Question Easy:
A 25-year-old man presents to the GP with dysuria and increased frequency of urination. He has no fever or back pain. A urine dipstick test shows leukocytes and nitrates. What is the most likely diagnosis?
A) Cystitis
B) Pyelonephritis
C) Urethritis
D) Prostatitis
E) Nephrolithiasis
Explanations & Answers:
Question Easy Answer:
A) Cystitis
Question Easy Explanation:
The presentation of dysuria, frequency, and the presence of leukocytes and nitrates on a urine dipstick is typical of a lower urinary tract infection, specifically cystitis. Pyelonephritis would more likely present with systemic symptoms like fever and back pain. Nitrates in the urine are indicative of bacterial infection, commonly seen in cystitis.
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Question Medium:
A 50-year-old woman with a history of recurrent urinary tract infections is found to have a renal stone on imaging. The composition of the stone shows magnesium ammonium phosphate. Which of the following is the predisposing factor for the formation of this type of stone?
A) Hypercalciuria
B) Hyperuricemia
C) Presence of urease-producing bacteria
D) Low urine pH
E) High oxalate intake
Question Medium Answer:
C) Presence of urease-producing bacteria
Question Medium Explanation:
Struvite stones, composed of magnesium ammonium phosphate, are often associated with chronic urinary tract infections with urease-producing bacteria such as Proteus species. These bacteria raise the urine pH to create an alkaline environment, facilitating struvite stone formation.
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Question Hard:
A 67-year-old man with a 40-pack-year smoking history presents with painless hematuria. Imaging reveals a mass originating in the right renal pelvis. Which of the following is the most likely histological type of this tumour?
A) Renal cell carcinoma
B) Transitional cell carcinoma
C) Squamous cell carcinoma
D) Wilms’ tumour
E) Oncocytoma
Question Hard Answer:
B) Transitional cell carcinoma
Question Hard Explanation:
The renal pelvis and ureter are lined by transitional epithelium, making transitional cell carcinoma the most likely histological type in this location, especially in a patient with a significant smoking history. Renal cell carcinoma typically arises from the renal parenchyma.
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Medical fact of the day:
🚰 Did you know that the kidneys filter approximately 180 litres of blood each day, yet only about 1 to 2 litres of urine are produced? This process is crucial for maintaining the body’s electrolyte balance and removing waste products.
Quote of the day:
“In the world of healthcare, your compassion is the heartbeat, and every gesture is a step towards healing.” 🌟