Question Easy:
A 65-year-old man presents with urinary frequency, urgency, and nocturia. On digital rectal examination, his prostate feels enlarged and smooth. What is the most likely diagnosis?
A) Bladder cancer
B) Prostatitis
C) Benign prostatic hyperplasia (BPH)
D) Prostate cancer
E) Urinary tract infection (UTI)
Explanations & Answers:
Question Easy Answer: C)
Question Easy Explanation: The symptoms of urinary frequency, urgency, and nocturia in conjunction with a smooth and enlarged prostate on examination are most suggestive of benign prostatic hyperplasia (BPH). According to NICE guidelines, BPH is a common condition in older men and is marked by these typical urinary symptoms.
Question Medium:
A 30-year-old woman presents with dysuria and hematuria. A urine dipstick test shows the presence of leukocytes and nitrites. What is the most appropriate initial treatment?
A) Trimethoprim
B) Nitrofurantoin
C) Cefalexin
D) Amoxicillin
E) Ciprofloxacin
Explanations & Answers:
Question Medium Answer: B)
Question Medium Explanation: Nitrofurantoin is recommended as a first-line treatment for uncomplicated urinary tract infections in women, per NICE and BNF guidelines, due to its efficacy and safety profile. It targets the typical pathogens found in UTIs and is considered safe for most healthy, non-pregnant adults.
Question Hard:
A 50-year-old woman with a history of hypertension presents with sudden onset severe right flank pain, nausea, and microscopic hematuria. A CT scan reveals a 5mm stone in the proximal right ureter. What is the most appropriate management step if conservative treatment is favored?
A) Percutaneous nephrolithotomy
B) Extracorporeal shock wave lithotripsy (ESWL)
C) Ureteroscopy
D) Increased oral fluid intake and analgesia
E) Ureteric stent insertion
Explanations & Answers:
Question Hard Answer: D)
Question Hard Explanation: For a 5mm stone located in the ureter, conservative management with increased oral fluid intake and analgesia is a common initial approach, as recommended by NICE. Most stones of this size will pass spontaneously. If conservative management fails, more invasive options can be considered.
Medical fact of the day: Nephrologists often use a patient’s urine output as a key indicator of renal function. A noticeable reduction to less than 0.5 mL/kg/hour can signify acute kidney injury, and early intervention is vital to prevent further renal damage.
Quote of the day: “Each patient interaction is a chance to inspire hope and instill confidence. Your impact goes beyond medicine; it touches lives.”