03/09/2024 – Renal and Urology

Question Easy:
A 35-year-old male presents with a sudden onset of left-sided lower back pain, radiating to the groin, alongside haematuria. Urinalysis shows microscopic haematuria but no leukocytes or nitrites. What is the most likely diagnosis?

A) Urinary tract infection
B) Renal colic
C) Appendicitis
D) Biliary colic
E) Testicular torsion

Explanations & Answers:

Question Easy Answer: B
Question Easy Explanation: This presentation is classic for renal colic, often caused by a kidney stone. Sudden severe flank pain that radiates to the groin and is accompanied by haematuria fits well with this diagnosis. UTI, appendicitis, biliary colic, and testicular torsion would present differently.

Question Medium:
A 55-year-old woman with a history of type 2 diabetes presents with generalized oedema, proteinuria, hypoalbuminaemia, and hyperlipidaemia. What is the most likely underlying condition?

A) Chronic kidney disease
B) Diabetic nephropathy
C) Pyelonephritis
D) Nephrotic syndrome
E) Glomerulonephritis

Explanations & Answers:

Question Medium Answer: D
Question Medium Explanation: The combination of generalized oedema, significant proteinuria, hypoalbuminaemia, and hyperlipidaemia suggests nephrotic syndrome. Although diabetic nephropathy could present with proteinuria, the full nephrotic syndrome picture is more specific.

Question Hard:
A 70-year-old man presents with painless gross haematuria. He has a 40-pack-year history of smoking. Ultrasound shows a well-demarcated mass in the bladder. What is the most appropriate next step in management?

A) Immediate catheterization
B) Prescribe antibiotics and follow-up in 2 weeks
C) Refer for cystoscopy and biopsy
D) Initiate chemotherapy
E) Perform a transurethral resection of the bladder tumor (TURBT)

Explanations & Answers:

Question Hard Answer: C
Question Hard Explanation: Painless gross haematuria in an older patient with a significant smoking history is highly suspicious for bladder cancer. The next step is a cystoscopy and biopsy to confirm the diagnosis and guide further management. TURBT would be considered after diagnosis, not initially.

Medical fact of the day: The kidneys filter about 180 litres of blood every day, roughly equivalent to filtering all the blood in your body 30 times daily! This crucial function helps maintain homeostasis by removing waste products and extra fluids.

Quote of the day: “In healthcare, we offer more than treatment; we provide hope and compassion, bridging the gap between science and humanity.”