NBME Step 2 CK Form 7 Renal ultrasonography (NBME Answers)

Retired NBME Step 2 CK Form 7 Answers

step2ck_form7/Block 2/Question#20 (reveal difficulty score)
A 62-year-old woman is admitted to the ...
Renal ultrasonography 🔍 / 📺 / 🌳 / 📖
tags: renal inc

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submitted by ∗step_prep5(246)

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Middle-aged woman with a recent GU surgery who develops a significant AKI with a BUN:creatinine ratio < 15 with a bland urinalysis, most concerning for a post-renal AKI secondary to ureteral damage, which would be worked-up with a renal ultrasound looking for hydronephrosis
Key idea: GU surgeries in women are highly associated with damage to the ureters, which can lead to a post-renal AKI (VERY HIGH YIELD FOR NBME EXAMS!)

https://step-prep.org/tutoring/

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iluvlamp The question shows the labs/findings prior to the surgery, not s/p GU surgery. I think your explanation is still valid though physiologically because maybe the tumor is compressing the ureter, causing a post-renal AKI. Still agree ureter damage from GU surgery is mega high yield. +13

antwon This all makes sense, but isn't it true that renal ultrasonography cannot detect distal ureter damage? +3

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submitted by ∗charcot_bouchard(574)

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I feel the discussion is missing the key points here. Any one after step 1 will know this is ureter damage board has a hard on for following any ovarian/uterine procedure.

Ques is which test - Urine culture, renal biopsy is easy to rule out. nothing for ureter. Renal arteriography is also same. Nothing say about ureter.

I picked IVU which seem reasonable to me because it is the one most specific for ureter and overall help assess the kidneys, ureters, bladder, and urethra for any extravasation of contrast dye

And that's the key. U cant give contrast to a patient who has creatinine of 5. Its contraindicated. So and is USG.

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azibird Patient is PREoperative. We're looking for hydronephrosis to confirm post-renal obstruction. +1

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submitted by ∗jlbae(159)

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Renal US is inexpensive, fast, and noninvasive. Definitely the best first test for imaging postrenal AKI.

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submitted by ∗duat98(39)

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An ovarian mass in a female with weight loss + renal failure = ovarian cancer met to the renal system. The next step is US to look for the mass etc

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