Question Easy:
A 20-year-old university student comes to the GP surgery with complaints of frequent urination, urgency, and a burning sensation during urination. She has no fever and is otherwise well. What is the most likely diagnosis?
A) Acute pyelonephritis
B) Urinary tract infection (UTI)
C) Interstitial cystitis
D) Renal colic
E) Glomerulonephritis
Explanations & Answers:
Question Easy Answer:
B) Urinary tract infection (UTI)
Question Easy Explanation:
The symptoms described, which include frequent urination, urgency, and dysuria, are classic for a urinary tract infection, commonly known as cystitis in young women. There is no systemic illness or fever, which makes more severe infections like pyelonephritis less likely. According to NHS guidelines, UTIs are common in young women and have distinct symptoms that usually do not include fever unless involving the kidneys.
Question Medium:
A 68-year-old man with a history of hypertension presents with swelling in the legs and occasional breathlessness. He has a 30 pack-year history of smoking. On examination, a right-sided varicocele is noted. What is the most likely underlying cause of his symptoms?
A) Chronic kidney disease
B) Renal cell carcinoma
C) Heart failure
D) Prostatitis
E) Nephrotic syndrome
Explanations & Answers:
Question Medium Answer:
B) Renal cell carcinoma
Question Medium Explanation:
The presence of a right-sided varicocele, especially in an older patient, is unusual and raises suspicion for a retroperitoneal mass. Renal cell carcinoma can lead to the development of a varicocele due to obstruction of the testicular vein. Other symptoms, such as swelling and breathlessness, could be associated with renal dysfunction or paraneoplastic effects. NICE guidelines suggest that any new-onset varicocele in older patients should be investigated for renal masses.
Question Hard:
A 42-year-old woman with systemic lupus erythematosus (SLE) presents to the nephrology clinic with proteinuria, hematuria, and declining renal function. A renal biopsy shows a “full house” pattern of immunofluorescence. What subtype of lupus nephritis is she most likely suffering from according to the ISN/RPS classification?
A) Class I (Minimal mesangial lupus nephritis)
B) Class II (Mesangial proliferative lupus nephritis)
C) Class III (Focal lupus nephritis)
D) Class IV (Diffuse lupus nephritis)
E) Class V (Membranous lupus nephritis)
Explanations & Answers:
Question Hard Answer:
D) Class IV (Diffuse lupus nephritis)
Question Hard Explanation:
The “full house” immunofluorescence pattern indicates the deposition of multiple immunoglobulins and complements, common in lupus nephritis. Class IV (or diffuse lupus nephritis) is characterized by extensive involvement and proliferation, explaining the severe clinical presentation with significant proteinuria and hematuria. It is the most serious form because it involves more than 50% of glomeruli, as per the International Society of Nephrology/Renal Pathology Society classification. NICE guidelines recommend aggressive treatment for Class IV due to its potential for rapid progression.
Medical fact of the day: The earliest recorded successful kidney removal was performed in 1869 in Scotland by surgeon George Grey Turner, long before modern transplant techniques were developed. Today, kidney transplants are among the most common organ transplants in the UK.
Quote of the day: “In the quiet moments of care, we find our greatest strength — for it’s not just the treatment that heals, but the compassion we give.”