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NBME 18 Answers

nbme18/Block 4/Question#7 (reveal difficulty score)
A 64-year-old man with non-Hodgkin lymphoma ...
Bilateral stents in the ureters ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

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submitted by โˆ—adong(144)

This is a case of late post-renal azotemia, as you can tell by the BUN/Cr ratio that is <15 and the 3 day history of pain. They also tell you that the hydronephrosis and lymphadenopathy are compressing the ureters so it makes sense that you would want to stent the ureters. The others are all in the wrong location: Foley catheter (penis), suprapubic tube (bladder), stent in renal arteries (self explanatory).

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plaguedbyspleen  And just for further explanation (and correct me if I'm mistaken), the BUN/Cr ratio is low because both BUN and Cr are elevated. Think about the increased hydrostatic pressure in the collecting duct pushing more water back into the blood. With water goes BUN. Also keep in mind that this patient has bilateral obstruction of the ureters but if the obstruction was unilateral you could see a normal ratio because the healthy kidney would be compensating. +1

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