MSRA Category: Renal Medicine/Urology

MSRA-2363

A 27-year-old woman comes to her General Practitioner complaining of urinary frequency, dysuria, suprapubic pain and back pain. Her symptoms have been getting worse over the past 48 hours. On examination, she has a normal temperature, blood pressure and heart rate. A urine dipstick test shows positive results for leukocytes and nitrites but negative for blood. She is typically healthy and not taking any medications. This is her first time experiencing symptoms of a urinary tract infection. What would be the most appropriate initial investigation to arrange for this patient? Choose the SINGLE most likely option.

MSRA-2364

A 52-year-old man presents to his General Practitioner with frank haematuria that has been present for the past four weeks. He does not have any dysuria or frequency. He is otherwise well and has not lost any weight. A urine dip is positive for blood but negative for glucose and infection.
What would be the most appropriate next step in this patient’s management?

MSRA-2365

A 62-year-old retired construction worker is found to have haematuria during a routine check-up. He has a past history of hypertension, for which he takes medication. An abdominal X-ray shows no signs of renal stones. Blood tests reveal elevated plasma viscosity and mild anaemia, with a haemoglobin level of 110 g/l (reference range 120–160 g/l) and a slightly low ferritin level.
What is the most likely diagnosis based on this clinical presentation?

MSRA-2366

Which of the following statements best describes bladder cancer?

MSRA-2367

A 45-year-old man is diagnosed with end-stage renal disease. What is the most frequent complication that may arise when considering long-term peritoneal dialysis for this patient?

MSRA-2368

A 45-year-old woman presents with macroscopic haematuria, proteinuria of 2.0 g/24 h (reference range <0.2 g/24 h) and a serum creatinine level of 167 µmol/l (reference range 50–110 µmol/l). What potential diagnosis should be considered?

MSRA-2353

A 56-year-old man is admitted to the hospital with a high stoma output from his ileostomy. He had a colectomy 8 years ago due to severe ulcerative colitis. He complains of leg cramps and occasional palpitations, and feels weak. Upon examination, his abdomen is soft with slight tenderness throughout. His blood work reveals a sodium level of 138 mmol/l, potassium level of 2.2 mmol/l, urea level of 13.3 mmol/l, and creatinine level of 150 µmol/l. An ECG shows flattened T waves and U waves. He is admitted to the medical admission unit. How should his electrolyte imbalance be managed?

MSRA-2369

You perform an annual medication review of a 68-year-old man with chronic kidney disease (CKD) stage 5 (GFR <15 ml/min/1.73 m2) on dialysis.
Which of the following is the most likely cause of death in this group of patients?

MSRA-2354

A 47-year-old man comes to the clinic complaining of fatigue. Upon examination, his blood pressure is found to be 190/110 mmHg. Routine blood tests show the following results:
– Sodium: 145 mmol/L
– Potassium: 2.5 mmol/L
– Bicarbonate: 33 mmol/L
– Urea: 5.6 mmol/L
– Creatinine: 80 µmol/L

What is the probable diagnosis?

MSRA-2370

A 65-year-old woman with type 2 diabetes is found to have an elevated plasma creatinine of 150 μmol/l (reference range 62–106 μmol/l). Her blood pressure is 170/95 mmHg, and fundoscopy reveals mild hypertensive changes and background diabetic retinopathy. She has a neuroischaemic ulcer on her left foot and no palpable pedal pulses. Urine dipstick is negative, and renal ultrasound shows a 8.5-cm left kidney and a 6.2-cm right kidney, with reduced cortical thickness.
What is the most likely cause of the renal impairment?