Abdominal and GI imaging: obstructed infected kidney: practice question

A Radiology 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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Radiology · Abdominal and GI imaging: obstructed infected kidney

Sample item

A diabetic woman has fever, rigors and flank pain. Ultrasound shows a dilated pelvicalyceal system with echogenic debris, and CT shows an obstructing ureteric stone. She is hypotensive. Which is the most appropriate next step?

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

The answer and the reasoning

A. Urgent percutaneous nephrostomy

An infected obstructed kidney is a urological emergency and needs urgent decompression, by percutaneous nephrostomy or retrograde stent, together with antibiotics. Definitive stone treatment follows once sepsis settles. Lithotripsy or oral treatment alone risks worsening septic shock.

Option by option

  • A. Urgent percutaneous nephrostomy (correct)

    Correct. Urgent drainage of the infected obstructed system is lifesaving.

  • B. Observation with analgesia and fluids alone

    Observation would allow progression to septic shock and loss of renal function.

  • C. Oral antibiotics and elective stone removal

    Oral antibiotics cannot sterilise an obstructed collecting system in a septic patient.

  • D. Extracorporeal shock wave lithotripsy now

    Lithotripsy into an infected system can precipitate septicaemia and is deferred until it is drained.

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 Radiology question

What is the answer to this Radiology question?

The best answer is A, Urgent percutaneous nephrostomy. An infected obstructed kidney is a urological emergency and needs urgent decompression, by percutaneous nephrostomy or retrograde stent, together with antibiotics.

Why is "Observation with analgesia and fluids alone" not the answer?

Observation would allow progression to septic shock and loss of renal function.

Why is "Oral antibiotics and elective stone removal" not the answer?

Oral antibiotics cannot sterilise an obstructed collecting system in a septic patient.

Why is "Extracorporeal shock wave lithotripsy now" not the answer?

Lithotripsy into an infected system can precipitate septicaemia and is deferred until it is drained.

What concept does this question test?

It tests Abdominal and GI imaging: obstructed infected kidney in Radiology. Definitive stone treatment follows once sepsis settles. Lithotripsy or oral treatment alone risks worsening septic shock.

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 Abdominal and GI imaging: obstructed infected kidney?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology 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.