17/09/2024 – Renal and Urology

Question Easy:
A 24-year-old male presents with sudden onset of severe testicular pain that started two hours ago. On examination, there is tenderness and swelling of the left testicle, and the cremasteric reflex is absent. What is the most likely diagnosis?

A) Epididymitis
B) Testicular torsion
C) Hydrocele
D) Varicocele
E) Inguinal hernia

Explanations & Answers:

Question Easy Answer: B
Question Easy Explanation: Testicular torsion presents with sudden onset of severe testicular pain, tenderness, and swelling. The absence of the cremasteric reflex is a key clinical sign. Immediate surgical intervention is required. NICE guidelines highlight the urgency as torsion can lead to testicular loss if not treated within a few hours.

Question Medium:
A 45-year-old woman presents with fatigue, pruritus, and dark urine. Her past medical history includes hypertension and type 2 diabetes mellitus. On examination, she has mild hepatomegaly. Which one of the following investigations is most likely to confirm the diagnosis of renal amyloidosis?

A) Serum creatinine
B) Urinalysis for Bence Jones proteins
C) Serum protein electrophoresis
D) Renal biopsy
E) Abdominal ultrasound

Explanations & Answers:

Question Medium Answer: D
Question Medium Explanation: Renal biopsy is the gold standard for diagnosing renal amyloidosis, as it allows direct visualisation of amyloid deposits under polarized light microscopy. NICE guidelines recommend biopsy when there is a high index of suspicion based on clinical and laboratory findings.

Question Hard:
A 60-year-old male with a history of recurrent urinary tract infections presents with hematuria and left-sided flank pain. Imaging reveals a 4 cm mass in the left kidney. Which of the following is the most appropriate next step in management?

A) Antibiotic therapy
B) Urinary catheterization
C) Radical nephrectomy
D) Partial nephrectomy
E) Observation with serial imaging

Explanations & Answers:

Question Hard Answer: C
Question Hard Explanation: The management of a renal mass suspected to be malignant, particularly in the context of symptoms and an appropriate size, is typically radical nephrectomy. NICE guidelines advocate this approach for tumors larger than 4 cm or if there are indications of aggressive pathology, in order to ensure complete removal and reduce the risk of recurrence.

Medical fact of the day: Did you know that the UK sees a significant number of renal transplant procedures each year, with living kidney donations helping to bridge the gap between demand and supply? This has tremendously improved the life expectancy and quality of life for patients with end-stage renal disease.

Quote of the day: “In the realm of healthcare, every act of care ignites a spark of hope. Keep the flame of compassion burning.”