Question Easy:
A 65-year-old man presents with painless haematuria. He is a non-smoker and has no history of trauma. What is the most appropriate next step in management? 🚑
A) Immediate antibiotic therapy
B) Urgent cystoscopy
C) MRI of the pelvis
D) Reassurance and follow-up in 6 months
E) Ultrasound of the kidneys
Explanations & Answers:
Question Easy Answer: B
Question Easy Explanation: Urgent cystoscopy is recommended for patients with painless haematuria to rule out bladder cancer, as per NICE guidelines. While other imaging techniques can be useful, cystoscopy provides a direct view and biopsy opportunity, making it the gold standard.
Question Medium:
A 45-year-old woman presents with recurrent urinary tract infections (UTIs). She has been treated multiple times with antibiotics without lasting relief. Which underlying condition should be considered? 🚺
A) Diabetes mellitus
B) Hyperthyroidism
C) Rheumatoid arthritis
D) Crohn’s disease
E) Asthma
Explanations & Answers:
Question Medium Answer: A
Question Medium Explanation: Recurrent UTIs can be a sign of poorly controlled diabetes mellitus. High blood sugar levels may lead to an increased risk of infections. NICE guidelines recommend screening for diabetes in individuals with recurrent UTIs.
Question Hard:
A 30-year-old male presents with severe flank pain radiating to the groin. A CT scan confirms a 7mm kidney stone in the proximal ureter. Which of the following is the most appropriate definitive management? 🏥
A) Watchful waiting with pain management
B) Percutaneous nephrolithotomy
C) Extracorporeal shock wave lithotripsy (ESWL)
D) Ureteroscopy and laser lithotripsy
E) Open surgical removal
Explanations & Answers:
Question Hard Answer: D
Question Hard Explanation: For a 7mm stone in the proximal ureter, ureteroscopy with laser lithotripsy is considered the most appropriate definitive treatment. According to NICE guidelines, this method is effective in fragmenting and removing the stone. ESWL can also be used but is less effective for stones larger than 5mm in this location.
Medical fact of the day: Did you know that chronic kidney disease (CKD) affects about 1 in 10 people in the UK? Early detection through routine screening can significantly improve outcomes and delay the progression to end-stage renal disease. (NHS)
Quote of the day: “In the chaos of medical practice, never forget that each patient relies on your compassion as much as your expertise.” 🌟