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haematuria

Practice targeted AMC-style multiple-choice questions on haematuria.

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flank painkidney stonesultrasoundurologymiddle-aged manemergency medicinemiddle-aged womancomputed tomography (CT)emergency managementnausea
Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k — CC BY 2.5 · Source

A 48-year-old woman presents with acute onset severe left flank pain radiating to the groin, associated with nausea. She denies fever or dysuria. Vitals are stable. Urinalysis shows haematuria. Serum creatinine is 75 µmol/L. An ultrasound is performed. Considering the clinical presentation and the findings demonstrated in the provided image, which of the following is the most appropriate next diagnostic step?

A. Prescribe tamsulosin and arrange outpatient follow-up.
B. Repeat the renal ultrasound in 24 hours.
C. Perform a retrograde pyelogram.
D. Arrange a non-contrast CT scan of the kidneys, ureters, and bladder.
E. Obtain a plain abdominal X-ray (KUB).
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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k — CC BY 2.5 · Source

A 45-year-old male presents to the emergency department with sudden onset severe left flank pain radiating to the groin. He reports some nausea but no vomiting. His temperature is 37.5°C, pulse 88 bpm, BP 130/80 mmHg, respiratory rate 16/min, oxygen saturation 98% on room air. On examination, he has significant left costovertebral angle tenderness. Urinalysis shows microscopic haematuria and trace leukocytes. His creatinine is 90 µmol/L (baseline unknown). An ultrasound of the kidneys is performed, shown in the image. Based on the clinical presentation and the finding shown in the image, which of the following developments would most strongly necessitate urgent urological intervention?

A. Discovery of bilateral hydronephrosis on repeat imaging.
B. Passage of a small stone fragment.
C. Persistence of severe pain despite adequate analgesia.
D. Development of fever and rigors.
E. Increase in serum creatinine to 150 µmol/L.
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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k — CC BY 2.5 · Source

A 38-year-old man presents with sudden onset severe left flank pain radiating to the groin, associated with nausea. He is afebrile, blood pressure 140/90 mmHg, heart rate 95 bpm. Urinalysis shows microscopic haematuria. Serum creatinine is 80 µmol/L. An ultrasound is performed. Considering the clinical presentation and the findings demonstrated in the provided image, which of the following best explains the mechanism of the patient's pain?

A. Spasm of the renal artery
B. Increased pressure within the renal pelvis and collecting system
C. Ischaemia of the renal medulla
D. Distension of the renal capsule due to oedema
E. Inflammation of the renal parenchyma
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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k — CC BY 2.5 · Source

A 45-year-old male presents to the emergency department with sudden onset severe left flank pain radiating to the groin. He reports some nausea but no vomiting. His temperature is 37.5°C, pulse 88 bpm, BP 130/80 mmHg, respiratory rate 16/min, oxygen saturation 98% on room air. On examination, he has significant left costovertebral angle tenderness. Urinalysis shows microscopic haematuria and trace leukocytes. His creatinine is 90 µmol/L (baseline unknown). An ultrasound of the kidneys is performed, shown in the image. Based on the clinical presentation and the finding shown in the image, what is the most appropriate immediate next step in management?

A. Admit for observation, serial renal function tests, and pain management.
B. Arrange urgent non-contrast CT scan of the kidneys, ureters, and bladder.
C. Arrange urgent flexible cystoscopy and retrograde pyelography.
D. Administer intravenous fluids, opioid analgesia, and prescribe tamsulosin for medical expulsive therapy.
E. Urgent urology consultation for consideration of upper tract decompression.
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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k — CC BY 2.5 · Source

A 38-year-old woman presents with sudden onset, severe left flank pain radiating to her groin. She reports associated nausea but denies fever or dysuria. On examination, she is afebrile, blood pressure 125/75 mmHg, heart rate 80 bpm. Urinalysis shows microscopic haematuria. Serum creatinine is 80 µmol/L. An ultrasound is performed. Considering the clinical presentation and the findings demonstrated in the provided image, which of the following is the most likely underlying mechanism causing the patient's pain?

A. Stretching of the renal capsule due to rapid kidney enlargement from a mass.
B. Direct irritation of nerve endings in the bladder wall.
C. Ischaemia of the renal cortex due to vascular compromise.
D. Inflammation of the renal parenchyma due to infection.
E. Increased pressure within the renal pelvis and ureter proximal to an obstruction.
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