Question Easy:
A 25-year-old woman presents with dysuria, increased urinary frequency, and urgency. 🕵️♀️ She denies fever, flank pain, or vaginal discharge. A urine dipstick test shows positive nitrites and leukocytes. What is the most likely diagnosis?
A) Pyelonephritis
B) Cystitis
C) Urethritis
D) Vaginal thrush
E) Interstitial cystitis
Explanations & Answers:
Question Easy Answer: B) Cystitis
Question Easy Explanation: The symptoms of dysuria, frequency, and urgency along with positive nitrites and leukocytes on a urine dipstick test indicate a urinary tract infection (UTI), most commonly cystitis. NICE guidelines emphasize that these signs and symptoms are typically associated with lower UTIs like cystitis.
Question Medium:
A 68-year-old man presents with hematuria and left flank pain. 🏥 Ultrasound reveals hydronephrosis. A CT scan shows a 2 cm stone in the left ureter at the pelviureteric junction. What is the initial management step?
A) Urgent nephrostomy
B) Extracorporeal shock wave lithotripsy (ESWL)
C) Observation and analgesia
D) Ureteroscopy
E) Insertion of a double J stent
Explanations & Answers:
Question Medium Answer: E) Insertion of a double J stent
Question Medium Explanation: The presence of hydronephrosis and pain suggests obstruction, which requires relief. Insertion of a double J stent is recommended to relieve obstruction and prevent renal damage, according to NICE guidelines. This form of management allows drainage of the kidney while definitive treatment of the stone is planned.
Question Hard:
A 54-year-old man with a history of type 2 diabetes presents with fatigue, pruritus, and swelling of the legs. 🔍 Blood tests reveal a GFR of 25 mL/min/1.73 m². His albumin-to-creatinine ratio is 350 mg/mmol, and HbA1c is 8.5%. Which of the following medications is most appropriate to prescribe to slow the progression of his renal disease?
A) Metformin
B) Spironolactone
C) Ramipril
D) Furosemide
E) Dapagliflozin
Explanations & Answers:
Question Hard Answer: C) Ramipril
Question Hard Explanation: In patients with diabetic nephropathy and significant proteinuria, ACE inhibitors like Ramipril are recommended by NICE guidelines to reduce proteinuria and slow renal disease progression. This patient’s reduced GFR and increased albumin-to-creatinine ratio signal significant kidney damage, and ACE inhibitors are beneficial in such scenarios.
Medical fact of the day: Nephrolithiasis, commonly known as kidney stones, affects about 10-15% of the UK population. Recurrence within 5-7 years is experienced by more than 50% of those who get a stone, emphasizing the importance of preventive measures like proper hydration. 💧🪨
Quote of the day: “In the quiet moments of care, we find the loudest echoes of compassion. Let each patient teach you as much as you heal them.”