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A 32-Year-Old Woman Comes to the Physician Complaining of Severe

question 16

Multiple Choice

A 32-year-old woman comes to the physician complaining of severe left flank pain and gross hematuria. The pain started about 6 hours earlier and has steadily increased. It is not colicky in nature. There is no history of trauma, bleeding, or bruising. The patient has no weight loss, fever, chills, or dysuria. She considers herself in good health and works full-time as an editorial assistant. There is no family history of hematuria, kidney stones, or kidney disease. Her past medical history is unremarkable and she takes no medications.
On examination, the patient appears uncomfortable. Her vital signs are within normal limits. Some scattered small pits are noted in her teeth. Cardiac and pulmonary examinations are unremarkable. An ill-defined mass is felt in the left flank area on abdominal examination.
Laboratory results show a urinalysis with red bloods cells too numerous to count, normal complete blood count, and normal comprehensive metabolic panel.
An urgent ultrasound reveals a 10-cm echogenic mass in the left kidney. Smaller echogenic masses and 3 renal cysts are seen in the right kidney. Abdominal CT scan reveals a 10x13-cm mass in the left kidney with attenuation similar to perirenal fat.
Which of the following is the most likely diagnosis?

Definitions:

Moral Hazard Problem

A situation where one party engages in risky behavior knowing that it is protected against the consequences, usually by a contract or an agreement, leading to suboptimal outcomes for the other party.

Automobile Insurance

A policy purchased by vehicle owners to mitigate costs associated with car accidents.

Medical Coverage

Insurance that pays for medical expenses, including doctor visits, hospital stays, surgery, and sometimes prescription drugs.

Law Clerks

Individuals, often law school graduates, who assist judges by conducting legal research and drafting opinions.