Question Easy:
A 55-year-old man presents to the GP with fatigue and frothy urine. He has a blood pressure of 160/100 mmHg. Urinalysis shows 3+ proteinuria and no blood. Which of the following is the most likely diagnosis?
A) Acute kidney injury
B) Nephrotic syndrome
C) Urinary tract infection
D) Chronic kidney disease
E) Glomerulonephritis
Explanations & Answers:
Question Easy Answer:
B) Nephrotic syndrome
Question Easy Explanation:
This patient’s symptoms are consistent with nephrotic syndrome, which is characterized by significant proteinuria, hypoalbuminemia, edema, and often hypertension. Frothy urine is frequently due to high levels of protein in the urine, and the absence of hematuria helps exclude glomerulonephritis. According to NHS guidelines, nephrotic syndrome can lead to serious complications without treatment.
Question Medium:
A young woman presents to the emergency department with symptoms of dysuria, increased frequency, and suprapubic discomfort. Urinalysis shows leukocytes and nitrites. What is the most appropriate initial treatment?
A) Metronidazole
B) Fosfomycin
C) Trimethoprim
D) Ciprofloxacin
E) Nitrofurantoin
Explanations & Answers:
Question Medium Answer:
C) Trimethoprim
Question Medium Explanation:
This clinical picture is indicative of an uncomplicated urinary tract infection (UTI). NICE guidelines suggest either trimethoprim or nitrofurantoin as first-line treatments. Trimethoprim is favoured, particularly when the local antibiotic resistance status supports its use. For women with lower risk UTI or those who don’t have specific contraindications, it is an effective initial therapy.
Question Hard:
A 65-year-old man with a history of hypertension and chronic kidney disease presents with new onset hematuria and unilateral flank pain. An ultrasound reveals a solid mass in the right kidney. Which of the following is the most likely diagnosis?
A) Renal cyst
B) Nephroblastoma
C) Renal cell carcinoma
D) Transitional cell carcinoma
E) Hydronephrosis
Explanations & Answers:
Question Hard Answer:
C) Renal cell carcinoma
Question Hard Explanation:
The presence of a solid renal mass in an adult, especially with symptoms like hematuria and flank pain, strongly points towards renal cell carcinoma (RCC). While renal cysts are common, they typically don’t present as solid masses, and nephroblastoma is more common in paediatric patients. Transitional cell carcinoma typically originates in the renal pelvis rather than the renal parenchyma and presents differently. As per NHS and NICE recommendations, any solid renal masses in adults should be promptly investigated, often starting with imaging studies.
Medical fact of the day: Ever wondered why lithotripsy is considered a landmark treatment in urology? Developed in the 1980s, it’s a non-invasive procedure that uses shock waves to break down kidney stones, saving many from the need for open surgery. Lithotripsy has revolutionized renal stone management and is widely used in the UK!
Quote of the day: “In every challenge faced by a patient, there lies a chance for healing, learning, and growth for the caregiver.”