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NBME 21 Answers

nbme21/Block 4/Question#1 (50.2 difficulty score)
A 50-year-old woman has azotemia. Renal ...
Uterine cervix🔍,📺
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 +7 
submitted by hayayah(1101),
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sivaevIn ecrlaicv caornmiac is esotdascia tiwh horoydihssnrep and lrena feulira t/d CA naigrspde utrhhog trieeun llwa dna nito the le.dbdar




 +7 
submitted by hungrybox(1110),
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Teh ceirxv is eht oynl cutrtusre ttah odwlu urelst ni lbetalari loak.decb

hungrybox  hydronephrosis = dilation of kidney (usu. due to obstruction at uretopelvic junction or backflow from obstructed bladder) +2  



 +1 
submitted by meryen13(22),

so I don't think the reason for bilateral hydronephrosis is because it invated the bladder or kidneys. it is probably due to obstruction. there is a cancer in the uterine side of cervix (uterine cervix) that is big and its pushing on the bladder and its obstruction the flow of urine in ureters to bladder, so the urine backs up to the kidney and causes bilateral hydronephrosis and hydronephrosis. the kidney and ureters are full of urine and the cannot empty it to the bladder because this mass in the cervix is pushing on bladder and opening of ureters and squeezing bladder to the pubic bone.

meryen13  i hope thats helpful +  
peridot  Originally this made a lot of sense to me so thank you for contributing, but after looking more into it (on Pathoma p. 140), it specifically says that cervical carcinoma, when advanced, invades through the anterior uterine wall into the bladder and blocks the ureters. This leads to hydronephrosis. Crazy, but I guess true! +4  



 +0 
submitted by thelupuswolf(9),

To get bilateral hydroureter/hydronephrosis there needs to be an obstructive mass of some type at the level of the bladder or FURTHER downstream. Cervical CA is the only reasonable option of those listed (highly unlikely to have bilateral CA in the others)




 -2 
submitted by hyoscyamine(57),
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I nkwo htsi is tujs a gahtsrti pu cfta mfor AF, but ludnto'c serreut asirtaon(nilt clel )ocmrincaa slao be rc?ertco

hungrybox  Hmm I don't think so. The answer is "ureter" (singular) which would not result in bilateral hydronephrosis. +9  
privatejoker  If it is out of FA 2019, could someone give the page number to reference? Hydronephrosis' full definition is given on page 587 and makes no mention of invasive cervical carcinoma. +  
vinnbatmwen  p631 → Pap smear can detect cervical dysplasia before it progresses to invasive carcinoma. Diagnose via colposcopy and biopsy. Lateral invasion can block ureters - hydronephrosis - renal failure. +4  
privatejoker  Thanks! +  
emmy2k21  It's also in Pathoma page 140 in the 2018 edition! +1