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NBME 20 Answers

nbme20/Block 2/Question#19 (50.3 difficulty score)
A 66-year-old man is brought to the emergency ...
Cigarette smoking🔍

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submitted by hayayah(990),
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sI't satantnioril lcle naicoac,rm iwhch onmgiks is a monomc ksir cfotar ;ofr it anc vonevil hte lrnea clilce/ The iosht gaime hsosw hte rlappliya aentur of hte rumot veh(ewor it anc lsoa be lfta ro lanudor rgoaccdni ot taho.a)Pm

Also nnkwo sa eoialrhutl n.ocarcmai Mtso moocnm omtru fo yuarrni tract ytmsse nc(a ucroc in rlaen laecy,sc relna lpvi,es er,rtsue dan Can eb gutgeessd yb elassnpi arthaueim o(n sts)c.a

hello_planet  FA 2019 pg 588 +1  
kevin  Is the idea since that since the histology shows transitional cell cancer the most likely is smoking and that's the answer? The fact that this was unilateral really threw me off. Is it common to have unilateral carcinoma of the ureter (if that's what this case was, of the ureter) rather than bilateral? +  

submitted by step1soon(43),

Etiology → Cigarette smoking is major risk factor (50-80% of cancers, risk associated with duration and intensity) Also arylamines (2-naphthylamine) and aniline dyes In developing countries, Schistosoma haematobium ova are deposited in bladder wall and cause chronic inflammation, squamous metaplasia, dysplasia; 70% of tumors are squamous cell carcinoma HPV may cause condyloma, squamous dysplasia, squamous cell carcinoma sequence Phenacetin use (usually long term use in younger women, tumors involve upper collecting system) Chronic urinary tract infection and calculi Rarely cyclophosphamide with long term use

submitted by chandlerbas(86),

SPOLIER ALERT for future readers, the content following may contain subjects seen in other NBMEs

submitted by chandlerbas(86),

either bladder cancer (unilateral in this case) or transitional cell carcinoma (also uni) are precipitated by smoking inhalant toxic injury. BUT what matters more than the cause is that the reader recognize that this is without a doubt

obstructive hydronephrosis with dilated pelvicalyceal system and cortex of kidney showing atrophy and thinning.

Assuming that the pt lost blood from the MVA - this would further enhance the renal ischemia (PCT and ascending LOH are both very sensitive to ischemic conditions 30 minutes of blood loss is enough to exacerbate the already ischemic conditions.

submitted by monoloco(125),
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sI tsih hte eon whti the proo inkdey thta wsa tcu ni hafl naatisg tis wlil dan sha a ddlieta adlsit truee?r If so, aolpbbry gnwhsio su antroilsniat mcaarnico hitw ldim aiivnnos into taht slidat e.retru mahtaoP dsoe a tyeptr mwsoeea jbo of nialktg utoab GU canrecs nad( msot )rncscae ((adn stmo dnime)cie) .OIM

submitted by lancestephenson(27),
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hisT si TALRYLEIL eth esam othpo heyt edus to rbiesecd eht --lda4reoy ybo iwth fsedfiu arlccoit srensico mrof ENMB .81 Cna ensmooe nixpela thasw' iongg on rhee

lancestephenson  *Tubular atrophy, not cortical necrosis lol +  
charcot_bouchard  Can u fuckers talk about spoilers +1  
adong  same photo because the end gross pathology is the same. whether it's due to cancer or whatever the 4 year old boy had (some sort of obstruction IIRC) it ends with atrophy of the kidneys +