Question Easy:
A 32-year-old woman presents with dysuria, urgency, and increased frequency of urination. She has no fever or flank pain. Urinalysis shows the presence of white blood cells and nitrites. What is the most likely diagnosis? 🚻
A) Acute pyelonephritis
B) Interstitial cystitis
C) Acute cystitis
D) Urethral syndrome
E) Vaginitis
Question Medium:
A 55-year-old man with chronic kidney disease (CKD) stage 4 has been noted to have hyperphosphatemia. According to NICE guidelines, which initial management step is recommended? 🧪
A) Initiate oral phosphate binders
B) Start high-dose vitamin D supplements
C) Increase dietary phosphate intake
D) Commence dialysis
E) Prescribe a low-phosphate diet
Question Hard:
A 68-year-old man presents with hematuria and a palpable mass in the left flank. Ultrasound reveals a 5 cm hypervascular mass in the left kidney. CT scan furthers identifies the mass with irregular borders and possible para-aortic lymphadenopathy. Which treatment option is most suitable for this patient assuming the renal mass is malignant and the patient is fit for surgery? 🏥
A) Active surveillance
B) Partial nephrectomy
C) Radical nephrectomy
D) Percutaneous ablation
E) Radiotherapy
Explanations & Answers:
Question Easy Answer:
C) Acute cystitis
Question Easy Explanation:
The patient’s symptoms of dysuria, frequency, and urgency, along with the presence of white blood cells and nitrites on urinalysis, are characteristic of a urinary tract infection (UTI), also known as acute cystitis. According to NICE guidelines, these features are typically found in uncomplicated UTIs in women.
Question Medium Answer:
E) Prescribe a low-phosphate diet
Question Medium Explanation:
In patients with CKD, managing hyperphosphatemia initially involves dietary modifications. NICE guidelines recommend starting with a low-phosphate diet. Oral phosphate binders may be considered if dietary measures alone are insufficient to control phosphate levels.
Question Hard Answer:
C) Radical nephrectomy
Question Hard Explanation:
Given the patient’s age, enlarged mass with suspected malignant features, and possible lymphadenopathy, the most appropriate and definitive treatment would be a radical nephrectomy. This option aligns with current UK guidelines for treating renal cell carcinoma, particularly for localized renal tumors >4cm with no significant comorbidities prohibiting surgery.
Medical fact of the day:
Did you know that the kidneys filter approximately 180 liters of blood each day? This makes them incredibly efficient, considering the average human body contains only about 5-6 liters of blood. They filter all the body’s blood roughly every 30 minutes! 🩺
Quote of the day:
“In the vast ocean of healthcare, compassion is the vessel that guides us safely through the storms.” 🌊