NBME 23 Answers ↦
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
2019-07-14T15:08:22Z
spow
Why would the onset be 15 years later though?
+3
2020-01-29T04:55:56Z
drzed
I was thinking the same thing @spow. I had put urothelial carcinoma, thinking that a field defect would result in bilateral tumor.
+3
2020-02-06T17:50:16Z
charcot_bouchard
Chance of bilateral ureteral ca is very rare. Also preincipal r/f for transitional cell ca is Smoking not radiation
+
2019-08-11T13:58:36Z
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 (https://nbmeanswers.com/exam/nbme21/744). 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
2020-04-29T22:03:41Z
peridot
Whoop just realized that urothelial carcinoma is a possible answer choice here. Well, I'm lost.... :x
+
2020-04-29T22:04:55Z
abcdefbhiximab
Urothelial carcinoma presents as painless hematuria with risk factors (i.e. smoking, aniline dyes)
+1
2020-05-02T17:35:30Z
mutteringly
In addition, the wording says "distal ureteral narrowing" which wouldn't happen with bladder cancer
+
2020-05-22T05:08:50Z
submitted by sajaqua1(524), 2019-06-04T21:50:10Z
The tpetnai ahs a pirro ishryot of shoeemtrtycy tihw atrbillae oagopmosonelhcp-toiry, and eicvrede eatlnxre meba otniiarad to eth vsil.pe heT ttnaipe own lpssdayi hnieyosrposhrd dna edrehur,ytro iwth asdlti ereaturl orrgaiwnn lraitleyl.ab eTh eistkilel ontopi si atth we rea geesin ediaohsns romf oipurevs uyrrseg scntoctri hte t,eersur aiunsgc .thsi
E) oiatUehrll anccrmoai sloa( elcadl sniaianrlott clel or)cncamia is aols a otisl.yipisb haWt aesmk sthi niykluel is het ot:cnolia trliealab. hTe piorr rmoyteeycsht and teaiballr oghpopc-insrlayotoome udlwo ealve csra sestiu on hotb issed fo het ybo,d tub eth dsdo of llhaotrieu ccaimonar naigirs ltlyairleab are ryve lmis.
)A Teh tniepta dha a tmysoyehtec,r os the dods fo rrnruetce ccrivael rcimanoac aer olsa rbdiielncy .wlo C) and D) haUerrlt ncmdloyao nda ulrhtaer iotrsaitnaln lelc ploamilap rae in hte gonrw cintlaoo to ccouatn fro tailrleba rleauhrt rnagirwon ithw yhrorerted.u