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Review of Clinical Signs Review Questions

Evaluation of Hematuria

Bernard M. Karnath, MD

1. A 50-year-old man presents with a 3-week history of hematuria. He has no other medical illnesses but reports a 30-pack-year history of smoking. He reports that the hematuria is most prominent at the end of urination. The patient denies pain and does not have any family members with renal failure. Which of the following is the most likely diagnosis?
  1. Nephrolithiasis
  2. Polycystic kidney disease
  3. Thin basement membrane disease
  4. Tumor of the bladder neck
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2. A 20-year-old man presents with episodes of hematuria. He reports a history of kidney stones 3 years ago. Family history is significant for a father with end-stage renal disease. Which of the following is the most likely diagnosis?

  1. Alport’s syndrome
  2. Polycystic kidney disease
  3. Renal cell carcinoma
  4. Thin basement membrane disease
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3. A 20-year-old woman presents with episodes of dark urine. She recalls having an upper respiratory infection with cough, sore throat, and myalgias about 1 week prior to the hematuria episode. Physical examination is normal as are the results of laboratory testing, including complete blood count, blood urea nitrogen, serum creatinine, serum electrolytes, and serum complement. Antinuclear antibody assay is negative. Urinalysis shows many red blood cells. Which of the following is the most likely diagnosis?

  1. Alport’s syndrome
  2. Henoch-Schönlein Purpura
  3. IgA nephropathy
  4. Poststreptococcal glomerulonephritis
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4. A 30-year-old woman presents with acute onset of edema and hematuria. Approximately 3 weeks ago, she was treated for pharyngitis with oral penicillin. Since that time she has felt well but has noticed the onset of dark, cola-colored urine and swelling of her legs. On physical examination, blood pressure is 160/110 mm Hg and there is marked peripheral edema. Serum complement levels are low. Urinalysis shows many red blood cells. Which of the following is the most likely diagnosis?
  1. Alport’s syndrome
  2. Henoch-Schönlein purpura
  3. IgA nephropathy
  4. Poststreptococcal glomerulonephritis
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5. A 30-year-old man presents with right flank pain associated with gross hematuria. The physical examination reveals costovertebral angle tenderness. Urinalysis reveals 3+ heme, no protein, 40 red blood cells per high-power field (hpf), occasional white blood cells per hpf, and no bacteria. A plain radiograph of the abdomen and pelvis is normal. Spiral computed tomography (CT) without contrast shows a bright 2-cm object in the right renal pelvis with slight right hydronephrosis. Which material is this stone most likely composed of?

  1. Calcium
  2. Cystine
  3. Struvite
  4. Uric acid
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