Urology: obstructed infected kidney: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Urology: obstructed infected kidney

Sample item

A 35-year-old woman has left renal colic, temperature 39.2 degrees Celsius, pulse 124 per minute and blood pressure 90/60 mmHg. CT shows an 8 mm proximal ureteric stone with hydronephrosis and perinephric stranding. What is the most appropriate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Intravenous antibiotics and urgent decompression by ureteric stent or nephrostomy

An obstructed, infected kidney (obstructive pyelonephritis, pyonephrosis) is a urological emergency that can progress rapidly to septic shock. The infected system must be drained urgently, by retrograde ureteric stent or percutaneous nephrostomy, with intravenous antibiotics and resuscitation. Definitive stone treatment is deferred until sepsis has resolved.

Option by option

  • A. Immediate extracorporeal shock wave lithotripsy

    Lithotripsy in an infected obstructed system can precipitate septic shock.

  • B. Intravenous antibiotics and urgent decompression by ureteric stent or nephrostomy (correct)

    Decompression relieves the infected, obstructed system and is life-saving.

  • C. Tamsulosin and oral antibiotics with outpatient review

    Medical expulsive therapy and oral antibiotics are unsafe with sepsis and obstruction.

  • D. Immediate ureteroscopic laser lithotripsy

    Manipulating the stone in a septic patient risks bacteraemia, so definitive treatment is delayed.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Intravenous antibiotics and urgent decompression by ureteric stent or nephrostomy. An obstructed, infected kidney (obstructive pyelonephritis, pyonephrosis) is a urological emergency that can progress rapidly to septic shock.

Why is "Immediate extracorporeal shock wave lithotripsy" not the answer?

Lithotripsy in an infected obstructed system can precipitate septic shock.

Why is "Tamsulosin and oral antibiotics with outpatient review" not the answer?

Medical expulsive therapy and oral antibiotics are unsafe with sepsis and obstruction.

Why is "Immediate ureteroscopic laser lithotripsy" not the answer?

Manipulating the stone in a septic patient risks bacteraemia, so definitive treatment is delayed.

What concept does this question test?

It tests Urology: obstructed infected kidney in General Surgery. The infected system must be drained urgently, by retrograde ureteric stent or percutaneous nephrostomy, with intravenous antibiotics and resuscitation. Definitive stone treatment is deferred until sepsis has resolved.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Urology: obstructed infected kidney?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.