Question Easy:
A 45-year-old man presents to the GP with fatigue and reduced urine output. On examination, his blood pressure is 160/100 mmHg. Laboratory tests reveal a serum creatinine level of 250 µmol/L. What is the likely underlying cause of his renal impairment? 🚰
A) Diabetes Mellitus
B) Hypertension
C) Polycystic Kidney Disease
D) Acute Glomerulonephritis
E) Urinary Tract Infection
Question Medium:
A 65-year-old woman has a history of recurrent urinary tract infections (UTIs) and presents with fever, flank pain, and nausea. Urinalysis shows leukocytes, nitrites, and some casts. Which of the following antibiotics is the most appropriate initial treatment for her condition, considering UK guidelines for pyelonephritis? 👩⚕️
A) Nitrofurantoin
B) Trimethoprim
C) Amoxicillin
D) Ciprofloxacin
E) Doxycycline
Question Hard:
A 70-year-old man has a history of chronic kidney disease (stage 4) secondary to diabetic nephropathy. He presents with worsening anaemia. His Hb is 9 g/dL, MCV is 85 fL, serum ferritin is 500 µg/L, and transferrin saturation is 15%. What is the most appropriate treatment for his anaemia? 💉
A) Oral iron supplementation
B) Erythropoiesis-stimulating agent (ESA)
C) Red blood cell transfusion
D) Vitamin B12 supplementation
E) Folic acid supplementation
Explanations & Answers:
Question Easy Answer: B) Hypertension
Question Easy Explanation: Hypertension is a common cause of chronic kidney disease due to its effect on renal vasculature and glomeruli over time. Elevated blood pressure often leads to nephron damage, contributing to progressive renal impairment.
Question Medium Answer: D) Ciprofloxacin
Question Medium Explanation: According to NICE guidelines, ciprofloxacin is commonly used in the treatment of acute pyelonephritis due to its adequate coverage of Gram-negative organisms, such as E. coli, and good renal tissue penetration.
Question Hard Answer: B) Erythropoiesis-stimulating agent (ESA)
Question Hard Explanation: In patients with CKD and anaemia, especially when other causes such as iron deficiency are ruled out (high ferritin and low transferrin saturation), ESAs are recommended to stimulate red blood cell production, in line with NICE guidelines. Iron management should still be addressed to improve response to ESA therapy.
Medical fact of the day: In the UK, autosomal dominant polycystic kidney disease (ADPKD) is one of the most common inherited renal disorders, affecting approximately 1 in 1,000 individuals. It often leads to end-stage renal disease by the age of 60.
Quote of the day: “In the heart of care, amidst beeping monitors and silent prayers, lies the power to heal and the courage to keep trying.”