USMLE-Rx Step 2 Qmax Challenge #21652

Check out today’s Step 2 CK Qmax Question Challenge.

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A 78-year-old man presents to his physician complaining of a bulge in his groin that has gradually enlarged over the past year. It is less prominent when he lies on his back. He also has type 2 diabetes mellitus. He notes that he has had to get up three times each night to urinate for the past several years. During the day he feels the need to urinate every hour, though he often strains and experiences dribbling of urine. Otherwise, he has felt well, and denies any fevers, weight loss, abdominal pain, nausea, vomiting, or change in bowel habits. Physical examination shows a slightly distended abdomen with pain on palpation below the umbilicus. There is a bulging mass on the patient’s left medial thigh that is 4-5 cm in diameter. The mass easily reduces and is not visible when the patient is lying down. A digital rectal examination reveals an enlarged prostate; stool is guaiac negative.

Which of the following will alleviate this patient’s symptoms?

A. Bladder augmentation
B. High-fiber diet and stool softeners
C. Pyeloplasty
D. These findings are an unavoidable consequence of aging
E. Transurethral prostate resection
F. Ureteral reimplantation


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4 thoughts on “USMLE-Rx Step 2 Qmax Challenge #21652”

  1. Ans is E.
    TURP for prostatomegaly associated with LUTS
    I’m guessing the swelling is a hernia, which is not a cause of patient’s current urinary complaints.

  2. E it seems that the patient has symptoms of a benign prostatic hypertrophy. As for the bulge on the L medial thigh that is present when standing and disappears when prone, I vote for a hernia.

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