Question Easy:
A 55-year-old man visits his GP with a complaint of nocturia and poor urine stream. He denies any dysuria or haematuria. On digital rectal examination, his prostate is enlarged but not tender. What is the most likely diagnosis?
A) Prostate cancer
B) Acute prostatitis
C) Benign prostatic hyperplasia (BPH)
D) Chronic prostatitis
E) Urethral stricture
Explanations & Answers:
Question Easy Answer: C) Benign prostatic hyperplasia (BPH)
Question Easy Explanation: This patient presents with symptoms typical of BPH, such as nocturia and a poor urine stream. The enlargement of the prostate without tenderness further supports this diagnosis. According to NICE guidelines, these findings are consistent with BPH, a common condition in older men.
Question Medium:
A 45-year-old woman presents with fever, flank pain, and dysuria. Her urinalysis shows pyuria and bacteriuria. She is diagnosed with acute pyelonephritis. What is the recommended first-line oral antibiotic treatment as per NICE guidelines?
A) Ciprofloxacin
B) Nitrofurantoin
C) Trimethoprim
D) Flucloxacillin
E) Amoxicillin
Explanations & Answers:
Question Medium Answer: A) Ciprofloxacin
Question Medium Explanation: NICE guidelines recommend ciprofloxacin as a first-line oral treatment for acute pyelonephritis in the community when intravenous treatment is not required. Alternatives may include co-amoxiclav depending on local resistance patterns and patient allergies.
Question Hard:
A 63-year-old man with chronic kidney disease (CKD) stage 4 is reviewed in the renal clinic. His blood pressure is persistently high despite being on ramipril and amlodipine. According to NICE guidelines, which drug should be added next to his regimen?
A) Bendroflumethiazide
B) Losartan
C) Spironolactone
D) Atenolol
E) Doxazosin
Explanations & Answers:
Question Hard Answer: C) Spironolactone
Question Hard Explanation: In patients with CKD and resistant hypertension (uncontrolled on three or more drugs), adding spironolactone is suggested per NICE guidelines. While care is needed due to the risk of hyperkalaemia, spironolactone can be effective in lowering blood pressure in such patients.
Medical fact of the day: Did you know that polycystic kidney disease is the most common hereditary kidney disorder in the UK? It is a significant cause of kidney failure and typically requires careful management and lifestyle modifications to delay kidney deterioration.
Quote of the day: “In the heart of care, lies the power to heal more spirits than bodies.” 🌟