ICD-10-CM N-SERIES ADVANCED CLINICAL QUESTION BANK

(N00–N99 ONLY)

1. A patient presents to the nephrology clinic with sudden-onset periorbital edema, profound oliguria, and
macroscopic hematuria. Renal biopsy reveals acute nephritic syndrome characterized specifically by
diffuse mesangial proliferative glomerulonephritis, and the clinician documents the absolute absence of
any associated rapidly progressive changes or nephrotic-range proteinuria -

2. Following a brief prodromal illness, an adult patient rapidly develops severe anuria, uremia, and
aggressive fluid overload. A stat renal biopsy demonstrates a rapidly progressive nephritic syndrome
driven by diffuse endocapillary proliferative glomerulonephritis, necessitating immediate induction
therapy with high-dose pulse corticosteroids -

3. A young adult undergoes evaluation for recurrent, persistent episodes of gross hematuria that consistently
flare following upper respiratory infections. A comprehensive microscopic evaluation of a kidney biopsy
firmly establishes a diagnosis of recurrent and persistent hematuria with diffuse mesangiocapillary
glomerulonephritis without any clinical evidence of acute nephritic syndrome -

4. An elderly patient with a long-standing history of microscopic hematuria and slowly declining renal
function is admitted for severe volume overload. A specialized renal pathology report confirms chronic
nephritic syndrome exclusively associated with diffuse membranous glomerulonephritis, alongside
extensive tubular atrophy -

5. A patient is admitted to the medical ward exhibiting massive anasarca, profound hypoalbuminemia, and
extreme hyperlipidemia. 24-hour urine collection yields 5 grams of protein, and a percutaneous renal
biopsy confirms classic nephrotic syndrome resulting precisely from focal and segmental glomerular
lesions -

6. A patient undergoes diagnostic evaluation for asymptomatic but persistent urinary abnormalities,
including mild proteinuria and dysmorphic red blood cells. The final pathology report documents an
unspecified nephritic syndrome firmly associated with dense deposit disease, with no signs of acute
deterioration or massive protein loss -

7. During a routine occupational physical, a patient is found to have isolated, high-grade proteinuria entirely
lacking any hematuria, edema, or hypertension. Subsequent histological examination of renal tissue
explicitly identifies diffuse crescentic glomerulonephritis as the sole underlying morphological lesion
responsible for the protein leakage -

8. A pediatric patient with a documented, extensive family history of progressive renal failure and
sensorineural deafness presents with steadily declining glomerular filtration rates. A genetic and
histopathological workup yields a definitive diagnosis of hereditary nephropathy, not elsewhere classified,
presenting with other specified morphologic changes in the glomeruli -
 9. A female patient is admitted with severe, unilateral right-sided flank pain, spiking fevers to 103°F, intense
rigors, and marked costovertebral angle tenderness. Urine cultures confirm active bacterial growth, and
the hospitalist documents acute tubulo-interstitial nephritis, exclusively ruling out any concurrent renal
medullary necrosis or abscess formation -

10. An adolescent patient undergoes extensive urological investigation for recurrent lower urinary tract
infections and persistent structural abnormalities. Voiding cystourethrography unambiguously
demonstrates non-obstructive, severe vesicoureteral reflux directly causing chronic pyelonephritis and
widespread cortical scarring of the left kidney -

11. A patient with a known history of severe, unmanaged benign prostatic hyperplasia presents with
progressive renal impairment and chronic flank dullness. Imaging studies confirm significant chronic
obstructive pyelonephritis strictly secondary to long-standing lower urinary tract outflow resistance and
bilateral pelvicalyceal dilation -

12. A prenatal ultrasound of a 28-week fetus reveals a severe congenital anomaly of the genitourinary tract,
prompting an immediate postnatal evaluation that definitively identifies complete, unilateral
hydronephrosis directly caused by a stricture explicitly located at the ureteropelvic junction -

13. A patient presents to the emergency room writhing in extreme, colicky left flank pain radiating securely
into the left groin. A non-contrast computed tomography scan reveals severe left-sided hydronephrosis
explicitly resulting from an impacted calculus causing complete obstruction at the ureterovesical junction
-

14. A patient evaluates for chronic, intermittent right flank pain exacerbated by heavy fluid intake. A diuretic
renal scan completely rules out calculous disease, identifying a distinct crossing lower pole renal vessel
causing a functional stricture of the proximal ureter, strictly without any hydronephrosis present -

15. Following a prolonged course of high-dose nonsteroidal anti-inflammatory drug therapy for chronic joint
pain, a patient develops insidious, progressive kidney dysfunction. A nephrologist correlates the timeline
and clinical findings, formally diagnosing toxic nephropathy explicitly induced by other drugs,
medicaments, and biological substances -

16. An immunocompromised diabetic patient is admitted to the intensive care unit with persistent high-grade
fevers, localized flank erythema, and profound sepsis. Contrast-enhanced imaging of the abdomen
uncovers a massive, loculated purulent fluid collection confined completely within Gerota's fascia,
confirming a perinephric abscess -

17. A critically ill patient in shock following a massive hemorrhagic event demonstrates a sudden, profound
cessation of urine output. Laboratory values show a rapid tripling of baseline serum creatinine, and the
critical care team definitively diagnoses acute kidney failure predominantly driven by acute tubular
necrosis -

18. A pregnant patient suffering from severe abruptio placentae develops acute renal failure shortly after an
emergency cesarean section. Histological features and severe, irreversible anuria lead the consulting
 nephrologist to document the grim diagnosis of acute kidney failure associated with acute cortical
necrosis -

19. A patient with a chronic history of heavy analgesic abuse presents to the emergency department with
acute, unremitting flank pain and gross hematuria. Microscopic urinalysis reveals sloughed renal tissue,
and imaging solidifies a diagnosis of acute kidney failure specifically featuring acute medullary necrosis -

20. A patient with an established baseline estimated glomerular filtration rate of 35 mL/min/1.73m² presents
with severe dehydration following a bout of gastroenteritis. The provider explicitly documents
unspecified acute kidney failure superimposed completely upon the pre-existing chronic kidney disease
stage 3b -

21. A patient is evaluated in the outpatient nephrology clinic with a sustained estimated glomerular filtration
rate securely resting at 22 mL/min/1.73m² over the past six months. The nephrologist actively manages
the associated secondary hyperparathyroidism and formally documents severe chronic kidney disease,
stage 4 -

22. An elderly patient dependent on hemodialysis via a left arm arteriovenous fistula evaluates for an
assessment of a newly placed peritoneal dialysis catheter. The attending provider meticulously records the
diagnosis of end-stage renal disease, reflecting the absolute, permanent loss of all native renal function -

23. A patient complains of sudden, sharp, episodic pain localized perfectly in the right mid-back region
without any downward radiation. A KUB radiograph identifies a solitary, large radiopaque calculus
situated securely within the renal pelvis of the right kidney, completely without any ureteral involvement
-

24. A patient presents with agonizing, twisting lower abdominal pain, marked nausea, and frequent vomiting.
An emergency ultrasound explicitly visualizes a completely isolated, 8 mm obstructive calculus wedged
tightly in the mid-portion of the left ureter, strictly devoid of any intrarenal stones -

25. An asymptomatic patient undergoes an incidental abdominal CT scan for an unrelated gastrointestinal
complaint. The radiologist discovers multiple small calculi freely resting within the lower calyces of the
right kidney, alongside an additional distinct, non-obstructive calculus residing in the distal right ureter -

26. An adult male with a long-standing, poorly controlled history of severe bladder outlet obstruction presents
with profound dysuria, intermittent urinary stream interruption, and terminal hematuria. Cystoscopy
unmistakably visualizes a large, mobile, spherical calculus freely floating entirely within the urinary
bladder -

27. A psychiatric patient on chronic lithium therapy complains of extreme polyuria, consuming and excreting
over 8 liters of fluid daily. Specialized water deprivation testing definitively demonstrates a failure of the
kidneys to concentrate urine despite adequate antidiuretic hormone secretion, diagnosing nephrogenic
diabetes insipidus -

28. An elderly patient undergoes a comprehensive renal ultrasound due to a heavily diminished glomerular
filtration rate. The imaging confirms severe, bilateral thinning of the renal parenchyma and a profound
reduction in total kidney size, leading the radiologist to firmly document terminal atrophy of the kidney -
29. A patient with known systemic atherosclerosis presents with the abrupt, unprovoked onset of severe,
tearing flank pain. A stat renal angiogram confirms a complete, acute thromboembolic occlusion of a
major branch of the left renal artery, rapidly precipitating extensive ischemia and localized infarction of
the kidney -

30. A routine screening ultrasound performed on an asymptomatic 55-year-old patient reveals a single, large,
thin-walled, fluid-filled cystic lesion located squarely on the upper pole of the right kidney. The
nephrologist confirms it is entirely benign and definitively codes the finding as an acquired cyst of the
kidney -

31. Following a radical nephrectomy for localized renal cell carcinoma two years prior, a patient returns for a
surveillance scan. The imaging perfectly visualizes significant compensatory enlargement of the solitary
remaining kidney, which the radiologist definitively documents as benign hypertrophy of the kidney -

32. A female patient evaluates at the urgent care center complaining of severe suprapubic pressure, profound
dysuria, and frankly blood-tinged urine. Urinalysis confirms numerous red blood cells and nitrites, and
the provider diagnoses an acute cystitis explicitly accompanied by gross hematuria -

33. A patient suffers from long-term, debilitating pelvic pain and a relentless, urgent need to urinate up to 40
times a day. Cystoscopy with hydrodistention reveals classic Hunner's ulcers scattered across the bladder
wall, resulting in a diagnosis of chronic interstitial cystitis completely devoid of any active hematuria -

34. A patient is evaluated for chronic, persistent lower urinary tract discomfort, frequent voiding, and
recurring episodes of blood in the urine. Extensive urological workup completely rules out interstitial
disease or radiation damage, yielding a diagnosis of other specified chronic cystitis presenting
prominently with hematuria -

35. A patient with a documented severe spinal cord injury at the T10 level develops profound urinary
retention, overflow incontinence, and an inability to voluntarily initiate a void. Urodynamic studies
decisively show complete absence of detrusor contractions, confirming a flaccid neuropathic bladder, not
elsewhere classified -

36. An adult patient presents with a severely diminished urinary stream, marked hesitancy, and a sensation of
incomplete emptying. Advanced cystourethroscopy reveals pronounced, fibrous hypertrophy localized
entirely at the internal urethral sphincter, establishing a primary, non-prostatic diagnosis of bladder-neck
obstruction -

37. A patient with a known history of severe, fistulizing Crohn's disease reports passing copious amounts of
gas and fecal material directly through the urethra during urination. A cystogram with contrast firmly
establishes the presence of an active, communicating vesicointestinal fistula connecting the bladder to the
sigmoid colon -

38. A male patient presents with profound urinary hesitancy and a splayed urinary stream exactly one year
following a traumatic straddle injury to the perineum. A retrograde urethrogram demonstrates a dense,
fibrous narrowing affecting both the bulbar and membranous segments, documented as a post-traumatic
urethral stricture of overlapping sites -
39. A multiparous female patient evaluates in the urogynecology clinic complaining of unpredictable,
involuntary urine leakage occurring strictly during episodes of coughing, sneezing, or heavy lifting. A
provocative stress test is notably positive, confirming the isolated presence of stress incontinence without
any detrusor overactivity -

40. An elderly patient complains of a sudden, intense, and completely uncontrollable desire to urinate,
frequently resulting in massive urinary leakage before reaching the toilet. Urodynamic testing uncovers
severe detrusor muscle hyperreflexia during the filling phase, explicitly diagnosing pure urge
incontinence -

41. A patient reports to the urologist with complaints of involuntary urine loss triggered by both physical
exertion and an overwhelming, sudden compulsion to void. Comprehensive urodynamic evaluation
explicitly confirms the simultaneous presence of detrusor overactivity and sphincter incompetence,
diagnosing mixed incontinence -

42. A senior male patient evaluates for chronic, progressively worsening nocturia, a highly weakened urinary
stream, and an enlarged, smooth, non-tender prostate on digital rectal examination. The urologist
diagnoses nodular prostate enlargement explicitly resulting in lower urinary tract symptoms, specifically
post-void dribbling -

43. A male patient presents to the emergency room with a spiking high fever, severe perineal pain, exquisite
tenderness upon digital rectal examination, and marked dysuria. The provider orders a prolonged course
of targeted antibiotics to aggressively manage the localized inflammatory disease, exclusively coded as
acute prostatitis -

44. A male infant is evaluated for a completely painless, massive, fluid-filled transilluminating swelling
localized perfectly within the left scrotal sac. The pediatric urologist observes the condition over several
months without surgical intervention, precisely documenting it as an unspecified hydrocele -

45. A young male patient arrives at the emergency department with the sudden, explosive onset of
excruciating left scrotal pain, significant swelling, and a distinctly high-riding testicle. An immediate
scrotal Doppler ultrasound reveals absolutely absent arterial blood flow, prompting emergency surgical
exploration for extravaginal torsion of testis -

46. A sexually active male patient presents with acute, localized, severe pain and marked induration situated
squarely at the posterior aspect of the right testicle, which is visibly swollen. Urinalysis reveals pyuria,
and the provider diagnoses a combined inflammatory infection formally documented as epididymo-
orchitis -

47. A young female patient evaluates with acute, intense bilateral lower abdominal pain, mucopurulent
cervical discharge, and pronounced cervical motion tenderness. A pelvic ultrasound reveals severely
thickened, highly inflamed fallopian tubes and heavily enlarged ovaries, confirming a diagnosis of acute
salpingitis and oophoritis -

48. A female patient suffering from chronic, debilitating pelvic pain and severe dysmenorrhea undergoes an
elective diagnostic laparoscopy. The gynecologic surgeon directly visualizes and successfully biopsies
 multiple 'powder-burn' lesions localized purely on the outer serosal surface of the uterus, confirming
endometriosis of the uterus -

49. A multiparous female patient complains of a chronic, distinct feeling of pelvic heaviness and a visibly
protruding vaginal mass when bearing down. A focused pelvic examination confirms a significant anterior
vaginal wall prolapse strictly confined to the central region, correctly diagnosed as a midline cystocele -

50. A female patient undergoes a routine pelvic ultrasound for vague, non-specific abdominal bloating. The
imaging incidentally discovers a solitary, 4 cm simple, fluid-filled, completely asymptomatic sac located
entirely within the adnexa on the right side, recorded accurately as an unspecified ovarian cyst, right side
-

ANSWER KEY

1. N00.3 2. N01.4 3. N02.5 4. N03.2 5. N04.1

6. N05.6 7. N06.7 8. N07.8 9. N10 10. N11.0
11. N11.1 12. N13.0 13. N13.2 14. N13.5 15. N14.1
16. N15.1 17. N17.0 18. N17.1 19. N17.2 20. N17.9, N18.32
21. N18.4 22. N18.6 23. N20.0 24. N20.1 25. N20.2
26. N21.0 27. N25.1 28. N26.1 29. N28.0 30. N28.1
31. N28.81 32. N30.01 33. N30.10 34. N30.21 35. N31.2
36. N32.0 37. N32.1 38. N35.016 39. N39.3 40. N39.41
41. N39.46 42. N40.1, N39.44 43. N41.0 44. N43.3 45. N44.01
46. N45.3 47. N70.03 48. N80.00 49. N81.11 50. N83.201