Question Easy:
A 25-year-old man presents to the GP with dysuria and increased urinary frequency. He has no fever or back pain. What is the most likely diagnosis?
A) Acute pyelonephritis
B) Cystitis
C) Urethritis
D) Prostatitis
E) Renal colic
Question Medium:
A 67-year-old man with a history of hypertension and diabetes presents with sudden onset of severe left flank pain. He also has hematuria. An abdominal ultrasound shows a 6 mm obstruction in the left ureter. What is the most appropriate first-line management strategy?
A) Immediate surgical removal
B) Oral antibiotics
C) Alpha-blockers
D) Admission and IV antibiotics
E) Observation and increased fluid intake
Question Hard:
A 43-year-old woman with a history of recurrent calcium oxalate kidney stones presents for evaluation. Urine studies reveal hypercalciuria and low urinary citrate levels. What dietary change would most likely reduce her risk of recurrent kidney stones?
A) Increase dietary sodium
B) Decrease dietary calcium
C) Increase dietary calcium
D) Decrease dietary potassium
E) Decrease fluid intake
Explanations & Answers:
Question Easy Answer: B) Cystitis
Question Easy Explanation: The symptoms described are characteristic of cystitis, a lower urinary tract infection often presenting with dysuria and frequent urination without systemic signs such as fever or flank pain, which are more suggestive of pyelonephritis.
Question Medium Answer: C) Alpha-blockers
Question Medium Explanation: Alpha-blockers, such as tamsulosin, are recommended to help facilitate the passage of stones in the ureter, especially in those measuring between 5-10 mm. This aligns with NICE guidelines favoring medical expulsive therapy for ureteric stones in this size range.
Question Hard Answer: C) Increase dietary calcium
Question Hard Explanation: Counterintuitively, decreasing dietary calcium can increase the risk of calcium oxalate kidney stones. Consuming an adequate amount of calcium can help bind dietary oxalate in the gut, reducing its absorption and subsequent urinary excretion, hence reducing stone formation. This is in line with dietary recommendations for calcium oxalate stone prevention in the UK.
Medical fact of the day: Did you know that the UK was among the first to develop guidelines for managing chronic kidney disease (CKD) in primary care? These guidelines emphasize risk factor modification to slow CKD progression, aiming to improve patient outcomes in a community setting.
Quote of the day: “In the eyes of your patients, you are a beacon of hope; let your dedication light the path to their healing.”