Nephrology and electrolytes: glomerular haematuria: practice question

A General Medicine 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 Medicine · Nephrology and electrolytes: glomerular haematuria

Sample item

A 30-year-old has painless microscopic haematuria. Phase-contrast microscopy of fresh urine shows many dysmorphic red cells with acanthocytes and occasional red cell casts. Where is the bleeding most likely arising?

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

The answer and the reasoning

D. Glomerulus

Red cells passing through a damaged glomerular basement membrane and then through the tubules are deformed, giving dysmorphic cells and acanthocytes. Red cell casts form when cells are moulded in the tubule. Bleeding from the lower tract gives uniform, round red cells and no casts.

Option by option

  • A. Renal pelvis

    Pelvic bleeding would give non-dysmorphic red cells without casts.

  • B. Prostatic urethra

    Urethral bleeding would also give normal-shaped cells and no casts.

  • C. Urinary bladder

    Bladder bleeding would give round, uniform cells and often clots.

  • D. Glomerulus (correct)

    Correct. Dysmorphic cells and red cell casts point to bleeding from the glomerulus.

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.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Glomerulus. Red cells passing through a damaged glomerular basement membrane and then through the tubules are deformed, giving dysmorphic cells and acanthocytes.

Why is "Renal pelvis" not the answer?

Pelvic bleeding would give non-dysmorphic red cells without casts.

Why is "Prostatic urethra" not the answer?

Urethral bleeding would also give normal-shaped cells and no casts.

Why is "Urinary bladder" not the answer?

Bladder bleeding would give round, uniform cells and often clots.

What concept does this question test?

It tests Nephrology and electrolytes: glomerular haematuria in General Medicine. Red cell casts form when cells are moulded in the tubule. Bleeding from the lower tract gives uniform, round red cells and no casts.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Nephrology and electrolytes: glomerular haematuria?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine 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.