nbme 2 : block : 6 - orthop

[ArchivalUser]

6.) A 5-year-old boy is brought to the physician 1 hour after
urinating bright red blood. He has been taking ibuprofen since injuring his
right flank while wrestling with friends yesterday; he also has been
taking penicillin for 3 days for streptococcal pharyngitis. His
temperature is 36.7 C (98 F), blood pressure is 90/48mm Hg, pulse is 108/min,
and respirations are 18/min. Examination shows purple ecchymoses over
the shins and right flank; there is tenderness of the right
costovertebral area. The abdomen is nontender. Genital examination shows no
abnormalities. There is no edema. Urinalysis shows gross blood;
microscopic examination shows 5“10 leukocytes/hpf and erythrocytes that
are too numerous to count. Which of the following is the most likely
explanation for this patient's hematuria?

A) Acute pyelonephritis

B) Ibuprofen-induced acute papillary necrosis

C) Post-streptococcal glomerulonephritis

D) Rhabdomyolysis

E) Traumatic injury to the kidney

[ArchivalUser]

E renal trauma delayed beeding

[ArchivalUser]

Definitely we shoud R/o the traumatic injury.So E is correct

[ArchivalUser]

conf is btw b & e

[ArchivalUser]

analgesic induced pap. necrosis requires 3 pills per day for 6 yrs ingestion . not a idiosyncratic rxn
so ans shud be e

[ArchivalUser]

Why not D

[ArchivalUser]

i was thinking of DDD also

[ArchivalUser]

not d....microscopic exam shown rbcs...in rhabdo der will be hematuria but no rbcs...

[ArchivalUser]

i mean hematuria is due to myoglobin

[ArchivalUser]

post -strep gn -- The disorder may develop 1 - 2 weeks after an untreated throat infection, or 3 - 4 weeks after a skin infection.

rhabdomyolysis - no RBCs in urine

acute papillary necrosis - The most common presenting symptoms in symptomatic patients include fever and chills, flank and/or abdominal pain, and hematuria. here abdo is non tender.

Acute pyelonephritis- abdo pain, rigors etc will be present.

s0 i guess the answer will be e