Question Easy:
A 28-year-old male presents with severe left-sided flank pain radiating to the groin. He describes the pain as intermittent and colicky. He has noticed some blood in his urine but no fever. What is the most likely diagnosis? 😊
A) Urinary tract infection (UTI)
B) Pyelonephritis
C) Kidney stones
D) Bladder cancer
E) Appendicitis
Question Medium:
A 65-year-old man with a history of hypertension and diabetes presents with swelling in his legs and a frothy appearance to his urine. Urine dipstick reveals proteinuria and no hematuria. Which of the following is the most likely diagnosis?
A) Acute tubular necrosis
B) Chronic kidney disease
C) Nephrotic syndrome
D) Nephritic syndrome
E) Renal artery stenosis
Question Hard:
A 50-year-old woman presents with fatigue, pruritus, and a history of recurrent headaches. Lab tests indicate high serum calcium and high parathyroid hormone levels. Renal ultrasound shows bilateral nephrocalcinosis. What is the most likely underlying cause of her renal condition? 🚑
A) Paget’s disease
B) Vitamin D deficiency
C) Primary hyperparathyroidism
D) Sarcoidosis
E) Renal tubular acidosis
Explanations & Answers:
Question Easy Answer: C) Kidney stones
Question Easy Explanation: The presentation of severe flank pain radiating to the groin, especially if intermittent and colicky, is very typical of renal colic due to kidney stones. Hematuria is a common associated finding. According to NICE guidelines, sudden, severe, “loin to groin” pain is highly indicative of a kidney stone.
Question Medium Answer: C) Nephrotic syndrome
Question Medium Explanation: The presence of significant proteinuria, particularly in the absence of hematuria, with oedema (swelling of legs), and frothy urine strongly suggests nephrotic syndrome. NICE guidelines highlight nephrotic syndrome as characterized by heavy proteinuria, hypoalbuminemia, and oedema. In diabetes, nephrotic syndrome can occur due to diabetic nephropathy.
Question Hard Answer: C) Primary hyperparathyroidism
Question Hard Explanation: The combination of hypercalcemia, elevated parathyroid hormone, and nephrocalcinosis is indicative of primary hyperparathyroidism. This condition causes increased calcium reabsorption, leading to high serum calcium levels and renal calcification. The fatigue, pruritus, and recurrent headaches can also be symptoms associated with hypercalcemia. NICE guidelines and the BNF recommend assessing parathyroid hormone levels if hypercalcemia and nephrocalcinosis are present.
Medical fact of the day: In patients with autosomal dominant polycystic kidney disease (ADPKD), it’s not uncommon to see liver cysts in addition to kidney cysts. Regular monitoring for hypertension and renal function decline is essential, aligning with UK practice guidelines.
Quote of the day: “In medicine, as in life, it’s the meticulous details that craft the masterpiece of care.” 🌿