Question Easy:
A 58-year-old man presents with difficulty urinating and a weak stream. He is worried about prostate cancer. What is the most appropriate initial investigation to evaluate his symptoms in a primary care setting?
A) Digital rectal examination (DRE)
B) PSA (prostate-specific antigen) test
C) Urinalysis
D) CT scan of the pelvis
E) MRI of the prostate
Explanations & Answers:
Question Easy Answer: B) PSA (prostate-specific antigen) test
Question Easy Explanation: In primary care, a PSA test is often performed to evaluate symptoms that may be related to prostate conditions, including benign prostatic hyperplasia and prostate cancer, according to NHS guidelines. While a digital rectal examination (DRE) is also important, the PSA test serves as a crucial initial investigation in assessing prostate health.
Question Medium:
A 30-year-old woman presents with severe left flank pain, hematuria, and nausea. She has a history of recurrent kidney stones. What is the next best step in managing her current condition?
A) Start ibuprofen
B) Perform a CT scan of the abdomen and pelvis
C) Urinalysis
D) Prescribe antibiotics
E) Insert a urinary catheter
Question Medium Answer: B) Perform a CT scan of the abdomen and pelvis
Question Medium Explanation: The patient’s presentation is consistent with ureteric colic secondary to renal stones. A CT scan of the abdomen and pelvis is the preferred imaging modality to confirm the diagnosis of a kidney stone and to guide further management, aligning with NICE guidelines. It provides detailed information without contrast, particularly for stones.
Question Hard:
A 68-year-old man with chronic kidney disease (stage 4) is experiencing worsening anaemia. His current medications include lisinopril, atorvastatin, and ferrous sulfate. Which medication is the most appropriate to address his anaemia?
A) Oral iron therapy
B) Erythropoiesis-stimulating agent (ESA)
C) Vitamin B12 injections
D) Folic acid supplements
E) Blood transfusion
Question Hard Answer: B) Erythropoiesis-stimulating agent (ESA)
Question Hard Explanation: In patients with chronic kidney disease (CKD) and significant anaemia (usually Hb<11 g/dL), erythropoiesis-stimulating agents (ESAs) are used to stimulate red blood cell production, as per NICE guidelines. Oral iron is typically insufficient alone in late-stage CKD due to reduced erythropoietin production by the kidneys.
Medical fact of the day: One interesting fact is that the glomerular filtration rate (GFR) naturally decreases with age, approximately after 30 years of age, which is an essential consideration in managing older patients with potential renal impairment.
Quote of the day: “In the quiet dedication of each heartbeat lies the greatest power to heal. Let compassion be your companion on this noble journey.”