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Subject: Tommy's Concepts

Subject: Tommy's Concepts
Tommy's Concepts for the USMLE Step 1


You have seen over 2000 patients without any sleep.  It is a world record!  But you are now feeling palpitations and you are diaphoretic.  Still, you must go on.  You open the door to see a 60-year-old male with ONE episode of gross, painless hematuria. There is no history of trauma, and further questioning determines that he has complete hematuria, rather than initial  hematuria. Pt. Does not smoke, drink or do drugs and has had no other symptoms referable to the urinary tract. He has no known allergies. Physical examination, including rectal examination (medical student consult alert!) , is unremarkable with a NORMAL temperature.  A previous CT scan of the pelvis two months ago revealed no abnormalities.  Hs urinalysis is normal and shows no red cell casts. His hematocrit is 45%. Hemoglobin is 14.  What do you tell the patient you will do to find the DIAGNOSIS or the SOURCE???<br />
1-Nothing, repeat observation in two weeks<br />
2-Refer to Urology<br />
3-Pyelogram and cystoscopy<br />
4-Urine analysis and assess <br />
5-Find the PSA level<br />
6-Find the CEA level<br />
7-Do a prostate biopsy<br />
8-Do a repeat CT scan of the pelvis to assess for diverticulosis<br />
9-Do a KUB<br />
10-Do a pyelogram<br />
11-Infuse with 4 units of Packed RBCs<br />
12-Give antibiotics to cover for a UTI