Your 55-year-old male patient presents to the emergency ...

[Collmarie]

Your 55-year-old male patient presents to the emergency department with complaints of sudden development of severe right-sided, colicky lower abdominal pain. He cannot sit still on the examining table.
 
  The patient has previously been in good health. On physical examination, there are no signs of peritoneal inflammation. A urine sample reveals hematuria and crystalluria. Which is the next diagnostic test that should be done immediately?
  A. Ultrasound of the abdomen
  B. Abdominal x-ray
  C. Digital rectal examination
  D. Spiral CT scan

Question 2

An intravenous pyelogram should not be performed if serum creatinine is:
 
  A. Less than 1.5
  B. Greater than 1.0
  C. Greater than 1.6
  D. Less than 1.0

[Viet Thy]

Answer to Question 1

ANS: D
The initial study can be a KUB or IVP; however, many facilities can perform a stone protocol spiral CT, a much more definitive test for the evaluation of kidney stones. CT can demonstrate filling defects. CT scan is a highly specific and sensitive test for urinary tract calculi. After the initial evaluation with CT scan, pain reliever can be administered. An IVP can be done at another time when the patient can better prepare for the test.

Answer to Question 2

ANS: C
IVP (also known as intravenous urography or excretory urography) is a study for noninvasive evaluation of the renal pelvis and ureter, with moderate cost and ease of administration. It demonstrates a wide variety of upper tract lesions and is well tolerated by most patients with a serum creatinine of 1.6 or less.