Nephrology Question Bank

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1. A 6 years old female from Jizan with hematuria, all the following investigations are needed EXCEPT:

Jizan is an endemic region for sickle cell disease, so hematuria in a child from there warrants HbS testing and Hb electrophoresis to detect sickling-related papillary necrosis; urinalysis is essential as the first step. Cystoscopy is an invasive procedure not indicated as an initial workup for hematuria in a young child and is the exception here.

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2. 62 years old male with DVT and IVC obstruction due to thrombosis so most like diagnosis is

An adult with unexplained DVT and IVC thrombosis should raise suspicion of nephrotic syndrome, which causes a hypercoagulable state through urinary loss of antithrombin III and other anticoagulant proteins. This predisposes to venous (especially renal vein and IVC) thrombosis and pulmonary embolism, making nephrotic syndrome the most likely underlying diagnosis.

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3. Most common manifestation of renal cell carcinoma is:

Painless gross or microscopic hematuria is the most common presenting manifestation of renal cell carcinoma. The classic triad of hematuria, flank pain, and palpable mass occurs in only a minority of patients and usually indicates advanced disease.

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4. None opaque renal pelvis filling defect seen with IVP, US revels dense echoes & acoustic shadowing, what is the most likely diagnosis?

A non-opaque (radiolucent) filling defect on IVP that produces dense echoes with acoustic shadowing on ultrasound indicates a calculus rather than soft tissue. Uric acid stones are radiolucent on plain films/IVP yet still echogenic and shadowing on ultrasound, fitting this picture. Blood clots and crossing vessels would not cast an acoustic shadow.

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5. Radiosensitive testicular cancer:

Seminoma is the classic radiosensitive testicular germ cell tumor and responds well to radiotherapy. Non-seminomatous tumors such as yolk sac and choriocarcinoma are relatively radioresistant and are managed primarily with chemotherapy and surgery.

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6. Patient come abdominal pain and tender abdomen with hypernatremia and hyperkalemia and vomiting and diarrhoea, what is the next investigation:

In a patient with vomiting, diarrhea and electrolyte disturbances, urinalysis is a simple, immediate bedside investigation to assess renal function, hydration and possible underlying renal/metabolic cause. It guides further management before more advanced imaging is considered.

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7. Man with sudden onset of scrotal pain, also had history of vomiting, on examination tender scrotom and there is tender 4 cm mass over right groin, what you will do?

Sudden severe scrotal pain with vomiting and a tender testis is testicular torsion until proven otherwise, a surgical emergency requiring immediate urological/surgical consultation for exploration. Imaging should not delay surgery because the testis can infarct within hours, so prompt surgical involvement is the priority.

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8. Patient with dysuria, frequency and urgency but no flank pain, what is the treatment?

Dysuria, frequency and urgency without flank pain indicate uncomplicated lower UTI (cystitis). A short course of an appropriate oral antibiotic such as ciprofloxacin for a few days is adequate; imaging is not needed for simple cystitis.

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9. Diabetic patient on insulin and metformin has renal impairment. What's your next step:

Metformin is contraindicated in significant renal impairment because of the risk of lactic acidosis, so it should be stopped. An ACE inhibitor is added for its renoprotective effect, reducing intraglomerular pressure and proteinuria in diabetic nephropathy.

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10. Diabetic female her 24h-urine protein is 150mg

A 24-hour urine protein of 150 mg is within the normal range (normal is up to ~150 mg/day), so it does not indicate diabetic nephropathy and no specific intervention is required. Microalbuminuria, the earliest marker of diabetic kidney disease, would be 30-300 mg/day of albumin.