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Urology & Nephrology
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Question 1 of 17
A 68-year-old male patient who has been using an indwelling urinary catheter for the past several months due to severe urinary retention secondary to benign prostatic hyperplasia presents to the clinic. During the routine check-up, the nurse notices a bluish-purple discoloration of the urine bag, although the patient does not report any new symptoms or discomfort. The patient does not have a fever, and there are no signs of urgency or increased frequency in urination.
What is the next best step in the management of this patient who has presented with purple urine bag syndrome (PUBS).CorrectIncorrect
Question 2 of 17
A 29-year-old male presents to the emergency room with complaints of dysuria and frequent urination for the past three days. He reports experiencing a sudden onset of high fever yesterday evening along with suprapubic pain. He denies any recent sexual encounters or history of kidney issues. You note the urgency of his condition and suspect a urinary tract infection (UTI) could be the cause of his symptoms.
Which is the first line investigations to confirm the diagnosis?CorrectIncorrect
Question 3 of 17
A 4-year-old girl presents to your clinic accompanied by her parents. They report that she has been experiencing noticeable swelling around her eyes and ankles over the last few weeks. They also mention that she has been having less appetite recently. On physical examination, you notice generalized oedema, including periorbital and lower extremity swelling. You consider nephrotic syndrome as a potential diagnosis given her age and the presence of oedema.
In order to support your suspected diagnosis of nephrotic syndrome, which of the following triad of symptoms would you expect to find on further investigation?CorrectIncorrect
Question 4 of 17
A 68-year-old male patient presents to your clinic with complaints of frequent night-time urination and a weakened urinary stream that has been progressively worsening over the last few months. He also reports having difficulty in initiating urination and a feeling of incomplete bladder emptying. His medical history is otherwise unremarkable, and he is not on any medications currently.
During the physical examination, you perform a digital rectal examination and find an enlarged, firm, and smooth prostate. The patient has no signs of acute urinary retention or other complications currently.
Given his age and clinical symptoms, benign prostatic hyperplasia (BPH) is suspected.
What would be your next step in diagnosing this patient?CorrectIncorrect
Question 5 of 17
A 25-year-old male comes to your clinic complaining of acute onset of pain and swelling in his left testicle for the past three days. He also mentions experiencing a burning sensation while urinating. On physical examination, you note that the scrotal skin is red and swollen. The patient has a fever of 38.7°C (101.6°F). He reports that lifting the testicle slightly provides some relief from the pain.
What is your diagnosis?CorrectIncorrect
Question 6 of 17
A 65-year-old male patient presents to the clinic complaining of visible blood in his urine for the past two weeks. He reports no pain during urination, no increased urgency or frequency of urination, and no abdominal or flank pain. He has a 30-year history of smoking a pack of cigarettes daily but quit smoking 5 years ago. He has no history of urinary stones or recurrent urinary tract infections. He denies any recent fever, chills, or other signs of infection. On physical examination, his vitals are stable, and there are no obvious abnormalities noted in the abdominal and rectal examination. He has no family history of cancers.
What is your diagnosis?CorrectIncorrect
Question 7 of 17
A 45-year-old male presents to the emergency room with a complaint of severe, intermittent flank pain that radiates towards the groin. He mentions that he has been experiencing this pain for the last two days. He has a history of kidney stones. On physical examination, he is in apparent distress, but vital signs are stable. Urinalysis shows microscopic haematuria. A non-contrast CT of the abdomen and pelvis reveals a 1 cm stone in the left ureter, without signs of hydronephrosis. The physician considers different management options for this patient.
Which of the following is the most appropriate management option?CorrectIncorrect
Question 8 of 17
A 45-year-old female patient presents to the GP setting with a 2-day history of high fever 101.8°F (38.8°C), severe flank pain, and chills. She also mentions experiencing painful urination and frequent urgency to urinate. She denies any recent urinary tract interventions or having a history of diabetes mellitus. On examination, she has notable suprapubic tenderness and costovertebral angle tenderness. You initiate some urgent investigations which reveal pyuria and bacteriuria in the urinalysis.
Given her symptoms and the investigation findings suggestive of acute pyelonephritis, you consider the best next step in her management.CorrectIncorrect
Question 9 of 17
A 68-year-old male patient presents to the emergency department following a prolonged surgery procedure where he experienced massive haemorrhage leading to hypotensive shock. He has a history of hypertension and type 2 diabetes mellitus. His vital signs show a blood pressure of 85/50 mmHg and a heart rate of 112 bpm. Laboratory tests reveal an elevated serum creatinine level. The medical team suspects acute tubular necrosis (ATN), a common consequence of acute kidney injury (AKI) in this context.
You are tasked with identifying a predominant clinical feature that would be suggestive of acute tubular necrosis in this patient.CorrectIncorrect
Question 10 of 17
A 52-year-old woman presents to her general practitioner complaining of involuntary leakage of urine during activities such as coughing, laughing, and sneezing. She reports that the condition has been gradually worsening over the last year. She has a history of multiple vaginal deliveries. Upon examination, there is no evidence of infection, and her abdominal and pelvic examinations are unremarkable. Given her symptoms and history, a diagnosis of stress incontinence is suspected.
What should be the initial step in managing her stress incontinence?CorrectIncorrect
Question 11 of 17
A 28-year-old male presents to the clinic with a complaint of a slowly growing, painless lump in his right testicle that he has noticed over the past few months. He also mentions a feeling of heaviness in the scrotum and a dull ache in the lower abdomen that comes and goes. He denies any history of trauma, fever, or urinary symptoms. His medical history is unremarkable, but he does mention that he had cryptorchidism as a child which was corrected surgically. On physical examination, a non-tender, firm mass is palpated in the right testicle. The mass does not transilluminate.
Given the patient’s presentation and history, what is the most appropriate next step in management?CorrectIncorrect
Question 12 of 17
A 16-year-old male presents to the emergency department with a sudden onset of severe, right testicular pain that started roughly 3 hours ago. He also notes that the affected testis appears to be elevated compared to the other. He denies any recent trauma, dysuria, or urethral discharge. On physical examination, the right testis is notably swollen, tender, and high riding, with a horizontal lie. The cremasteric reflex is absent on the right side. There is an intense pain upon attempting to elevate the right testis, which is a negative Prehn’s sign, and indicates that this might not be epididymo-orchitis. The patient reports no significant medical history but mentions occasional similar but less severe episodes which resolved spontaneously in the past.
Given his presentation and physical examination findings, testicular torsion is highly suspected.CorrectIncorrect
Question 13 of 17
A 45-year-old male is brought to the emergency department after being found unconscious and lying on the floor for an unknown duration following a fall. His medical history is notable for statin medication due to high cholesterol levels. Physical examination reveals muscular weakness and swellings indicative of muscle breakdown. The urine is noted to be tea-coloured, and blood tests reveal elevated levels of creatine kinase, confirming muscle necrosis, and signs of acute kidney injury.
An urgent ECG is performed due to his risk factors and clinical presentation, which reveals tall T waves, suggesting the presence of hyperkalaemia.
What is next best step in terms of management?CorrectIncorrect
Question 14 of 17
A 68-year-old male patient presents to your clinic with complaints of difficulty initiating urination and experiencing a weak urinary stream for the past few months. He also mentions occasional hematuria and a recent onset of dull aching pain in his lower back and pelvic region that doesn’t seem to go away. The patient has lost some weight recently which he didn’t attribute to any change in diet or physical activity. He denies any previous history of urinary tract infections or kidney stones. He has a family history of prostate cancer; his father was diagnosed at the age of 72. Upon physical examination, you note an enlarged, firm, and irregular prostate on digital rectal examination (DRE). You suspect prostate cancer and decide to proceed with further investigations.
Given the patient’s clinical features, which of the following would be your next step in diagnosing this patient?CorrectIncorrect
Question 15 of 17
A 26-year-old male patient comes to a general practice setting complaining of noticing a “bag of worms” like structure in his scrotum, primarily affecting the left side. The patient mentions that he experiences no pain or discomfort in the region. He has no history of infertility and denies any recent trauma or infection in the genital area. On physical examination, the GP observes a bluish, worm-like mass in the scrotum, which reduces when the patient lies down. The GP decides to explore management options for a varicocele without symptoms.
Which of the following would be the most appropriate next step in managing this patient?CorrectIncorrect
Question 16 of 17
A 45-year-old male patient comes to the emergency department complaining of severe flank pain that has been intermittently radiating to his groin for the past 12 hours. He also reports high fever, chills, and a burning sensation while urinating. His medical history is significant for recurrent kidney stones.On physical examination, he appears distressed with a body temperature of 39.2°C (102.5°F). Palpation of the flank region elicits significant pain and there is costovertebral angle tenderness.
Laboratory tests show elevated white blood cell (WBC) count. Urinalysis is positive for hematuria and pyuria. An urgent non-contrast CT scan of the abdomen and pelvis shows a 1.5 cm stone obstructing the left ureter, causing moderate hydronephrosis of the left kidney.
Which of the following is the most appropriate next step in managing this patient’s condition?CorrectIncorrect
Question 17 of 17
A 26-year-old marathon runner presents to the emergency department several hours after collapsing post-race. She reports extreme muscle soreness, weakness, and an inability to get up. Her urine is noted to be a reddish-brown color. Blood tests reveal significantly elevated creatine kinase levels and signs of acute kidney injury. Her medical history doesn’t reveal any pre-existing conditions or medication use. You suspect rhabdomyolysis given her recent strenuous activity and the clinical presentation.
What is your initial management step?CorrectIncorrect