Question Easy:
A 65-year-old gentleman presents with marked peripheral edema, frothy urine, and hypoalbuminemia. You’re considering nephrotic syndrome. Which of the following features is most consistent with this diagnosis?
A) Hematuria
B) Hyperlipidemia
C) Oliguria
D) Fever
E) Hypertension
Explanations & Answers:
Question Easy Answer:
B) Hyperlipidemia
Question Easy Explanation:
Nephrotic syndrome commonly presents with a triad of peripheral edema, proteinuria leading to frothy urine, and hypoalbuminemia. Hyperlipidemia is also frequently associated because the liver increases lipoprotein production in response to low oncotic pressure. Hematuria and oliguria could be seen in other renal conditions, while fever and hypertension are less specific.
Question Medium:
A 45-year-old woman presents with recurrent episodes of acute cystitis. She is otherwise healthy and has normal renal function. According to NICE guidelines, which is the most appropriate long-term management?
A) Immediate use of broad-spectrum antibiotics with each episode
B) Continuous daily antibiotic prophylaxis
C) Self-start antibiotic treatment on symptom onset
D) Monthly urine cultures
E) Increased fluid intake
Explanations & Answers:
Question Medium Answer:
C) Self-start antibiotic treatment on symptom onset
Question Medium Explanation:
NICE guidelines recommend a selective approach for recurrent cystitis management. Self-start antibiotic treatment allows patients to treat promptly at the onset of symptoms, reducing the burden of continuous antibiotics and minimizing resistance. Continuous prophylaxis is typically reserved for more severe or frequent cases after evaluating risks and benefits.
Question Hard:
A 78-year-old man with a history of chronic kidney disease stage 4 presents with severe hyperkalemia. Which of the following is NOT an initial management step for hyperkalemia according to NHS guidelines?
A) Intravenous calcium gluconate
B) Intravenous insulin with glucose
C) Sodium bicarbonate
D) Salbutamol nebulizer
E) Oral sodium polystyrene sulfonate
Explanations & Answers:
Question Hard Answer:
E) Oral sodium polystyrene sulfonate
Question Hard Explanation:
Oral sodium polystyrene sulfonate (Resonium) is not an immediate treatment option for hyperkalemia, as it works more slowly to reduce potassium levels. Initial steps, as per NHS guidelines, include intravenous calcium gluconate to stabilize the cardiac membrane, intravenous insulin with glucose to promote intracellular potassium shift, sodium bicarbonate in cases of metabolic acidosis, and salbutamol as an adjunct. These measures promptly reduce serum potassium levels and protect against life-threatening arrhythmias.
Medical fact of the day: The kidney filters approximately 180 liters of blood per day! Despite this high volume, it reabsorbs most of the filtrate, ensuring only about 1-2 liters are excreted as urine.
Quote of the day: “In the race for life and health, it’s not always about speed, but about perseverance and the dedication to care.”