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NBME 20 Answers

nbme20/Block 2/Question#19

A 66-year-old man is brought to the emergency ...

Cigarette smoking

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 +4  upvote downvote
submitted by hayayah(525),

It's transitional cell carcinoma, which smoking is a common risk factor for; it can involve the renal pelvis/calyces. The histo image shows the papillary nature of the tumor (however it can also be flat or nodular according to Pathoma).

Also known as urothelial carcinoma. Most common tumor of urinary tract system (can occur in renal calyces, renal pelvis, ureters, and bladder). Can be suggested by painless hematuria (no casts).

usmlecrasher  i'm sorry guys it's bladder cancer blocking urine flow => reflux ureteral widening => reflux nephropathy. +1  

 +3  upvote downvote
submitted by step1soon(20),

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

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.

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

 -1  upvote downvote
submitted by monoloco(77),

Is this the one with the poor kidney that was cut in half against its will and has a dilated distal ureter? If so, probably showing us transitional carcinoma with mild invasion into that distal ureter. Pathoma does a pretty awesome job of talking about GU cancers (and most cancers) ((and most medicine)) IMO.

This is LITERALLY the same photo they used to describe the 4-year-old boy with diffuse cortical necrosis from NBME 18. Can someone explain what's going on here

lancestephenson  *Tubular atrophy, not cortical necrosis lol +  
charcot_bouchard  Can u fuckers talk about spoilers +  
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 +