Question Easy:
A 27-year-old man presents with dysuria and increased urinary frequency. He denies any fever or flank pain. On examination, his vital signs are stable, and there is no costovertebral angle tenderness. What is the most likely diagnosis? 🚽
A) Acute pyelonephritis
B) Cystitis
C) Prostatitis
D) Urethritis
E) Nephrolithiasis
Question Medium:
A 50-year-old woman is admitted with severe colicky left flank pain radiating to the groin. She has vomiting and hematuria. A non-contrast CT scan shows a 4mm stone in the proximal left ureter. What is the best initial management? 🔎
A) Urgent lithotripsy
B) Fever control
C) Intravenous antibiotics
D) Analgesia and hydration
E) Immediate surgical intervention
Question Hard:
A 63-year-old man with a history of hypertension and controlled Type 2 diabetes presents with fatigue, periorbital edema, and frothy urine over the past month. His blood pressure is 155/90 mmHg. Urinalysis shows 4+ proteinuria, and spot urine protein:creatinine ratio is 450 mg/mmol. What is the most likely histological finding on kidney biopsy? 🔬
A) Membranous nephropathy
B) Minimal change disease
C) Focal segmental glomerulosclerosis
D) IgA nephropathy
E) Diabetic nephropathy
Explanations & Answers:
Question Easy Answer: B) Cystitis
Question Easy Explanation: In young adults, dysuria and increased urinary frequency without systemic symptoms like fever suggest cystitis. NICE guidelines recommend considering cystitis as a common presentation of urinary tract infection (UTI) in this demographic.
Question Medium Answer: D) Analgesia and hydration
Question Medium Explanation: According to NHS guidelines, renal colic due to a ureteric stone is initially managed with pain relief, typically NSAIDs, and ensuring adequate hydration. Stones smaller than 5mm often pass spontaneously without procedural intervention.
Question Hard Answer: A) Membranous nephropathy
Question Hard Explanation: Membranous nephropathy is common in older adults presenting with nephrotic syndrome, characterized by significant proteinuria and edema. Histologically, it manifests as thickening of the glomerular basement membrane. NICE indicates membrane nephropathy as a probable finding given the presentation and demographics.
Medical fact of the day: The kidney filters about 180 liters of blood each day, but only around 1-2 liters are excreted as urine, showcasing the kidney’s efficiency in maintaining fluid balance and electrolyte homeostasis! 🧪
Quote of the day: “In the tapestry of care, every thread of compassion and knowledge weaves hope.” 🌟