On DRE, you note that a 45-year-old patient has a firm, smooth, ...

[Sportsfan2111]

On DRE, you note that a 45-year-old patient has a firm, smooth, non-tender but asymmetrically shaped prostate. The patient has no symptoms and has a normal urinalysis. The patient's PSA is within normal limits for the patient's age.
 
  The clinician should:
  A. Refer the patient for transrectal ultrasound guided prostate biopsy
  B. Obtain an abdominal x-ray of kidneys, ureter, and bladder
  C. Recognize this as a normal finding that requires periodic follow-up
  D. Obtain urine culture and sensitivity for prostatitis

Question 2

The most common complication of an untreated urinary obstruction due to a ureteral calculus is:
 
  A. Hydronephrosis
  B. Renal artery stenosis
  C. Ureteral rupture
  D. Kidney mass

[vish98]

Answer to Question 1

ANS: C
An asymmetric prostate is typically asymptomatic and not necessarily diagnostic of prostate cancer; asymmetry can be a normal finding on DRE but should be followed periodically to monitor for changes. Age-specific reference ranges for PSA (see Table 11.4) should be used as a guide when there is no previous PSA for comparison. A prostatic nodule found on DRE necessitates a referral to a urologist or radiologist for transrectal ultrasound-guided prostate biopsy and may well be the first indication of the presence of a cancer.

Answer to Question 2

ANS: A
Hydronephrosis is swelling of the renal pelvis caused by an obstructing stone, ureteral stricture, prostatic hyperplasia, or renal or abdominal tumor that prevents the kidney from draining. The obstruction can be unilateral or bilateral, symptoms can be sudden or gradual in onset, and progressive renal damage will occur with time.

[Sportsfan2111]

Excellent

[peter]

TYSM