Clinical Quiz

Increased Bleeding from Dialysis Access

A 71-year-old female on hemodialysis three times a week complained of increased bleeding lasting more than 15 minutes from her access, which is in her left upper extremity. She denies any other complaints.For the past four weeks, she has noticed progressively increased bleeding time after her dialysis needles are removed. This access has never been…

Should We Be “Washing-Out” for Adrenal Incidentalomas?

A 55-year-old woman with history of hypertension, melanoma, and urolithiasis is found to have a left adrenal mass on a non-contrast computed tomography (CT) scan evaluation obtained to assess renal colic. The mass measures 2.5 cm in diameter and demonstrates an attenuation of 30 Hounsfield units (HU). A metabolic work-up rules out hypercortisolemia and hyperaldosteronemia.…

African-American Woman with Urinary Frequency, Bladder Discomfort

A 28-year-old African-American woman presented with complaints of urinary frequency and bladder discomfort. She was found to have renal failure (creatinine [Cr] 4.1) and a urine culture was positive for Escherichia coli. She was treated with a full course of antibiotics but renal failure persisted. Medications included occasional nonsteroidals for headache and albuterol for asthma.…

Cystolithiasis in a Man With Painless Gross Hematuria

A robust 80-year-old male on active surveillance for low-risk adenocarcinoma of the prostate developed painless gross hematuria. He reported minimal to moderate lower urinary tract symptoms with an American Urologic Association symptom score of 10 and a quality of life score of 2. He does not use any medications for benign prostatic hyperplasia (BPH). His…

Hispanic Woman Admitted With Left Flank Pain

A 33-year-old Hispanic female was admitted for left flank pain and presumed “pyelonephritis.” The patient had been healthy until two weeks prior to admission, when she noticed her left flank pain. The pain had been present since. The pain seemed to worsen with certain body movements. The patient did not complain of fever, nausea, or…

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