Question Easy:
A 28-year-old man presents to the GP with dysuria and increased urinary frequency. He denies any fever or back pain. A urine dipstick test shows positive leukocytes and nitrites. What is the most likely diagnosis? 🌊
A) Pyelonephritis
B) Urethritis
C) Cystitis
D) Prostatitis
E) Renal calculi
Explanations & Answers:
Question Easy Answer: C) Cystitis
Question Easy Explanation: The presence of dysuria, increased urinary frequency, and positive leukocytes and nitrites on the urine dipstick suggests a urinary tract infection (UTI), with cystitis being the most common type. According to NICE guidelines, cystitis often presents with these symptoms in the absence of systemic signs like fever or flank pain, which would suggest pyelonephritis.
Question Medium:
A 45-year-old woman with a history of recurrent kidney stones presents with severe, colicky left flank pain radiating to the groin. Imaging reveals a 6mm calculus in the left ureter. What is the best immediate management for this patient? 💎
A) Oral antibiotics
B) Percutaneous nephrolithotomy
C) Observation and increased fluid intake
D) Extracorporeal shock wave lithotripsy (ESWL)
E) Ureteroscopy
Question Medium Answer: D) Extracorporeal shock wave lithotripsy (ESWL)
Question Medium Explanation: According to NHS guidelines, ESWL is a non-invasive treatment suitable for ureteric stones less than 10mm and causing significant symptoms. While increased fluid intake is essential, immediate symptom relief and stone management are best achieved with ESWL in this context.
Question Hard:
A 65-year-old male with a long-standing history of diabetes presents with new-onset fatigue, pruritus, and edema. Blood tests show hyperkalaemia, elevated urea, and creatinine levels. His eGFR is 15 mL/min/1.73 m². What is the most appropriate next step in management? 🚑
A) Start oral anticoagulation
B) Initiate haemodialysis
C) Prescribe antibiotics
D) Arrange for a renal biopsy
E) Start high-dose diuretics
Question Hard Answer: B) Initiate haemodialysis
Question Hard Explanation: The patient is presenting with signs of stage 5 chronic kidney disease (CKD) with an eGFR of 15 mL/min/1.73 m² and symptoms indicating the need for dialysis. NICE guidelines recommend initiating dialysis when patients have symptoms of advanced kidney failure, such as significant fatigue and edema, or when there is evidence of severe electrolyte imbalance.
Medical fact of the day: Did you know? In the UK, autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary renal disorder, affecting approximately 1 in 1,000 individuals and often leading to end-stage renal disease (ESRD) by the age of 60.
Quote of the day: “In caring for others, we find the courage to heal ourselves; may your journey light the way for many.” 🌟