Question Easy:
A 28-year-old woman presents to the GP with dysuria, increased frequency, and suprapubic pain. She has no fever or flank tenderness. A urine dipstick shows positive nitrites and leukocytes. What is the most likely diagnosis? 🚑
A) Acute pyelonephritis
B) Interstitial cystitis
C) Bacterial cystitis
D) Urethritis
E) Renal stones
Question Medium:
A 65-year-old man with a history of hypertension and type 2 diabetes presents with swelling in his legs and shortness of breath. His serum creatinine level is significantly elevated. Urine analysis reveals proteinuria (>3.5g/day) and microscopic hematuria. What is the most likely diagnosis? 🔬
A) Nephrotic syndrome
B) Acute tubular necrosis
C) Goodpasture’s syndrome
D) Minimal change disease
E) IgA nephropathy
Question Hard:
A 45-year-old male presents with left flank pain radiating to the groin. A CT scan without contrast shows a 6 mm stone in the left distal ureter. Despite hydration and analgesia, he continues to experience significant pain. According to NICE guidelines, what is the next best step in management? 🏥
A) Continue conservative management and wait for the stone to pass
B) Extracorporeal shock wave lithotripsy (ESWL)
C) Percutaneous nephrolithotomy
D) Ureteroscopy
E) Open surgical removal
Explanations & Answers:
Question Easy Answer: C) Bacterial cystitis
Question Easy Explanation: This clinical presentation is classic for a urinary tract infection (UTI), particularly cystitis. The presence of dysuria, frequency, and suprapubic pain accompanied by positive nitrites and leukocytes on dipstick makes bacterial cystitis the most likely diagnosis. In the UK, women with uncomplicated UTIs are typically managed with a short course of antibiotics per NICE guidelines.
Question Medium Answer: A) Nephrotic syndrome
Question Medium Explanation: The patient’s presentation of significant proteinuria, microscopic hematuria, and peripheral edema aligns with nephrotic syndrome. The combination of these symptoms with his background of diabetes further supports this. NICE guidelines recommend investigation and management tailored to underlying causes of nephrotic syndrome and concurrent management of symptoms such as edema and hypertension.
Question Hard Answer: D) Ureteroscopy
Question Hard Explanation: According to NICE guidelines, if conservative measures including hydration and analgesia are ineffective for a painful 6 mm ureteric stone, ureteroscopy is indicated. It is a minimally invasive procedure that allows both diagnosis and treatment, offering an immediate solution to obstructions or stones that cannot be naturally passed.
Medical fact of the day: The kidney filters around 180 litres of blood every day, producing approximately 1.5 to 2 litres of urine. This highlights the incredible efficiency and metabolic workload of the renal system in maintaining homeostasis.
Quote of the day: “The strength of your compassion and commitment is what transforms medical practice into an act of courage and healing.”