Question Easy:
A 45-year-old male presents with painless hematuria. He has a 30-pack-year smoking history. What is the most likely diagnosis?
A) Urinary tract infection
B) Bladder cancer
C) Glomerulonephritis
D) Nephrolithiasis
E) Benign prostatic hyperplasia
Explanations & Answers:
Question Easy Answer: B) Bladder cancer
Question Easy Explanation: Painless hematuria in a patient with a significant smoking history is highly suggestive of bladder cancer. NICE guidelines indicate that a history of smoking is a significant risk factor for bladder cancer. A referral to a urologist for cystoscopy and further evaluation is recommended.
Question Medium:
A 50-year-old woman presents with a 3-day history of dysuria, increased urinary frequency, and suprapubic pain. A urine dipstick test shows positive nitrates and leukocytes. What is the first-line treatment?
A) Trimethoprim
B) Nitrofurantoin
C) Ciprofloxacin
D) Amoxicillin
E) Doxycycline
Explanations & Answers:
Question Medium Answer: B) Nitrofurantoin
Question Medium Explanation: According to NICE guidelines, nitrofurantoin is the first-line treatment for uncomplicated urinary tract infections (UTIs) in women due to its efficacy and low resistance rates. Trimethoprim is an alternative, especially if nitrofurantoin is contraindicated or not tolerated.
Question Hard:
A 65-year-old male with chronic kidney disease (CKD) stage 4 presents with a sudden onset of shortness of breath, peripheral oedema, and increased blood pressure. His serum potassium level is 6.5 mmol/L. What is the most appropriate initial management?
A) Calcium gluconate
B) Salbutamol
C) Insulin with glucose
D) Sodium bicarbonate
E) Haemodialysis
Explanations & Answers:
Question Hard Answer: A) Calcium gluconate
Question Hard Explanation: In the management of hyperkalaemia, especially in symptomatic patients or those with ECG changes, the initial step is to stabilize the cardiac membrane with intravenous calcium gluconate as per NICE guidelines. This is followed by measures to reduce serum potassium levels such as using insulin with glucose, salbutamol, and considering haemodialysis if necessary.
Medical fact of the day: Did you know that glomerulonephritis is one of the leading causes of end-stage renal disease (ESRD) in the UK? Early diagnosis and treatment are crucial to prevent progression to chronic kidney disease.
Quote of the day: “In the tapestry of healthcare, each act of kindness and each moment of care weave the fabric of healing tighter and stronger.” 🌟