Question Easy: 🚰 A 60-year-old man presents with increased thirst and frequent urination. His blood tests reveal a serum sodium level of 148 mmol/L and a serum osmolality of 305 mOsm/kg. What is the most likely diagnosis?
A) Diabetes mellitus
B) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
C) Diabetes insipidus
D) Chronic kidney disease
E) Acute tubular necrosis
Explanations & Answers:
Question Easy Answer: C) Diabetes insipidus
Question Easy Explanation: Diabetes insipidus is characterised by large volumes of dilute urine and increased thirst, resulting in hypernatremia and a high serum osmolality. These findings are consistent with the 60-year-old man’s symptoms and laboratory results. Unlike diabetes mellitus, there is no glucose in the urine, and SIADH is usually associated with hyponatremia due to retained water.
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Question Medium: 🧪 A 45-year-old woman presents with severe abdominal pain radiating to the groin, hematuria, and nausea. An abdominal CT scan confirms a 5mm stone in the right ureter. What is the most appropriate initial management according to NICE guidelines?
A) Ureteroscopy
B) Extracorporeal shock wave lithotripsy (ESWL)
C) Percutaneous nephrolithotomy
D) Conservative management with analgesia
E) Open surgery
Explanations & Answers:
Question Medium Answer: D) Conservative management with analgesia
Question Medium Explanation: According to NICE guidelines, conservative management with pain relief such as NSAIDs is appropriate for small stones, like a 5mm one, as it is likely to pass spontaneously. Ureteroscopy or ESWL may be considered if conservative management fails or if there are complications.
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Question Hard: 🔍 A 75-year-old man with a long-standing history of benign prostatic hyperplasia (BPH) presents with worsening urinary symptoms, including frequency, urgency, and nocturia. His PSA level is 8 ng/mL, and digital rectal examination reveals a hard, irregular prostate. What is the next most appropriate step in management?
A) Initiate tamsulosin therapy
B) Repeat PSA in 6 months
C) Referral for prostate biopsy
D) Start antibiotic therapy for prostatitis
E) Perform a cystoscopy
Explanations & Answers:
Question Hard Answer: C) Referral for prostate biopsy
Question Hard Explanation: In a patient with a hard, irregular prostate and elevated PSA, there is a suspicion for prostate cancer. According to NHS guidelines, the next appropriate step is to refer the patient for a prostate biopsy to confirm the diagnosis. Initiating tamsulosin or antibiotics without further investigation would be inappropriate given the suspicion of malignancy.
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Medical fact of the day: Did you know that urinary tract infections (UTIs) are one of the most common bacterial infections globally? In the UK, they account for more than 1.5 million GP consultations each year, emphasizing how vital it is for healthcare professionals to manage these infections effectively according to NHS guidelines. 🚽
Quote of the day: “In the quiet moments of the ward, when exhaustion meets dedication, remember: every act of care leaves a lasting imprint. Shine on, for those under your care see your light even in their darkest times.” 🌟