A 66-year-old woman presents to her GP with visible haematuria without pain or infection. Initial urine culture is negative. She is otherwise well.
What is the most appropriate referral pathway?

A 68-year-old man presents to the emergency department with severe penile pain and swelling one day after having a urinary catheter inserted. On examination, the glans penis is swollen and congested, with the foreskin retracted behind the glans and unable to be brought forward. Attempts at manual reduction have failed despite adequate analgesia.

A 72-year-old man is investigated for lower urinary tract symptoms and is found to have an elevated PSA. Subsequent prostate biopsy confirms the presence of adenocarcinoma. The histology report describes the architectural patterns of the tumour in order to assess prognosis.

A 28-year-old pregnant woman at 24 weeks' gestation presents with fever, dysuria, and left flank pain. Urine dipstick shows leukocytes and nitrites. She is otherwise stable and not vomiting.

What is the first-line oral antibiotic recommended for treating acute pyelonephritis in pregnancy?

A 28-year-old man presents with a painless, firm testicular lump. There is no history of trauma or infection. Physical examination confirms a hard, non-tender mass in the right testis.

Which of the following tumour markers is most likely to be raised in suspected testicular cancer?

A 44-year-old man presents to the ED with sudden severe left flank pain radiating to the groin. He has nausea and took paracetamol at home without relief. Examination shows left flank tenderness; he is afebrile.

A 32-year-old woman presents to the emergency department with sudden left flank pain radiating to the groin and nausea. Her last menstrual period was 6 weeks ago. Examination shows left flank tenderness.

What is the most appropriate initial investigation?

An 18-week pregnant woman presents with dysuria, urinary frequency, and lower abdominal discomfort. Urine dip shows leukocytes and nitrites. She has no fever or flank pain.

Which of the following is the most appropriate first-line treatment?

A 55-year-old man presents with lower urinary tract symptoms, including weak urinary stream and nocturia. He is diagnosed with benign prostatic hyperplasia (BPH). The urologist starts him on finasteride.

What is the mechanism of action of finasteride?

A 68-year-old man with known prostate cancer presents with progressive lower back pain, numbness in both legs, and weakness. He is unable to walk without support. Examination shows reduced lower limb strength and decreased sensation below the waist.

What is the most likely diagnosis?

An 82-year-old man with epilepsy is brought to the ED after a fall and prolonged immobility at home. Blood tests show neutrophilia and creatine kinase 27,000 U/L (40–250 U/L). He is catheterised as part of the septic six, and the urine is red-brown and tests positive for blood.

What is the most likely explanation?

A 67-year-old man presents to his GP with nocturia and occasional urine dribbling. His past medical history includes hypertension and osteoarthritis. He reports difficulty fully emptying his bladder and multiple night-time trips to the toilet.

A 16-year-old boy presents to the emergency department with sudden onset severe left scrotal pain for the past 2 hours. He reports nausea and vomiting. On examination, the left testis is tender and swollen, and the cremasteric reflex is absent on that side.

What is the most likely diagnosis?

A 33-year old woman presents to A+E with severe, intermittent right flank pain. The pain started 3 hours ago and has since "travelled" to her right iliac fossa.

What is the most appropriate initial first-line investigation for this patient?

A 72-year-old man is brought to the emergency department by his carers. He is confused and has not passed urine for 24 hours. He cannot give a history. Examination reveals suprapubic tenderness and a dull percussion note.

What is the next most appropriate investigation?

A 57-year-old man presents with a 5-day history of gradually increasing right testicular pain. On examination, the right testis is swollen and erythematous, with moderate tenderness on palpation. The cremasteric reflex is present. He is married with no other sexual partners, and his past medical history includes heart failure.

An 85-year-old man presents with a one-week history of diarrhoea and vomiting. Blood tests show urea 28 mmol/L and creatinine 180 µmol/L. His previous creatinine was 72 µmol/L.

What stage of acute kidney injury (AKI) does this patient have?

A 65-year-old man presents to his GP with a 3-day history of painless haematuria, without other urinary symptoms. He has a 40-pack-year smoking history . Blood tests show normal renal function and a normal protein/creatinine ratio. Urine is sterile. An ultrasound of the kidneys has been arranged.

Which other investigation should also be requested?

A 58-year-old man with no prior renal disease is admitted for community-acquired pneumonia. His creatinine has risen from 100 µmol/L to 170 µmol/L in the past 24 hours (normal 60–120 µmol/L). Urine output has been consistently >0.5 mL/kg/hour.

Which of the following best describes the stage of acute kidney injury (AKI)?

A 42-year-old man usually fit and well presents to the emergency department with atraumatic lower back pain radiating to both legs, with numbness in the perineal area, and difficulty controlling his bladder over the past 24 hours. What is the most likely diagnosis?