Morning Quiz ☕

A 57-year-old man presents to the hospital with the following symptoms:

• Nausea and vomiting

• Severe cramping pain in the right flank

• Additional History:

• No fever or chills

• Similar, but milder, pain occurred a few days ago and resolved spontaneously

Medical History:

• Type 2 diabetes mellitus

• Obesity

• Hyperlipidemia

• Hypertension

• Gout

Vital Signs:

• Temperature: 37°C (98.6°F)

• Blood pressure: 160/100 mm Hg

• Pulse: 98/min

Physical Examination:

• Right flank tenderness

Laboratory Findings:

• Blood urea nitrogen (BUN): Normal

• Serum creatinine: Normal

Imaging Findings (Abdominal Ultrasound):

• Right-sided hydronephrosis

• Proximal ureteral dilation

Question:
Based on this presentation, which of the following is most likely to be found on urinalysis?

Options:
A. Malignant cells
B. Red blood cells
C. Red blood cell casts
D. Specific gravity of 1.002
E. White blood cell casts

Correct Answer 🎯: B. Red Blood Cells

⚙️

🧠 Obesity + Hyperlipidemia + Hypertension + Type 2 Diabetes Mellitus

⬇

↑ Risk of uric acid stone formation (gout history) and calcium oxalate stones (obesity, hyperlipidemia, diabetes)

⬇

Metabolic Dysregulation → ↑ Uric acid and calcium excretion in urine

⬇

🧠 Hyperuricemia + Hypercalciuria + Dehydration (if present)

⬇

Crystallization in the renal tubules or collecting system

⬇

Nephrolithiasis (kidney stone formation)

(think of a “clogged pipe 🚰” in the urinary system)

⬇

🧠 Stone moves from renal pelvis to ureter

⬇

Obstruction of the right ureter (proximal ureteral dilation on ultrasound)

⬇

Hydronephrosis (right-sided, as seen on ultrasound)

(“balloon inflating 🎈”)

⬇

🧠 Ureteral obstruction

⬇

↑ Intraluminal pressure in the renal pelvis and ureter

⬇

Stretching of the renal capsule and ureter
(like “stretching a rubber band 🎗️”)

⬇

Severe crampy right flank pain (renal colic)

⬇

🧠 Obstruction + Stretching

⬇

Activation of renal afferent nerves

⬇

Nausea and vomiting (visceral autonomic response)

🧠 Mechanical trauma from the stone

⬇

Damage to urothelium

⬇

Hematuria (red blood cells in urine) → Correct Answer: B. Red Blood Cells

(like “scratches on a wall 🪨”)

⚖️ Differential Table

📝 Flashcards

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