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NBME 23 Answers

nbme23/Block 1/Question#42 (43.7 difficulty score)
A 68-year-old woman comes to the office ...
Retroperitoneal fibrosisπŸ”

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submitted by sajaqua1(524),
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stinkysulfaeggs  Great explanation - just one addition. The retroperitoneal fibrosis could also be a direct consequence of the external beam radiation. It's linked to both causes. Either way, it's a better fit than urothelial carcinoma (in retrospect). +13  
spow  Why would the onset be 15 years later though? +3  
drzed  I was thinking the same thing @spow. I had put urothelial carcinoma, thinking that a field defect would result in bilateral tumor. +3  

submitted by colonelred_(99),
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ehT inattep adh a lotta ceyshomyrtte os a crerueecrn of arlcvice crecna is utavliryl nto ps.olsbei areoRnpiteloert isrofisb clmonyom utsesrl morf niitrdaoa raeythp to hte ,ilvesp hcwih can edla ot tallibear rrhhydsoniopes.

submitted by mousie(211),
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yhW not raehtlliou in?cracoma rO hwo idd ouy ruel it t?uo I wsa nikghint triiadano dlowu ersaeinc risk rof feurut C..A.

submitted by temmy(127),
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tahW of fi teh ceacrn is a itlerhoalu ncaerc in teh eddbral eud to ordiiaant .phateyr dwoul it otn cusea lsramii nsgis

charcot_bouchard  Chance of bilateral ureteral ca is very rare. Also preincipal r/f for transitional cell ca is Smoking not radiation +  
peridot  Hi temmy, yes it sounds like it would. There is a similar question from NBME 21 for those who have already taken that one ( In that one, it's cancer in the uterus instead of bladder, but it's the same concept - the cancer can spread from the uterus into the bladder, or compress on the bladder, leading to bilateral hydroureter and hydronephrosis. So basically the takeaway point from that question and this question is that we learned a few things that can lead to bilateral hydronephrosis and hydroureter: 1. bladder cancer 2. uterine cancer 3. surgical and radiation treatment of cancer in that region, leading to bilateral fibrosis of the ureters. +2  
peridot  Whoop just realized that urothelial carcinoma is a possible answer choice here. Well, I'm lost.... :x +  
abcdefbhiximab  Urothelial carcinoma presents as painless hematuria with risk factors (i.e. smoking, aniline dyes) +1  
mutteringly  In addition, the wording says "distal ureteral narrowing" which wouldn't happen with bladder cancer +