Question Easy:
A 23-year-old woman presents to her GP with dysuria, increased frequency of urination, and suprapubic pain. She has no vaginal discharge and is otherwise well. What is the most likely diagnosis?
A) Pyelonephritis
B) Cystitis
C) Urethritis
D) Vaginitis
E) Interstitial cystitis
Question Medium:
A 55-year-old man with a history of type 2 diabetes and hypertension presents with increasing oedema and frothy urine. He denies any hematuria. Blood tests reveal hypoalbuminemia and hyperlipidemia. What is the most likely underlying pathology?
A) Acute interstitial nephritis
B) IgA nephropathy
C) Nephrotic syndrome
D) Goodpasture’s syndrome
E) Post-streptococcal glomerulonephritis
Question Hard:
A 47-year-old man presents to the emergency department with severe right flank pain that radiates to the groin, nausea, and hematuria. He has had similar episodes before. A non-contrast CT of the abdomen confirms a 5 mm stone at the right distal ureter. What is the most appropriate management?
A) Extracorporeal shock wave lithotripsy
B) Ureteroscopy
C) Percutaneous nephrolithotomy
D) NSAIDs and fluids
E) Alpha-blocker therapy
Explanations & Answers:
Question Easy Answer: B) Cystitis
Question Easy Explanation: The symptoms of dysuria, increased frequency of urination, and suprapubic pain are classic for cystitis (bladder infection). This is especially likely in a young woman without any signs of systemic involvement or vaginitis.
Question Medium Answer: C) Nephrotic syndrome
Question Medium Explanation: The combination of oedema, frothy urine, hypoalbuminemia, and hyperlipidemia suggests nephrotic syndrome. In this condition, there’s increased glomerular permeability leading to significant proteinuria, which explains the hypoalbuminemia and associated symptoms.
Question Hard Answer: D) NSAIDs and fluids
Question Hard Explanation: For a 5 mm ureteral stone causing symptoms, conservative management with NSAIDs for pain and increased oral fluid intake can be effective in facilitating the passage of the stone. NICE guidelines suggest this approach for stones less than 5-7 mm, reserving more invasive measures for stones that fail to pass or cause complications.
Medical fact of the day: Did you know that kidney stones are more common in men than in women and are most prevalent between the ages of 40 and 60? Early dietary and lifestyle modifications can play a crucial role in reducing the risk of recurrence.
Quote of the day: “In the art of medicine, compassion, courage, and commitment are the most powerful remedies a caregiver can offer.”