NBME Step 2 CK Form 7 Renal ultrasonography (NBME Answers)

NBME Step 2 CK Form 7 Answers

step2ck_form7/Block 2/Question#20 (reveal difficulty score)
A 62-year-old woman is admitted to the ...
Renal ultrasonography 🔍 / 📺 / 🌳 / 📖
tags: renal inc

+2 upvote downvote
submitted by ∗step_prep5(246)

get full access to all content ⋅ pick a username

Middle-aged woman with a recent GU surgery who develops a significant AKI with a BUN:creatinine ratio < 15 with a bland urinalysis, most concerning for a post-renal AKI secondary to ureteral damage, which would be worked-up with a renal ultrasound looking for hydronephrosis
Key idea: GU surgeries in women are highly associated with damage to the ureters, which can lead to a post-renal AKI (VERY HIGH YIELD FOR NBME EXAMS!)

https://step-prep.org/tutoring/

get full access to all content ⋅ pick a username

iluvlamp The question shows the labs/findings prior to the surgery, not s/p GU surgery. I think your explanation is still valid though physiologically because maybe the tumor is compressing the ureter, causing a post-renal AKI. Still agree ureter damage from GU surgery is mega high yield. +13

antwon This all makes sense, but isn't it true that renal ultrasonography cannot detect distal ureter damage? +3

+0 upvote downvote
submitted by ∗charcot_bouchard(574)

get full access to all content ⋅ pick a username

I feel the discussion is missing the key points here. Any one after step 1 will know this is ureter damage board has a hard on for following any ovarian/uterine procedure.

Ques is which test - Urine culture, renal biopsy is easy to rule out. nothing for ureter. Renal arteriography is also same. Nothing say about ureter.

I picked IVU which seem reasonable to me because it is the one most specific for ureter and overall help assess the kidneys, ureters, bladder, and urethra for any extravasation of contrast dye

And that's the key. U cant give contrast to a patient who has creatinine of 5. Its contraindicated. So and is USG.

get full access to all content ⋅ pick a username

azibird Patient is PREoperative. We're looking for hydronephrosis to confirm post-renal obstruction. +1

+0 upvote downvote
submitted by ∗jlbae(159)

get full access to all content ⋅ pick a username

Renal US is inexpensive, fast, and noninvasive. Definitely the best first test for imaging postrenal AKI.

get full access to all content ⋅ pick a username

+0 upvote downvote
submitted by ∗duat98(39)

get full access to all content ⋅ pick a username

An ovarian mass in a female with weight loss + renal failure = ovarian cancer met to the renal system. The next step is US to look for the mass etc

get full access to all content ⋅ pick a username

Must-See Comments from step2ck_form7

seagull on Analgesic therapy
athleticmedic on Uterine atony
seagull on Haemophilus influenzae
jlbae on Lorazepam therapy
seagull on Spondylolisthesis
carolebaskin on B lymphocyte
yotsubato on Indomethacin
yotsubato on Uterine atony
study_dude_guy on Bone marrow aspiration
chris07 on Heat stroke
osler_weber_rendu on Compression fracture
buttercup on Repeat blood pressure measurement in 4 weeks
step_prep5 on CT scan of the head
thajoker on Brisk rotatory nystagmus on left lateral gaze