Question Easy: 😊 A 25-year-old male presents with a burning sensation during urination and increased frequency. He denies any fever or back pain. Which of the following is the most appropriate initial test to perform?
A) Serum creatinine
B) Abdominal ultrasound
C) Urine dipstick test
D) PSA level
E) CT abdomen
Explanations & Answers:
Question Easy Answer: C) Urine dipstick test
Question Easy Explanation: In a young male presenting with dysuria and increased frequency, a urinary tract infection (UTI) is suspected. The first-line investigation is a urine dipstick test to detect nitrites and leukocytes. This test is cost-effective and provides quick results, in line with NICE guidelines for suspected UTI in men.
Question Medium: A 45-year-old female presents with haematuria and left flank pain that started suddenly. Ultrasound shows a 5mm calculus in the left ureter. What is the most appropriate initial management? A) Percutaneous nephrolithotomy B) Dietary modification C) Shock wave lithotripsy D) Increase fluid intake and analgesia E) Immediate surgical removal
Question Medium Answer: D) Increase fluid intake and analgesia
Question Medium Explanation: For small ureteric stones (less than 10 mm), conservative management with increased hydration and analgesia is often recommended. This approach allows for ‘watchful waiting’ as stones of this size frequently pass spontaneously, as per NHS guidelines. Shock wave lithotripsy and surgical interventions are reserved for larger stones or those causing complications.
Question Hard: 🔍 A 70-year-old male is referred to the renal clinic with generalized oedema and significant proteinuria. His renal biopsy shows diffuse thickening of the glomerular capillary walls without hypercellularity, accompanied by subepithelial electron-dense deposits. Which condition is most likely? A) Minimal change disease B) IgA nephropathy C) Membranous nephropathy D) Focal segmental glomerulosclerosis E) Diabetic nephropathy
Question Hard Answer: C) Membranous nephropathy
Question Hard Explanation: The presence of nephrotic syndrome (significant proteinuria and oedema) with renal biopsy findings of diffuse capillary wall thickening and subepithelial deposits is diagnostic of membranous nephropathy. This aligns with the pathology of membranous glomerulopathy characterized by the deposition of immune complexes, consistent with NICE guidelines on the management of nephrotic syndrome in adults.
Medical fact of the day: Did you know that the UK has one of the lowest rates of deceased donor kidney transplants compared to many Western countries? This highlights the ongoing need for awareness and participation in organ donation programmes.
Quote of the day: “In the care of others, we find the heart of medicine. Every act of kindness, every assurance, builds a bridge for healing.” 🩺