Question Easy:
A 55-year-old man presents to the GP with new-onset hematuria and mild proteinuria. He has a history of hypertension and takes lisinopril. What is the most likely diagnosis?
A) Bladder cancer
B) Acute glomerulonephritis
C) Benign prostatic hyperplasia (BPH)
D) Nephrolithiasis
E) Urinary tract infection (UTI)
Question Medium:
A 68-year-old woman presents to the emergency department with sudden onset of severe back pain radiating to the groin, nausea, and hematuria. She has a history of recurrent UTIs. A CT scan confirms the presence of a 6mm kidney stone. What is the most appropriate initial management for this patient according to NICE guidelines?
A) Immediate lithotripsy
B) Surgical intervention
C) Pain relief and alpha-blockers
D) Admission for hydration therapy
E) Antibiotics
Question Hard:
A 72-year-old man with a history of type 2 diabetes mellitus and chronic kidney disease stage 3b presents with increased fatigue and pruritus. His recent blood test shows a GFR of 35 ml/min/1.73 m². He is on metformin, lisinopril, and atorvastatin. Which medication should be reviewed or dose-adjusted in this patient?
A) Metformin
B) Lisinopril
C) Atorvastatin
D) Aspirin
E) Furosemide
Explanations & Answers:
Question Easy Answer: B) Acute glomerulonephritis
Question Easy Explanation: Hematuria with proteinuria in a patient with hypertension suggests a glomerular cause. Acute glomerulonephritis, where there is inflammation of the kidney primarily affecting the glomeruli, fits this presentation. According to NICE guidelines, further investigation with renal function tests may be required if symptoms persist.
Question Medium Answer: C) Pain relief and alpha-blockers
Question Medium Explanation: NICE guidelines recommend initial management of kidney stones typically includes adequate pain relief, often with NSAIDs, and medications such as alpha-blockers to facilitate stone passage for stones of this size. Immediate lithotripsy and surgical interventions are reserved for complications or failure of conservative management.
Question Hard Answer: A) Metformin
Question Hard Explanation: Metformin should be reviewed in patients with reduced kidney function, specifically if eGFR is below 45 ml/min/1.73 m², due to the increased risk of lactic acidosis. In this case, with a GFR of 35 ml/min/1.73 m², NICE guidelines suggest stopping metformin or dose-adjusting with careful monitoring.
Medical fact of the day: The kidneys filter about 180 litres of blood each day, producing around 1-2 litres of urine. This powerful filtration system is vital for removing waste and balancing electrolytes, which is crucial in maintaining the body’s homeostasis.
Quote of the day: “In the intricate orchestra of healthcare, even the smallest act of kindness adds harmony to the healing symphony.” 🎶💙