Question Easy:
A 45-year-old woman presents with frothy urine and puffy eyes. Blood tests reveal hypoalbuminemia and proteinuria. Which of the following is the most likely diagnosis?
A) Nephritis
B) Nephrotic syndrome
C) Acute kidney injury
D) Chronic kidney disease
E) Hypertension
Explanations & Answers:
Question Easy Answer: B) Nephrotic syndrome
Question Easy Explanation: Nephrotic syndrome is characterised by significant proteinuria, hypoalbuminemia, and oedema, leading to symptoms such as frothy urine and puffy eyes. NICE guidelines recommend considering nephrotic syndrome in patients with these findings and initiating appropriate management to address symptom relief and underlying causes.
Question Medium:
A 60-year-old man presents with difficulty urinating, a weak stream, and nocturia. His PSA level is elevated, and a digital rectal examination reveals an enlarged, smooth prostate. What is the next best step in management?
A) Start alpha-blockers
B) Refer for prostate biopsy
C) Initiate antibiotics
D) Prescribe 5-alpha-reductase inhibitors
E) Schedule urgent urology referral
Explanations & Answers:
Question Medium Answer: A) Start alpha-blockers
Question Medium Explanation: The symptoms suggest benign prostatic hyperplasia (BPH). According to NICE guidelines, initial management of BPH with lower urinary tract symptoms often involves alpha-blockers to improve urinary flow and alleviate symptoms. Elevated PSA in this context should be monitored, but immediate biopsy or referral is not always necessary unless there are suspicious findings suggesting malignancy.
Question Hard:
A 35-year-old man presents with recurrent episodes of visible haematuria, especially after upper respiratory tract infections. Immunofluorescence on renal biopsy shows IgA deposition in the glomerular mesangium. What is the initial treatment approach?
A) Immunosuppressants
B) High-dose corticosteroids
C) Angiotensin-converting enzyme (ACE) inhibitors
D) Cyclophosphamide
E) Plasmapheresis
Explanations & Answers:
Question Hard Answer: C) Angiotensin-converting enzyme (ACE) inhibitors
Question Hard Explanation: The presentation and biopsy findings are consistent with IgA nephropathy, where hypertension and proteinuria are common findings. NICE guidelines suggest using ACE inhibitors as an initial treatment to control blood pressure and reduce proteinuria, thereby slowing disease progression. Immunosuppressive therapy is usually reserved for more severe cases.
Medical fact of the day: Kidney stones are surprisingly common in the UK, with 10-20% of men and 3-5% of women likely to develop one at some point in their lives. Prevention advice includes staying hydrated and moderating intake of salt and animal protein, as advised by NHS guidelines.
Quote of the day: “In the rush of saving lives, never forget the power of compassion—a medicine free of cost but priceless in value.”