Question Easy:
A 25-year-old male presents to the GP with dysuria and increased urinary frequency. He has no fever or flank pain. Urinalysis shows leukocytes and nitrites. What is the most likely diagnosis?
A) Pyelonephritis
B) Cystitis
C) Urethritis
D) Prostatitis
E) Renal colic
Question Medium:
A 45-year-old woman with a history of recurrent urinary tract infections develops severe left flank pain, fever, and vomiting 🆘. On examination, her left costovertebral angle is tender. Which of the following is the most appropriate initial investigation?
A) Abdominal X-ray
B) Urinalysis
C) Non-contrast CT of the abdomen
D) Ultrasound of the kidneys
E) Intravenous urography
Question Hard:
A 60-year-old man presents with painless visible haematuria. He smokes 20 cigarettes a day and has a history of occupational exposure to aniline dyes. Which of the following is the most likely diagnosis?
A) Renal cell carcinoma
B) Transitional cell carcinoma
C) Squamous cell carcinoma of the bladder
D) Benign prostatic hyperplasia
E) Nephrolithiasis
Explanations & Answers:
Question Easy Answer:
B) Cystitis
Question Easy Explanation:
The patient’s symptoms align with cystitis, which is an infection of the bladder often presenting with dysuria, frequency, and positive leukocytes and nitrites on urinalysis. These findings indicate a lower urinary tract infection, excluding conditions like pyelonephritis, which would likely present with systemic symptoms such as fever and flank pain.
Question Medium Answer:
C) Non-contrast CT of the abdomen
Question Medium Explanation:
The presentation is suggestive of acute pyelonephritis with possible complications like an obstructed ureter due to a stone. According to NICE guidelines, a non-contrast CT of the abdomen is crucial in detecting ureteric stones and evaluating any complications like obstruction, providing detailed information quickly and accurately.
Question Hard Answer:
B) Transitional cell carcinoma
Question Hard Explanation:
Painless visible haematuria in a smoker with occupational exposure to aniline dyes is highly suggestive of transitional cell carcinoma (TCC) of the bladder. TCC is strongly associated with smoking and particular occupational hazards. NICE emphasizes the need for urgent investigation of visible haematuria in patients over age 45, especially with such risk factors.
Medical fact of the day:
The kidney’s ability to regulate blood pressure goes beyond filtration! Through the renin-angiotensin-aldosterone system, the kidneys release hormones that not only control blood pressure but also the balance of salt and fluid in the body, a fact that highlights their critical role in overall cardiovascular health.
Quote of the day:
“Every heartbeat is a testament to the silent battles you fight each day. Keep going, for in every moment of care, you change a world, a life, a future.”