Question Easy:
A 28-year-old man presents to the GP with painless hematuria. He reports no recent trauma or urinary tract infections. What is the most appropriate initial investigation? 🚑
A) Urine cytology
B) Cystoscopy
C) Intravenous urography
D) Urinary tract ultrasound
E) MRI of the pelvis
Explanations & Answers:
Question Easy Answer:
D) Urinary tract ultrasound
Question Easy Explanation:
In cases of painless hematuria, initial imaging with ultrasound is recommended to check for any structural abnormalities or masses in the urinary tract. Ultrasound is a non-invasive and effective first-line investigation in line with NICE guidelines. Cystoscopy may be used later if an abnormality needs further visualization.
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Question Medium:
A 43-year-old woman with a history of recurrent urinary tract infections (UTIs) presents with fever, chills, and flank pain. Urinalysis shows the presence of nitrites and leukocyte esterase. What is the most likely causative organism? 🦠
A) Streptococcus pyogenes
B) Escherichia coli
C) Proteus mirabilis
D) Klebsiella pneumoniae
E) Staphylococcus saprophyticus
Explanations & Answers:
Question Medium Answer:
B) Escherichia coli
Question Medium Explanation:
Escherichia coli is the most common causative organism of UTIs, including pyelonephritis, as suggested by the presence of nitrites in urinalysis, which indicate gram-negative bacteria. This matches both NICE and NHS understanding of common UTI pathogens in the UK.
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Question Hard:
A 56-year-old man with a 15-year history of type 2 diabetes presents with frothy urine and peripheral edema. Blood tests reveal a low serum albumin level and elevated cholesterol. What is the most likely diagnosis? 🤔
A) Acute glomerulonephritis
B) Chronic kidney disease
C) Nephrotic syndrome
D) Pyelonephritis
E) Renal tubular acidosis
Explanations & Answers:
Question Hard Answer:
C) Nephrotic syndrome
Question Hard Explanation:
Nephrotic syndrome is characterized by significant proteinuria, leading to hypoalbuminemia, hyperlipidemia, and edema. This condition is more common in patients with diabetes due to diabetic nephropathy. The clinical presentation and lab findings align with this diagnosis, following BNF guidelines regarding the management and diagnosis of renal conditions in diabetes.
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Medical fact of the day:
In the UK, the prevalence of chronic kidney disease (CKD) is estimated to be about 13% in adults, with a significant number of people being undiagnosed due to its asymptomatic nature in early stages.
Quote of the day:
“Compassion is the root from which all healthcare flowers bloom. 🌺 In caring for others, we touch the essence of humanity.”