Question Easy:
A 24-year-old female presents with sudden onset of right flank pain radiating to the groin, associated with nausea and vomiting. A non-contrast CT scan demonstrates a 5mm ureteric stone. Which of the following is the most appropriate initial management for this patient? 🚑
A) Refer for surgery
B) Prescribe analgesia and discharge with urology follow-up
C) Start intravenous antibiotics immediately
D) Place a urethral catheter
E) Admit for observation
Question Medium:
A 52-year-old man with a history of hypertension presents with fatigue, foamy urine, and peripheral edema. His blood pressure is 150/95 mmHg. Urinalysis shows +++ proteinuria and hyaline casts. Serum albumin is low. What is the most likely diagnosis?
A) Acute kidney injury
B) Chronic kidney disease
C) Nephrotic syndrome
D) Nephritic syndrome
E) Urinary tract infection
Question Hard:
A 65-year-old diabetic patient is in the clinic for routine follow-up. His eGFR has decreased from 65 to 58 mL/min/1.73m² over the last year, and his HbA1c is 55 mmol/mol. What is the most appropriate action to slow the progression of his renal disease?
A) Increase the dose of his diuretic
B) Tighten glycaemic control
C) Reduce dietary protein intake
D) Start an ACE inhibitor
E) Refer to a nephrologist
Explanations & Answers:
Question Easy Answer: B
Question Easy Explanation: The most appropriate initial management for a small ureteric stone in a stable patient includes analgesia and outpatient follow-up, as suggested by NICE guidelines. Most small stones will pass spontaneously, and admission is usually unnecessary unless there are complications such as infection or intractable pain.
Question Medium Answer: C
Question Medium Explanation: The patient’s presentation is indicative of nephrotic syndrome, characterized by heavy proteinuria, hypoalbuminemia, and edema. Nephrotic syndrome can occur with various conditions, but the classic triad confirms the diagnosis according to NHS guidelines.
Question Hard Answer: D
Question Hard Explanation: In patients with diabetic nephropathy, starting an ACE inhibitor or an ARB is recommended to slow the progression of chronic kidney disease. These medications help reduce intraglomerular pressure and proteinuria, thereby protecting renal function, in line with both NICE and BNF recommendations.
Medical fact of the day: Did you know? The left kidney is positioned slightly higher than the right kidney due to the larger space occupied by the liver on the right side of the body.
Quote of the day: “In the moments of great challenge, remember that each step forward—even the smallest—is a leap toward healing and hope.” 🌟