Check out today’s Step 2 CK Qmax Question Challenge.
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A 63-year-old man presents to his physician because of low back pain and one episode of gross hematuria. He has had lower back pain, described as a dull ache just to the left of his spine, for 1 month. The pain is constant and does not radiate. He has no history of nephrolithiasis or back trauma. His temperature is 36.4°C (97.6°F) and heart rate is 68 beats/min. His abdomen is soft and nontender. He has no costovertebral angle tenderness and is able to lie on the examining table comfortably for the duration of the examination. A urine sample is noted to contain gross mucus. A plain film of the kidney and bladder shows no calcifications or other abnormalities. An ultrasound image of the kidneys and bladder shows a hypoechoic mass containing more focal hyperechoic structures located at the dome of bladder. The mass arises from the anterosuperior surface of the bladder in the midline, and is 4-6 cm in diameter. CT confirms the presence of this lesion, but does not show any extension outside of the bladder or any regional lymphadenopathy. A biopsy of the lesion is read as adenocarcinoma.
Which of the following is most likely structure of origin?
A. Lung
B. Prostate
C. Trigone of the bladder
D. Urachus
E. Ureter
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