnswerC::Retrograde urethrography
Answer C Explanation	AnswerCExp::'''Incorrect'''-Retrograde urethrography is done in cases where there is a suspicion of urethral injury.
Answer D	AnswerD::Retrograde cystography
Answer D Explanation	AnswerDExp::'''Incorrect'''-Intravenous pyelography should be performed before retrograde cystography to avoid obscuring visualization of the lower ureteral tract.
Answer E	AnswerE::Diagnostic peritoneal lavage
Answer E Explanation	AnswerEExp::'''Incorrect'''-Peritoneal lavage is not useful in the diagnosis of genitourinary injuries, as the structures involved are retroperitoneal.
Right Answer	RightAnswer::B
Explanation	[[Explanation::In stable patients with suspected genitourinary tract injury, the first urologic study other than a urinalysis should be on intravenous pyelogram. The technique of high-dose drip infusion is desirable because the high concentration of contrast achieved greatly facilitates the interpretation in an unprepared patient. Intravenous pyelography should be performed before retrograde cystography to avoid obscuring visualization of the lower ureteral tract. The study may also preclude the need for retrograde urethrography in cases where there is a suspicion of urethral injury. Educational Objective: In stable patients with suspected genitourinary tract injury, the first urologic study other than a urinalysis should be on intravenous pyelogram. Retrograde cystography will follow it to visualize the lower ureters. Retrograde urethrography will follow intravenous pyelography in cases where there is a suspicion of urethral injury. Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Intravenous pyelogram, WBRKeyword::Genitourinary tract injury, WBRKeyword::Retrograde urethrography, WBRKeyword::Retrograde cystography
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::