A 72-year-old man comes to the Emergency Department with haematuria and haemoptysis. His vital signs are heart rate 88 bpm, blood pressure 170/110 mmHg, respiratory rate 22 breaths per minute, and temperature 37.8 °C. Urinalysis shows protein and red cell casts. Serum testing reveals antibodies to the glomerular basement membrane. A renal biopsy is conducted.
What is the probable finding in the renal biopsy?
A 58-year-old man is admitted with severe shortness of breath during the early hours of the morning. Past history of note includes difficult-to-manage hypertension, for which he now takes amlodipine 10 mg, indapamide 1.5 mg and doxazosin 8 mg. He failed a trial of ramipril 1 year earlier due to a rise in his creatinine of 40% at the 1-week post-initiation stage. On examination, he has a blood pressure of 185/100 mmHg and a pulse of 100 bpm regular and is in frank pulmonary oedema. When you review his old notes, you find this is the second episode during the past 6 months. Echocardiography has shown a preserved ejection fraction. An electrocardiogram (ECG) reveals no abnormalities.
Which of the following is the most likely diagnosis in this case?
A 28-year-old man presents with sudden onset severe pain in his right loin. The pain began 3 hours ago just below the right side of his rib cage and has gradually moved down to his right groin, radiating into his right testis. He denies any visible haematuria. He is unable to tolerate physical examination and is writhing around on his bed.
What is the most appropriate initial management?
A 38-year-old woman with a history of systemic lupus erythematosus and recently diagnosed with CKD stage G3a (GFR 45 ml/min/1.73 m2) is seen by her GP. The GP notes that the patient has a BP of 152/90 mmHg, which is persistently elevated on two further readings taken on separate occasions by the practice nurse. The patient has no past history of hypertension. What is the most appropriate management for the patient’s hypertension?
A 6-year-old boy presents to the Emergency Department with periorbital pain, ascites, and oedema. He has no past medical history and is typically healthy, without recent illnesses. Upon examination, his serum urea is elevated and protein in his urine is ++++. What is the probable cause of his symptoms?
A 70-year-old woman with type II diabetes mellitus presents to the Emergency Department. She was found to be confused at home by her son. According to her son, the patient is independent and able to take care of herself. On examination she has a temperature of 38.1 °C. Her blood pressure is 136/74 mmHg, and her heart rate is 110 bpm. She is disorientated and not able to provide any history. Physical examination is unremarkable except for tenderness elicited at the right lower back.
Urine dipstick results are shown below:
Investigation Result Normal value
Colour Turbid Clear
pH 6.7 7.35–7.45
Glucose 2+ Negative
Bilirubin Negative Negative
Ketone 1+ Negative
Nitrite 2+ Negative
Leukocytes 3+ Negative
Blood 1+ Negative
Which of the following is the most likely diagnosis?
What ultrasound marker is most strongly linked to an elevated risk of trisomy 21 in the developing fetus?
A 35-year-old woman with haematuria underwent a kidney biopsy, but light microscopy results were inconclusive. As a result, the specimen was sent for electron microscopy. Which renal disease requires electron microscopy for diagnosis?
A 4-year-old child is brought to their General Practitioner (GP) with failure to thrive. His parents complain that he drinks a lot of water and urinates frequently and is not growing very well. The GP does blood and urine tests and diagnoses Fanconi syndrome.
Which of the following features would you most likely see in Fanconi syndrome?
A 54-year-old woman presents with back and flank pain affecting both sides. She has been diagnosed some years ago with antiphospholipid antibody syndrome and has suffered from a previous deep vein thrombosis. On assessment, temperature is 36.7oC, heart rate is 76 bpm, blood pressure 128/80 mmHg and she is still passing urine.
Investigations:
Investigation Result Normal value
Sodium (Na+) 141 mmol/l 135–145 mmol/l
Potassium (K+) 6.3 mmol/l 3.5–5.0 mmol/l
Urea 17.3 mmol/l 2.5–6.5 mmol/l
Creatinine 325 μmol/l 50–120 µmol/l
Urine proteinuria +++
Which of the following diagnoses fits best with this clinical scenario?