Question Easy:
A 55-year-old man presents with reduced urine output, peripheral oedema, and hypertension. Blood tests reveal a serum creatinine of 350 µmol/L. What is the most likely diagnosis?
A) Acute kidney injury
B) Chronic kidney disease
C) Nephrolithiasis
D) Urinary tract infection
E) Benign prostatic hyperplasia
Explanations & Answers:
Question Easy Answer:
A) Acute kidney injury
Question Easy Explanation:
Acute kidney injury (AKI) is a sudden reduction in kidney function resulting in decreased urine output and increased serum creatinine. Given the patient’s acute onset of symptoms, high creatinine level, and associated signs such as oedema and hypertension, AKI is the most likely diagnosis. Chronic kidney disease (CKD) typically has a more gradual onset.
Question Medium:
A 40-year-old woman presents with recurrent UTIs. She has diabetes mellitus, and her latest urine culture shows Escherichia coli. What is the first-line treatment for her condition according to NICE guidelines?
A) Trimethoprim
B) Nitrofurantoin
C) Amoxicillin
D) Ciprofloxacin
E) Co-amoxiclav
Explanations & Answers:
Question Medium Answer:
B) Nitrofurantoin
Question Medium Explanation:
Nitrofurantoin is recommended as a first-line treatment for uncomplicated lower urinary tract infections (UTIs) in non-pregnant women, according to NICE guidelines. Given the patient’s recurrent UTIs and diabetic status, it’s crucial to treat effectively to prevent complications. Trimethoprim is another option but may not be the first choice depending on local resistance patterns.
Question Hard:
A 28-year-old woman presents with hematuria, flank pain, and a palpable mass in her abdomen. She has no significant past medical history. An abdominal CT scan reveals a 6 cm renal mass. What is the most likely diagnosis?
A) Simple renal cyst
B) Renal cell carcinoma
C) Polycystic kidney disease
D) Pyelonephritis
E) Angiomyolipoma
Explanations & Answers:
Question Hard Answer:
B) Renal cell carcinoma
Question Hard Explanation:
The combination of hematuria, flank pain, and a palpable mass is classic for renal cell carcinoma (RCC). Other differentials such as a simple renal cyst or angiomyolipoma may present similarly but are less likely to present with all three symptoms and a sizable mass. Polycystic kidney disease is typically bilateral and presents differently, and pyelonephritis would be associated with infection signs like fever and pyuria.
Medical fact of the day: Did you know? Renal cell carcinoma accounts for approximately 2-3% of all adult malignancies in the UK, with smoking being a significant risk factor.
Quote of the day: “Medicine adds life to years and years to life. Each patient encounter is an opportunity to enhance an individual’s quality of living.” 🌟