Block 5-Nephro

36-year-old female calls your office because of a 2-day history of dysuria, urinary urgency, and urinary frequency. She has not had any fever, nausea, or vaginal discharge. She tells you her symptoms are similar to a previous urinary tract infection. She uses subdermal etonogestrel (Nexplanon) for contraception, takes no oral medications, and has no drug allergies. Which one of the following would be most appropriate at this point?

Which one of the following is a risk factor for uncomplicated cystitis?

Treatment of rhabdomyolysis should routinely include which one of the following?

A 30-year-old female presents with dysuria and flank pain. She reports a fever of 102°F yesterday morning. She has not taken any antipyretics since that time, and today her temperature is 36.7°C (98.1°F). She has a pulse rate of 93 beats/min, a respiratory rate of 16/min, and a blood pressure of 116/58 mm Hg. The remainder of her physical examination is unremarkable, except for marked costovertebral angle tenderness. A CBC reveals a WBC count of 14,590/mm3 (N 4300–10,800) with 85% neutrophils, 12% lymphocytes, and 3% basophils, but is otherwise normal. A urine β-hCG is negative. A urine dipstick is positive for leukocyte esterase, and urine microscopic analysis is notable for <1 RBC and >50 WBCs/hpf. Urine culture results are pending. You confirm she has no medication allergies. Which one of the following oral antibiotics would be most appropriate for empiric therapy?

A 46-year-old female has a 3-day history of dysuria with burning, frequency, and urgency. She reports no fever, weakness, or hematuria. Her chronic health problems include obesity and prediabetes. She has no known allergies. Which one of the following would be the most appropriate treatment regimen for this patient?

A mother brings her 7-year-old son in for a well child check and you find that their main concern is bedwetting. He has never achieved consistent nighttime continence. He currently wets the bed about 4 nights per week but has no difficulty maintaining continence during the day and reports no symptoms such as dysuria or urinary frequency. The parents have tried limiting his evening fluid intake but this has not helped. He is otherwise healthy. The patient wants to stop wearing nighttime diapers. Which one of the following interventions has the best evidence of long-term success in addressing this condition?

A 42-year-old male comes to your office with acute right flank pain that awakened him from sleep. The pain is colicky and he says it is the most intense pain that he has ever felt. The findings on a physical examination, in addition to blood on his urinalysis, make you suspect a urinary tract stone. Which one of the following imaging modalities would be most appropriate for confirming your suspicion?

72-year-old male sees you for an annual follow-up visit. He has well controlled type 2 diabetes mellitus, hypertension, and chronic kidney disease. His hemoglobin A1c is 6.2% today and his blood pressure is 122/76 mm Hg. Historically, his serum creatinine level has been rising by 0.1–0.2 mg/dL per year. Last year his creatinine level was 1.9 mg/dL (N 0.6–1.2), which translated to an estimated glomerular filtration rate (eGFR) of 39.8 mL/min/1.73 m2 (N 90–120). Which one of the following findings on this year’s laboratory testing should prompt a referral to a nephrologist for management?

A 47-year-old female with a 10-year history of type 2 diabetes mellitus is concerned about the recent onset of swelling in her legs accompanied by a sudden weight gain of 8 lb. She is also experiencing increased fatigue and shortness of breath with mild exertion. On examination she has a blood pressure of 150/95 mm Hg, which is above her baseline of 130/85 mm Hg. Her lungs are clear to auscultation and a cardiac examination is also normal. She has no hepatosplenomegaly, but her legs are swollen to the level of the midtibia bilaterally. You are concerned that her symptoms and examination findings may be related to an underlying renal pathology. To confirm your suspicion, the most appropriate diagnostic test at this time would be

 77-year-old white male tells you he has had urinary incontinence for more than a year. The incontinence occurs with sudden urgency. No association with coughing or positional change has been noted, and there is no history of fever or dysuria. He underwent transurethral resection of the prostate (TURP) for benign prostatic hyperplasia a year ago, and he says his urinary stream has improved. A rectal examination reveals a smoothly enlarged prostate without nodularity, and normal sphincter tone. No residual urine is found with post-void catheterization. Which one of the following is the most likely cause of this patient’s incontinence?