Question Easy:
A 50-year-old man presents with sudden onset of colicky left flank pain radiating to the groin, associated with nausea and vomiting. What is the most probable diagnosis?
A) Acute pyelonephritis
B) Renal colic
C) Urinary tract infection
D) Appendicitis
E) Diverticulitis
Explanations & Answers:
Question Easy Answer: B
Question Easy Explanation: ⚕️Renal colic, typically caused by kidney stones, presents with sudden onset of severe colicky pain radiating from the flank to the groin, often associated with nausea and vomiting. According to NICE guidelines, the description fits renal colic most accurately.
Question Medium:
A 35-year-old woman with a history of recurrent urinary tract infections presents with dysuria, increased frequency, and suprapubic pain. Urine dipstick is positive for nitrites and leukocytes. What is the most appropriate next step in her management?
A) Start empirical antibiotics
B) Perform a cystoscopy
C) Order a renal ultrasound
D) Refer to a urologist
E) Advise increased fluid intake
Explanations & Answers:
Question Medium Answer: A
Question Medium Explanation: 🚑According to NICE guidelines, starting empirical antibiotics is the most appropriate first step in managing uncomplicated recurrent UTIs, following confirmation with a urine dipstick positive for nitrites and leukocytes. Further investigation such as cystoscopy or renal ultrasound would be considered if treatment fails or if there are recurrent severe infections.
Question Hard:
A 60-year-old man with a history of hypertension and diabetes presents with proteinuria discovered on routine screening. His eGFR is 55 mL/min/1.73 m², and his blood pressure is 145/90 mmHg. Which of the following is the most appropriate medication to start?
A) Beta-blocker
B) Thiazide diuretic
C) ACE inhibitor
D) Calcium channel blocker
E) Angiotensin II receptor blocker (ARB)
Explanations & Answers:
Question Hard Answer: C
Question Hard Explanation: 💊According to NICE and NHS guidelines, an ACE inhibitor such as ramipril is recommended for managing proteinuria in patients with chronic kidney disease (CKD) and hypertension. ACE inhibitors help reduce protein excretion and slow disease progression, making them the first-line treatment in this scenario. ARBs are an alternative in case of intolerance to ACE inhibitors.
Medical fact of the day: Chronic kidney disease (CKD) often has no symptoms until it is advanced. According to NHS guidelines, early detection and management can prevent or delay progression to end-stage renal failure, emphasizing the importance of routine screening in at-risk populations.
Quote of the day: “In the marathon of medicine, empathy and perseverance are your strongest allies.” 🏃♂️💊