A 17-year-old boy presents to the emergency department with severe sore throat, fever, difficulty swallowing, and a muffled ‘potato’ voice. Physical examination reveals unilateral swelling of the left tonsillar pillar, uvular edema, and deviation of the uvula to the right. The patient also has trismus (difficulty opening the mouth). Which of the following is the most likely causative organism?
As you prepare to leave your medical office, you get a phone call from a patient’s family. The patient is a 59 year-old white male. The patient’s wife reports that the patient has been increasingly anxious and confused lately. He has been forgetful over the past three months. He has been inventing stories about people and places she never heard about before. Sometimes he has difficulty figuring out where he is located and what he is doing. He is unable to walk by himself. Even with assistance, he walks with a wide-based, short-stepped gait. He sees things other people do not see. He gets extremely agitated for very simple matters. He reported that he cannot feel his shoes when he wears them. This morning he complained of double vision and uncontrollable movements of his eyes from side to side. His past medical history is significant for hypertension. His surgical history is significant for appendectomy when he was 12 years-old and for bariatric surgery 3 years ago. At this time, he took some alcohol to ‘calm his nerves’ and went to bed. Patient’s wife would like to know what she can do for her husband?
A 30-year-old woman with medullary sponge kidney presents with dysuria and fever. She has a history of recurrent urinary tract infections and kidney stones. Her urinalysis shows pyuria and positive nitrites. A urine culture confirms E. coli infection. Which of the following is the most important preventive strategy for reducing complications in this patient?
A 42-year-old man with a history of nephrolithiasis presents with hematuria and mild flank pain. His serum calcium and parathyroid hormone levels are normal. A urinalysis reveals microscopic hematuria but no proteinuria. Non-contrast CT scan shows bilateral nephrocalcinosis. Which of the following imaging studies would best confirm the diagnosis of medullary sponge kidney?
A 35-year-old woman presents with recurrent episodes of flank pain and hematuria. She has a history of multiple kidney stones and frequent urinary tract infections. She denies any family history of kidney disease. A non-contrast CT scan reveals bilateral nephrocalcinosis. Laboratory tests show normal renal function. What is the most likely diagnosis?
A 30-year-old woman diagnosed with medullary sponge kidney after an incidental finding during an ultrasound for another issue is now discussing her condition with her doctor. She wants to understand if there’s a genetic component to this condition. Which of the following is true regarding the genetic aspects of medullary sponge kidney?
A 40-year-old male with a history of medullary sponge kidney has been managing recurrent stones. He is now concerned about his kidney function and potential impacts on his overall health. Which of the following statements about kidney function in medullary sponge kidney is most accurate?
A 35-year-old woman presents with recurrent urinary tract infections (UTIs) and hematuria. Imaging studies reveal multiple small cystic dilations in the renal pyramids, consistent with medullary sponge kidney (MSK). She is curious about the long-term implications of her condition. Which of the following complications is most commonly associated with medullary sponge kidney?
A 5-year-old boy with a history of recurrent UTIs undergoes a renal ultrasound, which shows mild hydronephrosis. A VCUG is performed, and grade III vesicoureteral reflux is diagnosed. His parents are concerned about the potential complications if left untreated.They ask about the long-term risks of this condition. Which of the following is the most significant long-term complication of untreated vesicoureteral reflux?
A 3-year-old girl presents to the pediatric clinic with recurrent febrile urinary tract infections (UTIs). Her mother reports that the child has had three episodes of fever, dysuria, and foul-smelling urine over the past year. Each episode was treated with antibiotics. A voiding cystourethrogram (VCUG) is performed and it reveals retrograde flow of urine from the bladder into the ureters during micturition. What is the most likely diagnosis in this patient?
