A 67-Year-Old Man Comes to the Physician with Hematuria

question 636

Multiple Choice

A 67-year-old man comes to the physician with hematuria.  Three days ago, he experienced an episode of gross hematuria that resolved spontaneously.  There was no associated dysuria, fever, chills, or flank pain.  He did not pass any blood clots in his urine.  He denies bleeding or bruising elsewhere except for very rare oozing from the gums after brushing his teeth.  The patient has no history of kidney stones or recent trauma.  He awakens twice at night to urinate and has noticed a decrease in the size and force of his urine stream over the past 2 years.
His past medical history is significant for hypertension, hyperlipidemia, and coronary artery disease.  He underwent placement of 2 drug-eluting coronary artery stents after a non-ST elevation myocardial infarction 3 months ago.  His current medications include low-dose aspirin, clopidogrel, lisinopril, metoprolol, and rosuvastatin.
Physical examination is unremarkable.
Laboratory results are as follows:

Urine culture is negative.
What is the best next step in the management of this patient?

• A)CT urography followed by cystoscopy
• B)Discontinue aspirin and clopidogrel
• C)Discontinue clopidogrel
• D)Obtain coagulation studies
• E)Reassurance and repeat urinalysis in 2 weeks

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Definitions:

Lease Revenue Recognition

The process of recognizing income earned from leasing out assets over the lease term.

Lease Liability

An obligation representing the present value of lease payments due over the lease term by the lessee.

Executory Costs

Ongoing operational expenses related to a leased asset, typically including insurance, maintenance, and taxes, that are usually paid for by the lessee.

Salvage Value

Salvage value is the estimated resale value of an asset at the end of its useful life.