Question Easy:
A 55-year-old man presents with fatigue, itching, swollen ankles, and frothy urine. A urine dipstick reveals proteinuria (+++). Which of the following is the most likely diagnosis?
A) Acute pyelonephritis
B) Nephrotic syndrome
C) Urinary tract infection
D) Glomerulonephritis
E) Renal colic
Question Medium:
A 32-year-old woman comes to the GP with recurrent urinary tract infections (UTIs), occurring every few months for the last 2 years. She is otherwise healthy and not pregnant. Which of the following is the most appropriate management for her recurrent UTIs?
A) Prophylactic antibiotics
B) Increase fluid intake
C) Cranberry juice
D) Antiseptic wipes
E) Post-coital voiding
Question Hard:
A 67-year-old man with a history of hypertension presents with sudden onset severe left flank pain and gross hematuria. On examination, the patient is mildly tender in the left flank. An abdominal ultrasound reveals a small, shrunken left kidney and a normal right kidney. What is the most likely cause of his symptoms?
A) Renal artery stenosis
B) Renal cell carcinoma
C) Ureteric stone
D) Polycystic kidney disease
E) Pyelonephritis
Explanations & Answers:
Question Easy Answer: B) Nephrotic syndrome
Question Easy Explanation: The presentation of proteinuria, oedema, and frothy urine is classic for nephrotic syndrome. According to NICE guidelines, nephrotic syndrome is characterized by significant proteinuria, hypoalbuminemia, and oedema.
Question Medium Answer: A) Prophylactic antibiotics
Question Medium Explanation: For recurrent UTIs, NICE guidelines recommend the consideration of prophylactic antibiotics in patients suffering from frequent infections. Increased fluid intake and other measures can be suggested as additional advice.
Question Hard Answer: A) Renal artery stenosis
Question Hard Explanation: The presentation is suggestive of renal artery stenosis, particularly with the findings of a shrunken kidney on ultrasound, hematuria, and flank pain. Renal artery stenosis can lead to ischemic atrophy of the affected kidney, aligning with this presentation.
Medical fact of the day: Did you know? The UK was the first country in the world to perform a successful kidney transplant in 1960 at Edinburgh Royal Infirmary!
Quote of the day: “In the art of healing, we find the courage to strive endlessly—where every small victory is a miracle and every step forward, a beacon of hope.” 🌟