Question Easy:
A 45-year-old man presents to the GP with symptoms of increased thirst and urination. A subsequent blood test reveals a serum sodium level of 150 mmol/L. What is the most likely diagnosis? 🩺
A) Primary hyperaldosteronism
B) Diabetes mellitus
C) Diabetes insipidus
D) Psychogenic polydipsia
E) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Explanations & Answers:
Question Easy Answer:
C) Diabetes insipidus
Question Easy Explanation:
Diabetes insipidus is characterized by polyuria and polydipsia due to a lack of antidiuretic hormone (ADH) or a renal insensitivity to ADH, leading to diluted urine and increased sodium in the blood. The serum sodium level of 150 mmol/L suggests hypernatremia, which is consistent with diabetes insipidus, as opposed to the other options which would present differently.
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Question Medium:
A 32-year-old lady presents with dysuria and increased urinary frequency of 2 days’ duration. She has no fever or flank pain. Urinalysis shows leukocytes and nitrites. What is the next best step in managing this patient? 🚑
A) Prescribe a 7-day course of nitrofurantoin
B) Prescribe a 3-day course of trimethoprim
C) Prescribe cranberry supplements
D) Advise increased fluid intake only
E) Refer for renal ultrasound
Explanations & Answers:
Question Medium Answer:
B) Prescribe a 3-day course of trimethoprim
Question Medium Explanation:
According to NICE guidelines, for uncomplicated urinary tract infections (UTIs) in women, a short course of antibiotics is recommended. A 3-day course of trimethoprim is effective unless the patient is at risk of antibiotic resistance, an option that should be confirmed based on local guidelines and resistance patterns. This is preferred as opposed to a longer course of nitrofurantoin without complicated symptoms.
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Question Hard:
A 70-year-old man with a history of hypertension and benign prostatic hyperplasia presents to the emergency department with signs of acute kidney injury (AKI). His medications include lisinopril and tamsulosin. What is the most likely cause of his AKI? 📉
A) Dehydration due to diarrhoea
B) Obstruction due to prostate enlargement
C) Acute interstitial nephritis from lisinopril
D) Contrast-induced nephropathy
E) Tamsulosin-induced hypotension
Explanations & Answers:
Question Hard Answer:
B) Obstruction due to prostate enlargement
Question Hard Explanation:
In older men with benign prostatic hyperplasia (BPH), obstruction can lead to post-renal acute kidney injury due to impaired bladder emptying. This patient’s history and medication list do not suggest causes such as acute interstitial nephritis or contrast-induced nephropathy. Given his BPH and AKI, prostatic enlargement causing urinary retention is a likely culprit, as suggested by NHS protocols for managing AKI in such patients.
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Medical fact of the day:
Kidneys filter around 180 litres of blood every day! They work tirelessly to remove waste, keep your electrolytes balanced, and regulate blood pressure.
Quote of the day:
“In the relentless rhythm of healthcare, let compassion be the heartbeat that never misses a beat.” 🩺