WBR0566

Author	Vendhan Ramanujam
Exam Type	USMLE Step 3
Main Category	Inpatient Facilities, Emergency Room
Sub Category	Genitourinary, Surgery
Prompt	A 20 year old high school football player is brought to emergency room with the complaint of passing blood in his urine. He developed this complaint three hours after his football match when he got kicked in his left flank. Physical examination does not reveal any significant finding. His vital signs are heart rate 70 beats/min, respiratory rate 16/minute, blood pressure 110/70 mm Hg and oral temperature 36.8 C. Along with the initial diagnostic tests in the emergency room, an intravenous pyelography was done for a suspected genitourinary tract injury. The diagnostic test performed, revealed an extravasation of contrast into the renal parenchyma. Treatment of this patient should consist of
Answer A	Exploration and suture of laceration
Answer A Explanation	Incorrect-Since the patient is stable following a blunt trauma to his kidney, surgical exploration and treatment is not indicated. Failure of a conservative treatment might indicate the necessity for a surgical intervention.
Answer B	Exploration and wedge resection of left kidney
Answer B Explanation	Incorrect-Since the patient is stable following a blunt trauma to his kidney, surgical exploration and treatment is not indicated. Failure of a conservative treatment might indicate the necessity for a surgical intervention.
Answer C	Nephrostomy
Answer C Explanation	Incorrect-Since the patient is stable following a blunt trauma to his kidney, surgical exploration and treatment is not indicated. Failure of a conservative treatment might indicate the necessity for a surgical intervention.
Answer D	Resumption of normal daily activities, excluding sports
Answer D Explanation	Incorrect-Bed rest reduces the likelihood of secondary hemorrhage. So resumption of normal daily activities, excluding sports is not advisable.
Answer E	Antibiotics and serial monitoring of blood count and vital signs
Answer E Explanation	Correct-Seventy to eighty percent of patients with blunt renal trauma are successfully treated nonsurgically. Bed rest may reduce the likelihood of secondary hemorrhage; antibiotics may reduce the chance of development of infection in a perirenal hematoma. Monitoring of blood count and vital signs will be essential in case of secondary bleeding.
Right Answer	E
Explanation	Seventy to eighty percent of patients with blunt renal trauma are successfully treated nonsurgically. Bed rest may reduce the likelihood of secondary hemorrhage; antibiotics may reduce the chance of development of infection in a perirenal hematoma. Fever, increasing leukocytosis, evidence of secondary hemorrhage, and persistent or increasing pain and tenderness in the region of the kidney are the indicators of failure of conservative treatment. Educational Objective: Conservative treatment with bed rest and antibiotics is indicated in patients with blunt renal trauma. Failure of the conservative treatment may indicate the necessity for a surgical intervention. Educational Objective: References:
Approved	Yes
Keyword	Genitourinary injury
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