00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Mins)
  • Question 1 - You encounter a 50-year-old man who presents with a personal issue. He has...

    Correct

    • You encounter a 50-year-old man who presents with a personal issue. He has been experiencing difficulties with achieving and maintaining erections for the past year, with a gradual worsening of symptoms. He infrequently seeks medical attention and has no prior medical history.

      What is the predominant organic etiology for this particular symptom?

      Your Answer: Vascular causes

      Explanation:

      Erectile dysfunction (ED) is a condition where a person is unable to achieve or maintain an erection sufficient for sexual activity. The causes of ED can be categorized into organic, psychogenic, and mixed, with certain medications also contributing to the condition.

      Organic causes of ED include vasculogenic, neurogenic, structural, and hormonal factors. Among these, vasculogenic causes are the most common and are often linked to cardiovascular disease, hypertension, hyperlipidemia, diabetes mellitus, smoking, and major pelvic surgery.

      The risk factors for ED are similar to those for cardiovascular disease and include obesity, diabetes, dyslipidemia, metabolic syndrome, hypertension, endothelial dysfunction, and lifestyle factors such as lack of exercise and smoking. Therefore, when evaluating a man with ED, it is important to screen for cardiovascular disease and obtain a thorough psychosexual history.

      Erectile dysfunction (ED) is a condition where a man is unable to achieve or maintain an erection that is sufficient for sexual performance. It is not a disease but a symptom that can be caused by organic, psychogenic, or mixed factors. It is important to differentiate between the causes of ED, with factors such as a gradual onset of symptoms and lack of tumescence favoring an organic cause, while sudden onset of symptoms and decreased libido favoring a psychogenic cause. Risk factors for ED include cardiovascular disease, alcohol use, and certain medications.

      To assess for ED, it is recommended to measure lipid and fasting glucose serum levels to calculate cardiovascular risk. Free testosterone should also be measured in the morning, and if low or borderline, further assessment may be needed. PDE-5 inhibitors, such as sildenafil, are the first-line treatment for ED and should be prescribed to all patients regardless of the cause. Vacuum erection devices can be used as an alternative for those who cannot or will not take PDE-5 inhibitors. Referral to urology may be appropriate for young men who have always had difficulty achieving an erection, and those who cycle for more than three hours per week should be advised to stop.

    • This question is part of the following fields:

      • Kidney And Urology
      106.6
      Seconds
  • Question 2 - A 56-year-old female with rheumatoid arthritis presents with proteinuria during her yearly check-up....

    Incorrect

    • A 56-year-old female with rheumatoid arthritis presents with proteinuria during her yearly check-up. Which medication is most commonly linked to the occurrence of proteinuria?

      Your Answer: Ciclosporin

      Correct Answer: Gold

      Explanation:

      Causes of Nephrotic Syndrome

      Nephrotic syndrome is a condition characterized by the presence of protein in the urine, low levels of protein in the blood, high levels of cholesterol, and swelling in different parts of the body. The causes of nephrotic syndrome can be classified into primary glomerulonephritis, systemic disease, drugs, and others.

      Primary glomerulonephritis is the most common cause of nephrotic syndrome, accounting for around 80% of cases. The different types of primary glomerulonephritis include minimal change glomerulonephritis, membranous glomerulonephritis, focal segmental glomerulosclerosis, and membranoproliferative glomerulonephritis.

      Systemic diseases such as diabetes mellitus, systemic lupus erythematosus, and amyloidosis can also cause nephrotic syndrome, accounting for about 20% of cases. Certain drugs like gold and penicillamine can also lead to the development of nephrotic syndrome.

      Other causes of nephrotic syndrome include congenital factors, neoplasia such as carcinoma, lymphoma, leukaemia, myeloma, and infections like bacterial endocarditis, hepatitis B, and malaria.

      The diagram shows the different types of glomerulonephritis and how they typically present. Understanding the underlying cause of nephrotic syndrome is crucial in determining the appropriate treatment plan for the patient.

    • This question is part of the following fields:

      • Kidney And Urology
      78.2
      Seconds
  • Question 3 - A 62-year-old male comes to the clinic complaining of red discolouration of his...

    Correct

    • A 62-year-old male comes to the clinic complaining of red discolouration of his urine. He was diagnosed with a deep vein thrombosis two months ago and has been taking warfarin since then. His most recent INR test, done two days ago, shows a reading of 2.7. During the examination, no abnormalities are found, but his dipstick urine test shows +++ of blood and + protein. A MSU test shows no growth. What is the best course of action for this patient?

      Your Answer: Reassure and monitor INR and warfarin dose closely

      Explanation:

      Urgent Referral for Unexplained Haematuria and Previous DVT

      This patient presents with unexplained haematuria and a history of previous DVT. It is important to consider the possibility of underlying occult neoplasia of the renal tract. Therefore, an urgent referral to the urologists is the most appropriate course of action.

      It is important to note that in cases where the patient is on therapeutic INR with warfarin, the haematuria should not be attributed to the medication. Warfarin may unmask a potential neoplasm, and it is crucial to investigate the underlying cause of the haematuria. Early detection and treatment of neoplasia can significantly improve patient outcomes.

    • This question is part of the following fields:

      • Kidney And Urology
      76.9
      Seconds
  • Question 4 - A 65-year-old man with chronic renal failure has been diagnosed with renal osteodystrophy....

    Correct

    • A 65-year-old man with chronic renal failure has been diagnosed with renal osteodystrophy. A medical student is present and asks for an explanation of the mechanism for this.
      Select the option that most accurately describes the changes involved.

      Your Answer: Phosphate excretion is decreased, parathyroid hormone levels are increased and 1,25-OH vitamin D levels are decreased

      Explanation:

      Understanding Renal Osteodystrophy: Causes, Diagnosis, and Treatment

      Renal osteodystrophy is a condition that occurs as a result of hyperparathyroidism secondary to hyperphosphatemia combined with hypocalcemia. These conditions are caused by the decreased excretion of phosphate by the damaged kidney. Additionally, low activated vitamin D3 levels are a result of the damaged kidneys’ inability to hydroxylate vitamin D3 into its active form, calcitriol, which results in further hypocalcemia due to decreased calcium absorption in the gut. Hyperparathyroidism then leads to increased osteoclastic activity, cyst formation, and bone marrow fibrosis.

      Diagnosis of renal osteodystrophy usually occurs after treatment for end-stage renal disease begins. Blood tests will indicate decreased calcium and calcitriol and increased phosphate and parathyroid hormone. X-rays will also show bone features of renal osteodystrophy, such as chondrocalcinosis at the knees and pubic symphysis, osteopenia, and bone fractures.

      Treatment for renal osteodystrophy involves increasing 25(OH)-vitamin D levels by taking alfacalcidol, which increases endogenous calcitriol production and can effectively suppress parathormone in the early stages of chronic kidney disease. Normal 25(OH)-vitamin D levels also prevent the development of osteomalacia. Gut phosphate binders, such as calcium salts and sevelamer (Renagel®), may help reduce phosphate levels.

      In conclusion, understanding the causes, diagnosis, and treatment of renal osteodystrophy is crucial for managing this condition effectively. Early detection and treatment can prevent further complications and improve the quality of life for those affected.

    • This question is part of the following fields:

      • Kidney And Urology
      63.9
      Seconds
  • Question 5 - A 21-year-old man presents to his GP with a complaint of a lump...

    Incorrect

    • A 21-year-old man presents to his GP with a complaint of a lump in his scrotum that he noticed while showering. He reports feeling some discomfort in the area but denies any pain. He has been in a committed relationship with his girlfriend and had a clear sexual health screen two weeks ago.

      During the physical examination, the GP notes a soft mass on the front part of the right testis that cannot be distinguished from the testis itself. The lump is not tender to touch and transilluminates.

      What is the most likely diagnosis for this patient?

      Your Answer: Testicular tumour

      Correct Answer: Hydrocoele

      Explanation:

      When examining scrotal lumps, it is crucial to differentiate between a hydrocoele and other types of testicular masses. This can be done by determining whether the lump is connected to the testis or separate from it, and whether it is solid or fluid-filled.

      A hydrocoele is a fluid-filled sac that forms around the testis within the tunica vaginalis. It is cystic in nature and cannot be distinguished from the testis itself. However, it can be identified by its ability to transilluminate. Although a hydrocoele is typically benign, it can sometimes be a symptom of a testicular tumor, which can be ruled out with an ultrasound scan.

      In contrast, testicular tumors are usually connected to the testis and have an irregular shape. They are not cystic and do not transilluminate, but they can also cause a secondary hydrocoele.

      Varicocoeles and epididymal cysts are separate from the testis and can be identified by their distinct location.

      Scrotal Swelling: Causes and Management

      Scrotal swelling can be caused by various conditions, including inguinal hernia, testicular tumors, acute epididymo-orchitis, epididymal cysts, hydrocele, testicular torsion, and varicocele. Inguinal hernia is characterized by inguinoscrotal swelling that cannot be examined above it, while testicular tumors often have a discrete testicular nodule and symptoms of metastatic disease. Acute epididymo-orchitis is often accompanied by dysuria and urethral discharge, while epididymal cysts are usually painless and occur in individuals over 40 years old. Hydrocele is a non-painful, soft fluctuant swelling that can be examined above, while testicular torsion is characterized by severe, sudden onset testicular pain and requires urgent surgery. Varicocele is characterized by varicosities of the pampiniform plexus and may affect fertility.

      The management of scrotal swelling depends on the underlying condition. Testicular malignancy is treated with orchidectomy via an inguinal approach, while torsion requires prompt surgical exploration and testicular fixation. Varicoceles are usually managed conservatively, but surgery or radiological management can be considered if there are concerns about testicular function or infertility. Epididymal cysts can be excised using a scrotal approach, while hydroceles are managed differently in children and adults. In children, an inguinal approach is used to ligate the underlying pathology, while in adults, a scrotal approach is preferred to excise or plicate the hydrocele sac.

    • This question is part of the following fields:

      • Kidney And Urology
      50.5
      Seconds
  • Question 6 - A 60-year-old man comes to see you to discuss PSA testing. He plays...

    Incorrect

    • A 60-year-old man comes to see you to discuss PSA testing. He plays tennis with a few friends once a week and they have all been talking about the PSA test after one of his friends went to see his own GP with 'waterworks' problems.

      He has no lower urinary tract symptoms and denies any history of haematuria or erectile dysfunction. He has one brother who is 63 and his father is still alive aged 86. There is no family history of prostate cancer. He is currently well.

      He is very keen to have a PSA blood test performed.

      What advice would you give to this patient?

      Your Answer: PSA testing is recommended to all men over the age of 60 as a screening tool for prostate cancer and so he should have a PSA performed

      Correct Answer: He should be advised of the benefits and limitations of PSA testing and make an individual decision on whether to have the test

      Explanation:

      PSA Testing in Asymptomatic Men

      PSA testing in asymptomatic men is a controversial issue, with some advocating for it as a screening test and others wary of overtreatment and patient harm. The limitations of PSA testing in terms of sensitivity and specificity are significant, with two out of three men with a raised PSA not having prostate cancer and 15 out of 100 with a negative PSA having prostate cancer. Additionally, PSA testing cannot distinguish between slow and fast-growing cancers.

      Currently, PSA testing is not recommended as a screening test for prostate cancer in men of any age. However, in men with lower urinary tract symptoms, haematuria, or erectile dysfunction, digital rectal examination (DRE) and PSA testing should be offered. Asymptomatic men with no family history of prostate cancer should be informed of the pros and cons of the test and allowed to make their own decision. DRE should also be offered, and advice given on the combined use of DRE and PSA testing to detect any prostate abnormalities.

      If a focal abnormality suggestive of cancer is found during DRE, this alone should prompt referral, and a PSA should be performed but would not alter the decision to refer. Similarly, an abnormal PSA with a normal DRE should also prompt referral. A normal DRE doesn’t mean that PSA testing is necessarily unwarranted.

      Family history is an important factor when considering prostate cancer. If the patient has a first-degree relative with prostate cancer, this may influence their decision on whether to have a PSA blood test. The risk of prostate cancer is increased by 112-140% for men with an affected father and 187-230% for men with an affected brother. Risks are higher for men under the age of 65 and for men where the relative is diagnosed before the age of 60.

    • This question is part of the following fields:

      • Kidney And Urology
      242.1
      Seconds
  • Question 7 - An 80-year-old patient presents with lower urinary tract symptoms. Which of the following...

    Correct

    • An 80-year-old patient presents with lower urinary tract symptoms. Which of the following statements about benign prostatic hyperplasia is not true?

      Your Answer: Goserelin is licensed for refractory cases

      Explanation:

      The use of Goserelin (Zoladex) is not recommended for treating benign prostatic hyperplasia.

      Benign prostatic hyperplasia (BPH) is a common condition that affects older men, with around 50% of 50-year-old men showing evidence of BPH and 30% experiencing symptoms. The risk of BPH increases with age, with around 80% of 80-year-old men having evidence of the condition. Ethnicity also plays a role, with black men having a higher risk than white or Asian men. BPH typically presents with lower urinary tract symptoms (LUTS), which can be categorised into obstructive (voiding) symptoms and irritative (storage) symptoms. Complications of BPH can include urinary tract infections, retention, and obstructive uropathy.

      Assessment of BPH may involve dipstick urine testing, U&Es, and PSA testing if obstructive symptoms are present or if the patient is concerned about prostate cancer. A urinary frequency-volume chart and the International Prostate Symptom Score (IPSS) can also be used to assess the severity of LUTS and their impact on quality of life. Management options for BPH include watchful waiting, alpha-1 antagonists, 5 alpha-reductase inhibitors, combination therapy, and surgery. Alpha-1 antagonists are considered first-line for moderate-to-severe voiding symptoms and can improve symptoms in around 70% of men, but may cause adverse effects such as dizziness and dry mouth. 5 alpha-reductase inhibitors may slow disease progression and reduce prostate volume, but can cause adverse effects such as erectile dysfunction and reduced libido. Combination therapy may be used for bothersome moderate-to-severe voiding symptoms and prostatic enlargement. Antimuscarinic drugs may be tried for persistent storage symptoms. Surgery, such as transurethral resection of the prostate (TURP), may also be an option.

    • This question is part of the following fields:

      • Kidney And Urology
      151.1
      Seconds
  • Question 8 - A 7-month-old girl presents with a fever (38 oC) for 48 hours and...

    Incorrect

    • A 7-month-old girl presents with a fever (38 oC) for 48 hours and occasional vomiting. A urine sample was sent to the laboratory and you receive the following result:
      White cells
      > 100 cells per µl
      Red blood cells
      > 100 cells per µl
      Organisms
      3+
      Epithelial cells
      1+
      Culture
      Escherichia coli> 108
      Which of the following would be the single most appropriate initial management for this child?

      Your Answer: Repeat the urine sample to ensure that it is not a contaminated specimen

      Correct Answer: Start antibiotics immediately

      Explanation:

      Interpretation of Urine Test Results in Children with Suspected Urinary Tract Infection

      Interpretation of urine test results in children with suspected urinary tract infection (UTI) is crucial in determining the appropriate course of treatment. A positive result for bacteriuria and fever of 38oC or higher suggests a typical bacterial infection, which may progress to an upper UTI. In such cases, referral to a paediatric specialist is recommended. However, if there are no indications of an atypical infection or serious illness, treatment with an antibiotic showing a low resistance pattern is reasonable.

      It is important to note that routine prophylaxis with antibiotics after a first infection is not necessary, nor is imaging required if the child responds to treatment within 48 hours. However, imaging is necessary during and after atypical infections and after recurrent infections for a child of this age. Therefore, careful interpretation of urine test results and appropriate follow-up measures are essential in managing UTIs in children.

    • This question is part of the following fields:

      • Kidney And Urology
      80.3
      Seconds
  • Question 9 - A previously healthy 8-year-old girl presents generally unwell, with reduced volumes of smoky-coloured...

    Incorrect

    • A previously healthy 8-year-old girl presents generally unwell, with reduced volumes of smoky-coloured urine. She had a sore throat two weeks previously. Immunisations up to date. There is no FH/SH of note. On examination her temperature is 37.6°C. She looks quiet and unwell, with slight periorbital oedema. Respiratory rate 15/min, pulse 90/min, blood pressure is 130/100 mmHg. Her JVP is elevated and she has tenderness in both loins. Urine dipstick show 3+ haematuria and 3+ proteinuria. Red cell casts are seen on urine microscopy. What is the most likely diagnosis?

      Your Answer: von Willebrand's disease

      Correct Answer: Post-streptococcal glomerulonephritis

      Explanation:

      Nephritis, also known as acute nephritic syndrome, is a condition characterized by haematuria, proteinuria, oliguria, and oedema with elevated blood pressure. In most cases, the preceding throat infection makes post-streptococcal glomerulonephritis the most likely cause. While blood tests such as ASOT may be useful in confirming the diagnosis, the clinical picture is usually clear.

      The severity of nephritis varies from transient asymptomatic haematuria to severe nephritis with acute renal and heart failure. Treatment is supportive, with close attention to fluid balance. Penicillin is often prescribed, but it may not influence the disease course or spread to family members. Fortunately, 95% of patients recover completely.

      In some cases, uraemia may accompany oliguria, but the clinical and dipstick findings are usually enough for a presumptive diagnosis. In children, the prognosis is excellent, with complete recovery in the vast majority of cases. Fewer than 1% of children experience elevated creatinine levels 10-15 years after an episode.

      Overall, understanding the symptoms, diagnosis, and treatment of nephritis is crucial for managing this condition effectively.

    • This question is part of the following fields:

      • Kidney And Urology
      87.9
      Seconds
  • Question 10 - You see a 6-year-old boy who you see for occasional bouts of abdominal...

    Incorrect

    • You see a 6-year-old boy who you see for occasional bouts of abdominal pain. His appetite is good, and he opens his bowels regularly. There are no other symptoms reported, and examination is unremarkable. A urine dipstick is positive for leucocytes but negative otherwise.

      What would be the next most appropriate management step?

      Your Answer: Send for MC&S and only treat if growth confirmed

      Correct Answer: No action necessary

      Explanation:

      NICE Guidelines for UTI Diagnosis in Children

      According to NICE guidelines, children aged 3 years and above who test positive for leucocytes on a dipstick test but negative for nitrites should have a urine sample sent for MC&S. Antibiotic treatment should only be started if there is good clinical evidence of a UTI. Symptoms in verbal children may include frequency, dysuria, and changes in continence, while younger children may present with nonspecific symptoms such as fever, vomiting, and poor feeding.

      If the dipstick test shows only nitrite positivity, antibiotic treatment should be initiated, and a urine sample should be sent for culture. However, if the dipstick test shows both nitrite and leucocyte positivity, a UTI is confirmed, and a culture should be sent if there is a risk of serious illness or a history of previous UTIs. These guidelines aim to ensure accurate diagnosis and appropriate treatment of UTIs in children.

    • This question is part of the following fields:

      • Kidney And Urology
      87.3
      Seconds
  • Question 11 - You see a 30-year-old gentleman who is being investigated for subfertility. His semen...

    Correct

    • You see a 30-year-old gentleman who is being investigated for subfertility. His semen analysis result shows a mild oligozoospermia.

      What would be the next most appropriate management step?

      Your Answer: Repeat test in 12 weeks

      Explanation:

      Repeat Confirmatory Semen Analysis and Other Fertility Advice

      According to NICE, it is recommended to repeat confirmatory semen analysis after 3 months (12 weeks) from the initial test. This is to allow the cycle of spermatozoa to be completed. However, if there is a significant deficiency in spermatozoa, a repeat test should be taken as early as possible.

      While it is known that elevated scrotal temperatures can reduce semen quality, it is uncertain whether wearing loose-fitting underwear can improve fertility. Nevertheless, it is still advisable to wear looser underwear while trying to conceive.

      Screening for antisperm antibodies is not recommended as there is no effective treatment to improve fertility. The significance of these antibodies is still unclear.

      Overall, these recommendations can help couples who are trying to conceive to take practical steps towards improving their fertility.

    • This question is part of the following fields:

      • Kidney And Urology
      46.2
      Seconds
  • Question 12 - A 57-year-old man with a history of stage 3a chronic kidney disease and...

    Incorrect

    • A 57-year-old man with a history of stage 3a chronic kidney disease and hypertension presents with recurrent gout. He has experienced three episodes in the past year and requires prophylactic therapy with allopurinol. He is currently taking amlodipine and atorvastatin. What is the recommended approach for initiating allopurinol in this patient?

      Your Answer: Commence allopurinol and provide prednisolone to take simultaneously while starting

      Correct Answer: Commence allopurinol and provide colchicine to take simultaneously while starting

      Explanation:

      When starting allopurinol for this patient, it is important to use either NSAID or colchicine cover. This is because allopurinol can cause acute flares of gout due to changes in uric acid levels in the serum and tissues. Therefore, commencing allopurinol without any cover is not recommended. However, since the patient has chronic kidney disease, non-steroidal anti-inflammatories should be avoided. Indomethacin may be an alternative cover option for some patients. Prednisolone is effective but has many adverse effects and should only be used for a few days. It is important to note that this patient doesn’t have any contraindications to allopurinol, such as a history of hypersensitivity syndrome, Stevens-Johnson syndrome, toxic epidermal necrolysis, having the HLA-B*5801 allele, or severe renal failure.

      Gout is caused by chronic hyperuricaemia and is managed acutely with NSAIDs or colchicine. Urate-lowering therapy (ULT) is recommended for patients with >= 2 attacks in 12 months, tophi, renal disease, uric acid renal stones, or prophylaxis if on cytotoxics or diuretics. Allopurinol is first-line ULT, with a delayed start recommended until inflammation has settled. Lifestyle modifications include reducing alcohol intake, losing weight if obese, and avoiding high-purine foods. Other options for refractory cases include febuxostat, uricase, and pegloticase.

    • This question is part of the following fields:

      • Kidney And Urology
      111.2
      Seconds
  • Question 13 - A 25-year-old man presents with flu-like symptoms and subsequently develops haematuria. His urine...

    Incorrect

    • A 25-year-old man presents with flu-like symptoms and subsequently develops haematuria. His urine dipstick is positive for blood and protein, and a urine culture is sent. He is prescribed trimethoprim but later reports feeling ill and coughing up blood. Urine microscopy reveals red cell casts. What is the MOST LIKELY diagnosis? Choose ONE answer only.

      Your Answer: Post-streptococcal glomerulonephritis

      Correct Answer: Goodpasture syndrome

      Explanation:

      Understanding Goodpasture Syndrome: A Rare Autoimmune Disease with Pulmonary and Renal Complications

      Goodpasture syndrome is a rare autoimmune disease that typically occurs after an influenza infection. It is caused by a type II antigen-antibody reaction, resulting in circulating anti-glomerular basement membrane antibodies. This disease primarily affects young men, and smokers are at a higher risk of developing severe pulmonary complications. Pulmonary haemorrhage can be massive and lead to respiratory failure. Additionally, it causes rapidly progressive glomerulonephritis, which has a poor prognosis if left untreated. Urine microscopy shows casts, and blood testing is positive for anti-glomerular basement membrane antibodies. Chest X-ray typically shows blotchy shadowing. Treatment involves steroids and plasmapheresis.

      While other diseases can cause pulmonary and renal symptoms, they are unlikely to present in combination. Collagen diseases like systemic lupus erythematosus (SLE), rheumatoid arthritis, idiopathic rapidly progressive glomerulonephritis, microscopic polyarteritis, granulomatosis with polyangiitis, and essential mixed cryoglobulinaemia can also cause pulmonary haemorrhage with renal failure. However, acute poststreptococcal glomerulonephritis, resulting from an antecedent infection of the skin or throat caused by nephritogenic strains of group A beta-hemolytic streptococci, doesn’t present with pulmonary haemorrhage. Symptoms of this disease include odema, gross haematuria, malaise, lethargy, anorexia, fever, abdominal pain, and headache. Red blood cell casts are commonly found in the urine.

      In conclusion, understanding Goodpasture syndrome is crucial for early diagnosis and treatment. This rare autoimmune disease can cause severe pulmonary and renal complications, and prompt intervention is necessary to improve patient outcomes.

    • This question is part of the following fields:

      • Kidney And Urology
      96.2
      Seconds
  • Question 14 - A 76-year-old man has been experiencing widespread aches and pains in his chest,...

    Correct

    • A 76-year-old man has been experiencing widespread aches and pains in his chest, back, and hips for several months. He also reports difficulty with urinary flow and frequent nighttime urination. What is the most suitable course of action?

      Your Answer: Check prostate-specific antigen (PSA) levels

      Explanation:

      Prostate Cancer and Prostatism: Symptoms and Diagnosis

      Patients with prostatism who experience bony pain should be evaluated for prostate cancer, as it often metastasizes to bone. A digital rectal examination should be performed after taking blood for PSA, as the prostate will typically feel hard and irregular in cases of prostate cancer. While chronic urinary retention and urinary infection may be present, investigations should focus on identifying the underlying cause rather than providing symptomatic treatment with an α-blocker. Without a confirmed diagnosis of benign prostatic hyperplasia, finasteride should not be prescribed.

    • This question is part of the following fields:

      • Kidney And Urology
      61.9
      Seconds
  • Question 15 - You are evaluating a 58-year-old man with lower urinary tract symptoms. He presented...

    Incorrect

    • You are evaluating a 58-year-old man with lower urinary tract symptoms. He presented six months ago with complaints of weak urinary stream, hesitancy, intermittency, terminal dribbling, and nocturia ×2. He denies any history of visible haematuria or erectile dysfunction. Urine dipstick testing is normal, his eGFR is stable at 84, and his PSA is 0.9 ng/mL. On digital rectal examination, his prostate is less than 30 g in size with no sinister features.

      Despite conservative management and modification of his fluid intake, his symptoms persist and he has returned seeking advice on taking a tablet. His international prostate symptom score was 17 at his initial visit and is now 15. He reports that his quality of life is affected by his urinary symptoms and he is unhappy. He is otherwise healthy and not taking any other medications.

      What is the most appropriate initial pharmacological approach for this patient's symptoms?

      Your Answer: Tamsulosin 400 mcgs OD

      Correct Answer: Finasteride 5 mg OD and oxybutynin 5 mg BD

      Explanation:

      NICE Guidelines for Drug Treatment of Lower Urinary Tract Symptoms

      NICE recommends drug treatment for bothersome lower urinary tract symptoms (LUTS) if conservative measures fail. For moderate to severe LUTS, an alpha-blocker like tamsulosin should be offered. Patients should be reviewed after four to six weeks until stable. If LUTS is accompanied by an enlarged prostate or a high PSA level, a 5-alpha reductase inhibitor like finasteride should be prescribed. Anticholinergic drugs like oxybutynin can be used to manage storage symptoms. For patients with moderate to severe LUTS and an enlarged prostate or high PSA level, both an alpha-blocker and a 5-alpha reductase inhibitor can be started. In the case of a patient with moderate LUTS, a prostate less than 30 g, and a PSA level less than 1.4, starting an alpha-blocker like tamsulosin and reviewing the patient in four to six weeks is the most appropriate approach.

    • This question is part of the following fields:

      • Kidney And Urology
      139
      Seconds
  • Question 16 - You receive a letter explaining that one of your patients, Mrs. Smith has...

    Incorrect

    • You receive a letter explaining that one of your patients, Mrs. Smith has recently been diagnosed with chronic kidney disease (CKD) 5 and is due to commence haemodialysis. It outlines the vaccines that she now requires. Which diseases does she need protection against?

      Your Answer: Pneumococcal, influenza, Hepatitis B and C

      Correct Answer: Pneumococcal, influenza and Hepatitis B

      Explanation:

      Haemodialysis units must remain vigilant against blood-borne viruses, despite following standard infection control measures, in order to safeguard both patients and healthcare staff. Fortunately, the occurrence of hepatitis B outbreaks associated with dialysis units has significantly decreased over the past three decades. The Department of Health recommends immunisation against Pneumococcus, influenza, and Hepatitis B for individuals with chronic kidney disease, including those undergoing haemodialysis. While vaccination schedules for both children and adults are rapidly evolving, healthcare professionals must stay informed of these changes and be aware of recommendations for special groups. Although the administration of vaccinations is often delegated, general practitioners must be knowledgeable about contraindications and schedules to provide guidance to patients and parents. Conducting audits of specific target groups may reveal a need for catch-up immunisation in light of changing recommendations.

      The Department of Health recommends that people over the age of 65 and those with certain medical conditions receive an annual influenza vaccination. These medical conditions include chronic respiratory disease, chronic heart disease, chronic kidney disease, chronic liver disease, chronic neurological disease, diabetes mellitus, immunosuppression, asplenia or splenic dysfunction, and pregnancy. Additionally, health and social care staff, those living in long-stay residential care homes, and carers of the elderly or disabled may also be considered for vaccination at the discretion of their GP.

      The pneumococcal polysaccharide vaccine is recommended for all adults over the age of 65 and those with certain medical conditions. These medical conditions include asplenia or splenic dysfunction, chronic respiratory disease, chronic heart disease, chronic kidney disease, chronic liver disease, diabetes mellitus, immunosuppression, cochlear implants, and patients with cerebrospinal fluid leaks. Asthma is only included if it requires the use of oral steroids at a dose sufficient to act as a significant immunosuppressant. Controlled hypertension is not an indication for vaccination.

    • This question is part of the following fields:

      • Kidney And Urology
      97.7
      Seconds
  • Question 17 - A 68-year-old woman comes to her doctor complaining of dysuria and increased urinary...

    Correct

    • A 68-year-old woman comes to her doctor complaining of dysuria and increased urinary frequency. She is in good health otherwise and doesn't show any signs of sepsis. During a urine dip test at the doctor's office, blood, leukocytes, protein, and nitrites are detected. The patient has a medical history of asthma, which is treated with salbutamol and beclomethasone inhalers, hypertension, which is treated with amlodipine 10 mg daily and ramipril 5mg daily, and stage 3 chronic kidney disease.

      Which antibiotic should be avoided when treating this patient's urinary tract infection?

      Your Answer: Nitrofurantoin

      Explanation:

      Patients with CKD stage 3 or higher should avoid taking nitrofurantoin due to the risk of treatment failure and side effects caused by drug accumulation. Nitrofurantoin is an antibiotic that requires adequate renal filtration to be effective in treating urinary tract infections. However, in patients with an eGFR of less than 40-60 ml/min, the drug is ineffective and can accumulate, leading to potential toxicity. Nitrofurantoin can also cause side effects such as peripheral neuropathy, hepatotoxicity, and pulmonary reactions. Amoxicillin and co-amoxiclav are safer options for treating urinary tract infections in patients with renal impairment, while ciprofloxacin may require dose reduction from an eGFR of 30-60 ml/min to avoid crystalluria. Patients taking nitrofurantoin should be aware that it can discolour urine and is safe to use during pregnancy except at full term.

      Prescribing for Patients with Renal Failure

      Prescribing medication for patients with renal failure can be challenging. It is important to know which drugs to avoid and which ones require dose adjustment. Antibiotics such as tetracycline and nitrofurantoin, as well as NSAIDs, lithium, and metformin should be avoided in patients with renal failure. These drugs can cause further damage to the kidneys or accumulate in the body, leading to toxicity.

      On the other hand, some drugs require dose adjustment in patients with chronic kidney disease. Antibiotics such as penicillins, cephalosporins, vancomycin, gentamicin, and streptomycin, as well as digoxin, atenolol, methotrexate, sulphonylureas, and furosemide, are among the drugs that require dose adjustment. Opioids should also be used with caution in patients with renal failure.

      There are also drugs that are relatively safe to use in patients with renal failure. Antibiotics such as erythromycin and rifampicin, as well as diazepam and warfarin, can sometimes be used at normal doses depending on the degree of chronic kidney disease.

      In summary, prescribing medication for patients with renal failure requires careful consideration of the drugs’ potential effects on the kidneys and the need for dose adjustment. It is important to consult with a healthcare provider to ensure safe and effective medication management for these patients.

    • This question is part of the following fields:

      • Kidney And Urology
      96.8
      Seconds
  • Question 18 - A 50-year-old woman comes to the clinic complaining of urinary incontinence. She reports...

    Incorrect

    • A 50-year-old woman comes to the clinic complaining of urinary incontinence. She reports frequent urine leakage and a strong urge to urinate that she cannot control. She denies experiencing dysuria or hematuria and has no gastrointestinal symptoms. Physical examination reveals a soft, non-tender abdomen, and urinalysis is normal. The patient drinks seven glasses of water per day and avoids caffeinated beverages. She has a BMI of 20.2 and is a non-smoker. If non-pharmacological interventions fail, what is the first-line medication for her condition?

      Your Answer: Desmopressin

      Correct Answer: Furosemide

      Explanation:

      Treatment options for Urinary Urge Incontinence

      Urinary urge incontinence is a common condition that can be treated with supervised bladder training for at least six weeks. This training can be provided by a continence nurse, physiotherapist, or urology clinic. If symptoms persist, an Antimuscarinic drug can be prescribed, with the lowest effective dose used and titrated upwards if necessary. It may take up to four weeks for the drug to take effect, and side effects such as dry mouth and constipation may occur. First-line drugs include oxybutynin, tolterodine, and darifenacin.

      It is important to note that diuretics such as furosemide can potentially worsen symptoms of urinary urge incontinence. Amitriptyline is not recommended for this condition, as it is primarily used for depression, neuropathic pain, and migraine prophylaxis. Duloxetine may be used as a second-line treatment for stress incontinence, but it is not included in NICE guidelines for urinary urge incontinence. Desmopressin is typically used for other conditions such as diabetes insipidus, multiple sclerosis, enuresis, and bleeding disorders.

      In summary, supervised bladder training and Antimuscarinic drugs are effective treatment options for urinary urge incontinence. It is important to consult with a healthcare professional to determine the best course of treatment for individual cases.

    • This question is part of the following fields:

      • Kidney And Urology
      79.3
      Seconds
  • Question 19 - A 72-year-old man presents with complaints of erectile dysfunction. You suggest a trial...

    Correct

    • A 72-year-old man presents with complaints of erectile dysfunction. You suggest a trial of a phosphodiesterase inhibitor (such as sildenafil) after discussing his condition. What would be a contraindication to prescribing this medication?

      Your Answer: Recent chest pain awaiting cardiology opinion

      Explanation:

      The use of PDE 5 inhibitors, such as sildenafil, is contraindicated in individuals who have recently experienced a myocardial infarction or unstable angina. However, in the case of someone experiencing chest pain and awaiting cardiology opinion, caution should also be exercised before prescribing these medications due to the potential cardiac nature of the symptoms. Additionally, patients with known angina who use a GTN spray should wait at least 24 hours after taking sildenafil or vardenafil, or 48 hours after taking tadalafil, to avoid the risk of excessive hypotension leading to a myocardial infarction.

      Phosphodiesterase type V inhibitors are medications used to treat erectile dysfunction and pulmonary hypertension. They work by increasing cGMP, which leads to relaxation of smooth muscles in blood vessels supplying the corpus cavernosum. The most well-known PDE5 inhibitor is sildenafil, also known as Viagra, which is taken about an hour before sexual activity. Other examples include tadalafil (Cialis) and vardenafil (Levitra), which have longer-lasting effects and can be taken regularly. However, these medications have contraindications, such as not being safe for patients taking nitrates or those with hypotension. They can also cause side effects such as visual disturbances, blue discolouration, and headaches. It is important to consult with a healthcare provider before taking PDE5 inhibitors.

    • This question is part of the following fields:

      • Kidney And Urology
      25
      Seconds
  • Question 20 - A 50-year-old man comes to his General Practitioner complaining of recurrent loin-to-groin pain...

    Correct

    • A 50-year-old man comes to his General Practitioner complaining of recurrent loin-to-groin pain and frank haematuria. A CT scan of his KUB shows a renal calculus located at the left vesico-ureteric junction. What is the most accurate understanding of this man's condition?

      Your Answer: Recurrent proteus urinary tract infections (UTIs) are associated with renal calculi

      Explanation:

      Understanding Renal Calculi and Recurrent Proteus Urinary Tract Infections

      Recurrent Proteus urinary tract infections (UTIs) are often associated with renal calculi, which can be detected through persistently alkaline urine and a finding of Proteus on culture. This is because Proteus organisms produce urease, which converts urea into ammonia and alkalinizes the urine, leading to the formation of organic and inorganic compounds that contribute to calculi formation.

      The severity of symptoms related to renal calculi is directly proportional to the size of the stone. Smaller stones usually cause severe pain as they pass into the ureter, while larger stones such as staghorn calculi often remain asymptomatic in the kidney. A moving stone is usually more painful than a static stone.

      Contrary to popular belief, most symptomatic urinary calculi originate in the upper renal tract, with the location and composition varying for different types of stones. While gallstones are composed of bile salts, renal stones are usually composed of calcium, oxalate, or uric acid.

      About 75% of renal calculi are radio-opaque, meaning they can be detected through conventional KUB X-rays. However, urate and xanthine stones are radiolucent and may be too small to be detected through this method. Understanding the relationship between recurrent Proteus UTIs and renal calculi can help prompt early detection and treatment.

    • This question is part of the following fields:

      • Kidney And Urology
      92.2
      Seconds
  • Question 21 - A 68-year-old woman is undergoing haemodialysis for chronic kidney disease.
    Which complication is most...

    Incorrect

    • A 68-year-old woman is undergoing haemodialysis for chronic kidney disease.
      Which complication is most likely to occur?

      Your Answer: Hypokalaemia

      Correct Answer: Nausea and headache

      Explanation:

      Complications of Dialysis: Understanding the Risks and Symptoms

      Dialysis is a life-saving treatment for patients with end-stage renal disease, but it is not without its risks and complications. One of the most common side effects of removing too much fluid or removing it too rapidly is hypotension, fatigue, chest pains, leg cramps, nausea, and headaches. These symptoms can persist after treatment and are sometimes referred to as the dialysis hangover or dialysis washout.

      Another rare but serious neurological complication is dialysis disequilibrium syndrome, which is characterized by weakness, dizziness, headache, and mental status changes. Hypertension, hyperkalemia, infection, amyloidosis, and malnutrition are other potential complications.

      Contrary to popular belief, hyperkalemia is more commonly seen in dialysis patients than hypokalemia. Patients who undergo hemodialysis are also at an increased risk of contracting hepatitis B, but vaccination has significantly reduced the incidence of this complication.

      Secondary hyperparathyroidism and associated osteodystrophy have been major causes of morbidity in long-term dialysis patients, but better management of calcium and phosphorus metabolism and the availability of new drugs have improved outcomes. Malnutrition and weight loss are more commonly seen than weight gain, which may be due to loss of amino acids and peptides in the dialysate, sodium restriction, and dialysis-induced hypercatabolism.

      In conclusion, understanding the risks and symptoms of dialysis complications is crucial for patients and healthcare providers to ensure the best possible outcomes.

    • This question is part of the following fields:

      • Kidney And Urology
      39.5
      Seconds
  • Question 22 - A 53-year-old man presents to the GUM clinic with a swollen, tender, and...

    Incorrect

    • A 53-year-old man presents to the GUM clinic with a swollen, tender, and red glans penis that he has been experiencing for the past five days. He is unable to retract his foreskin fully and is experiencing pain while urinating. He has no history of sexual activity and has been treated for balanitis three times in the past year with saline baths and topical clotrimazole, despite testing negative for sexually transmitted and bacterial infections. He has a medical history of diabetes mellitus.

      After treating the acute episode with saline baths and topical clotrimazole, what is the most appropriate next step in managing this patient?

      Your Answer:

      Correct Answer: Refer for circumcision

      Explanation:

      Recurrent balanitis can be effectively treated with circumcision.

      Balanitis, which is characterized by inflammation of the glans penis, can be caused by various factors such as sexually transmitted infections, dermatitis, bacterial infections, or fungal infections like Candida. In this case, the patient’s diabetes has made them susceptible to opportunistic fungal infections.

      For acute infections, treatment involves addressing the underlying cause and using saline baths. Topical treatments like hydrocortisone, clotrimazole, miconazole, or nystatin cream may also be recommended depending on the cause of the infection.

      However, if the balanitis keeps recurrent, circumcision is the most appropriate treatment option. This procedure can effectively prevent the condition from happening again.

      Understanding Circumcision

      Circumcision is a practice that has been carried out in various cultures for centuries. Today, it is mainly practiced by people of the Jewish and Islamic faith for religious or cultural reasons. However, it is important to note that circumcision for these reasons is not available on the NHS.

      The medical benefits of circumcision are still a topic of debate. However, some studies have shown that it can reduce the risk of penile cancer, urinary tract infections, and sexually transmitted infections, including HIV.

      There are also medical indications for circumcision, such as phimosis, recurrent balanitis, balanitis xerotica obliterans, and paraphimosis. It is crucial to rule out hypospadias before performing circumcision as the foreskin may be needed for surgical repair.

      Circumcision can be performed under local or general anesthesia. It is a personal decision that should be made after careful consideration of the potential benefits and risks.

    • This question is part of the following fields:

      • Kidney And Urology
      0
      Seconds
  • Question 23 - A 65-year-old woman presents to your clinic with a complaint of significant urge...

    Incorrect

    • A 65-year-old woman presents to your clinic with a complaint of significant urge incontinence (UI) for the past year. She denies any stress incontinence and has been ruled out for infection. What is the initial recommended treatment for urge incontinence?

      Your Answer:

      Correct Answer: Bladder training for a minimum of six weeks

      Explanation:

      Managing Urge Incontinence

      Urge incontinence is a condition where urine leakage occurs involuntarily, often preceded by a sudden urge to urinate. According to NICE guidance on Urinary incontinence (CG171), women with urge incontinence or mixed incontinence should be offered bladder training as a first-line treatment for at least six weeks. This involves learning techniques to control the urge to urinate and gradually increasing the time between visits to the toilet. If bladder training is not effective, immediate release oxybutynin may be offered as an alternative treatment.

    • This question is part of the following fields:

      • Kidney And Urology
      0
      Seconds
  • Question 24 - A 63-year-old man attends for diabetic annual review. His current medication consists of...

    Incorrect

    • A 63-year-old man attends for diabetic annual review. His current medication consists of metformin 500 mg TDS, pioglitazone 30 mg OD, ramipril 10 mg OD, and atorvastatin 20 mg ON. His latest HbA1c blood test result is 66 mmol/mol. His renal function shows an eGFR of >90 ml/min.

      As part of his review his urine is dipstick tested and shows blood+. It is negative for glucose, protein, leucocytes, nitrites and ketones.

      The patient feels well and denies any urinary symptoms or frank haematuria. His blood pressure is 126/82 mmHg.

      You provide him with two urine containers and ask him to submit further samples in one and two weeks time for repeat testing. You also send a urine sample to the laboratory for microalbuminuria testing.

      The repeat tests show persisting blood+ only. His urine albumin:creatinine ratio is 1.9 and there is a leucocytosis on blood testing.

      What is the most appropriate approach in managing this patient?

      Your Answer:

      Correct Answer: Review his medications and refer urgently to a urologist

      Explanation:

      Managing Microscopic Haematuria

      Persistent microscopic haematuria should be considered clinically relevant if present on at least two out of three samples tested at weekly intervals. A dipstick showing ‘trace’ blood should be considered negative. Blood 1+ or more is significant. If a patient is aged 60 and over and has unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test, referral to a Urologist as an urgent suspected cancer is advised according to NICE guidelines on the recognition and referral of suspected cancer.

      It is important to note that certain medications, such as clopidogrel, aspirin, and warfarin, should not be attributed to microscopic haematuria. Additionally, if the sample is painless, it must have 1+ of blood or more on at least 2 out of 3 occasions to be considered abnormal.

      If a patient is on pioglitazone, which carries a small but significant increased risk of bladder cancer, it would be prudent to stop the medication at least until the microscopic haematuria has been investigated.

      In summary, managing microscopic haematuria involves careful consideration of the frequency and amount of blood present in the sample, as well as referral to a specialist for further investigation in certain cases.

    • This question is part of the following fields:

      • Kidney And Urology
      0
      Seconds
  • Question 25 - A digital rectal examination and PSA test should be offered to which of...

    Incorrect

    • A digital rectal examination and PSA test should be offered to which of the following patients?

      Your Answer:

      Correct Answer: A 62-year-old man with unexplained lower back pain

      Explanation:

      According to NICE guidelines, men experiencing unexplained symptoms such as erectile dysfunction, haematuria, lower back pain, bone pain, and weight loss (especially in the elderly) should be offered a PR and PSA test. However, before conducting a PSA test, a urine dipstick/MSU should be done to rule out any infection. If a UTI is treated, PSA testing should be avoided for at least a month.

      If the age-specific PSA is high or increasing, even in asymptomatic patients with a normal PR examination, an urgent referral should be made. In cases where the PSA is at the upper limit of normal in asymptomatic patients, a repeat PSA should be conducted after 1-3 months. If the PSA is increasing, an urgent referral should be made. These guidelines are outlined in the NICE referral guidelines for suspected cancer.

      Understanding Prostate Cancer: Features and Risk Factors

      Prostate cancer is a prevalent type of cancer among adult males in the UK, and it is the second leading cause of cancer-related deaths in men, next to lung cancer. Several risk factors increase the likelihood of developing prostate cancer, including increasing age, obesity, Afro-Caribbean ethnicity, and a family history of the disease. In fact, around 5-10% of cases have a strong family history.

      Localised prostate cancer is often asymptomatic, which means that it doesn’t show any symptoms. This is because the cancer cells tend to develop in the periphery of the prostate, which doesn’t cause obstructive symptoms early on. However, some possible features of prostate cancer include bladder outlet obstruction, hesitancy, urinary retention, haematuria, haematospermia, pain in the back, perineal or testicular area, and an asymmetrical, hard, nodular enlargement with loss of median sulcus during a digital rectal examination.

      Understanding the features and risk factors of prostate cancer is crucial in detecting and treating the disease early on. In some cases, prostate cancer may metastasize or spread to other parts of the body, such as the bones. A bone scan using technetium-99m labelled diphosphonates can detect multiple osteoblastic metastasis, which is a common finding in patients with metastatic prostate cancer.

    • This question is part of the following fields:

      • Kidney And Urology
      0
      Seconds
  • Question 26 - A 56-year-old woman presents to your clinic with a complaint of frequent urine...

    Incorrect

    • A 56-year-old woman presents to your clinic with a complaint of frequent urine leakage. What is the initial method to evaluate urinary incontinence or overactive bladder in women?

      Your Answer:

      Correct Answer: Trial of therapy

      Explanation:

      Importance of a Bladder Diary in Assessing Urinary Incontinence

      A bladder diary is a crucial tool in the initial assessment of urinary incontinence or overactive bladder syndrome in women. It helps to identify patterns and triggers of urinary symptoms, which can aid in the diagnosis and treatment of the condition. Women should be encouraged to complete a minimum of three days of the diary to cover variations of their usual activities, including work and leisure time.

      By keeping track of their urinary habits, women can provide their healthcare provider with valuable information about their symptoms, such as frequency, urgency, and leakage. This information can help the provider to determine the type and severity of the condition and develop an appropriate treatment plan. Therefore, it is essential for women to use a bladder diary when experiencing urinary incontinence or overactive bladder syndrome.

    • This question is part of the following fields:

      • Kidney And Urology
      0
      Seconds
  • Question 27 - A 65-year-old man comes in for a follow-up appointment one month after being...

    Incorrect

    • A 65-year-old man comes in for a follow-up appointment one month after being prescribed colchicine for his first gout attack. He has fully recovered and has no lingering symptoms. He has no significant medical history except for a resolved AKI after experiencing diarrhea last year. He is not taking any regular medication.

      What is the best course of action for long-term urate-lowering therapy?

      Your Answer:

      Correct Answer: Offer allopurinol today

      Explanation:

      The updated guidelines from the British Society for Rheumatology recommend that urate-lowering therapy should be initiated early after the first episode of gout. Therefore, it is suggested that all patients should be offered this therapy after their initial attack, rather than waiting for further episodes or ongoing symptoms. It is important to note that colchicine cannot be used as a long-term urate-lowering medication on its own. There is no need to wait for a month before starting allopurinol, as long as the acute attack has resolved. Although allopurinol can still be prescribed for patients with renal impairment, caution must be taken with the dosage. Febuxostat should only be considered as a second line medication if allopurinol is not suitable or has not been tolerated by the patient.

      Gout is caused by chronic hyperuricaemia and is managed acutely with NSAIDs or colchicine. Urate-lowering therapy (ULT) is recommended for patients with >= 2 attacks in 12 months, tophi, renal disease, uric acid renal stones, or prophylaxis if on cytotoxics or diuretics. Allopurinol is first-line ULT, with a delayed start recommended until inflammation has settled. Lifestyle modifications include reducing alcohol intake, losing weight if obese, and avoiding high-purine foods. Other options for refractory cases include febuxostat, uricase, and pegloticase.

    • This question is part of the following fields:

      • Kidney And Urology
      0
      Seconds
  • Question 28 - A 54-year-old woman with Rheumatoid arthritis complains of dysuria, frequency, and foul-smelling urine...

    Incorrect

    • A 54-year-old woman with Rheumatoid arthritis complains of dysuria, frequency, and foul-smelling urine for the past 3 days. Upon urinalysis, blood, nitrites, leukocytes, and protein are detected. Upon checking her repeat prescription, it is found that she is taking methotrexate for her Rheumatoid disease. She has no allergies. Which antibiotic should not be prescribed due to the potential for severe bone marrow suppression?

      Your Answer:

      Correct Answer: Trimethoprim

      Explanation:

      The combination of methotrexate and antibiotics containing trimethoprim can lead to bone marrow suppression and potentially fatal pancytopenia. Therefore, it is important to avoid using trimethoprim and co-trimoxazole with methotrexate due to their anti-folate properties, which can cause folate depletion. Fatal cases of megaloblastic anemia and pancytopenia have been reported. Nitrofurantoin and cefalexin do not have any known interactions with methotrexate, and penicillins may reduce its excretion.

      Methotrexate is an antimetabolite that hinders the activity of dihydrofolate reductase, an enzyme that is crucial for the synthesis of purines and pyrimidines. It is a significant drug that can effectively control diseases, but its side-effects can be life-threatening. Therefore, careful prescribing and close monitoring are essential. Methotrexate is commonly used to treat inflammatory arthritis, especially rheumatoid arthritis, psoriasis, and acute lymphoblastic leukaemia. However, it can cause adverse effects such as mucositis, myelosuppression, pneumonitis, pulmonary fibrosis, and liver fibrosis.

      Women should avoid pregnancy for at least six months after stopping methotrexate treatment, and men using methotrexate should use effective contraception for at least six months after treatment. Prescribing methotrexate requires familiarity with guidelines relating to its use. It is taken weekly, and FBC, U&E, and LFTs need to be regularly monitored. Folic acid 5mg once weekly should be co-prescribed, taken more than 24 hours after methotrexate dose. The starting dose of methotrexate is 7.5 mg weekly, and only one strength of methotrexate tablet should be prescribed.

      It is important to avoid prescribing trimethoprim or co-trimoxazole concurrently as it increases the risk of marrow aplasia. High-dose aspirin also increases the risk of methotrexate toxicity due to reduced excretion. In case of methotrexate toxicity, the treatment of choice is folinic acid. Overall, methotrexate is a potent drug that requires careful prescribing and monitoring to ensure its effectiveness and safety.

    • This question is part of the following fields:

      • Kidney And Urology
      0
      Seconds
  • Question 29 - A 65-year-old woman presents with dysuria, frequency of urination, and suprapubic discomfort. Urine...

    Incorrect

    • A 65-year-old woman presents with dysuria, frequency of urination, and suprapubic discomfort. Urine dipstick testing shows:
      nitrites+
      leucocytes++
      blood++

      She has had four urinary tract infections in the last six months, with each episode confirmed by laboratory testing. On each occasion, urine dipstick testing has shown microscopic blood as well as nitrite and leucocyte positivity. After treatment with antibiotics, the infections have settled, but on the last occasion, she experienced visible haematuria.

      The patient asks if there is anything she can do to prevent these infections. She had only one previous UTI about six years ago. What is the best approach in this case?

      Your Answer:

      Correct Answer: Refer her to a urologist as urgent suspected cancer at this point in time

      Explanation:

      Referral Guidelines for Recurrent UTI with Non-Visible Haematuria

      Recurrent UTI is defined as three or more episodes in a year. In the case of a woman with her fourth episode in the last six months, it is important to investigate further. If visible or non-visible haematuria is present on dipstick testing when a UTI is suspected, a urine sample should be sent to the laboratory for mc+s testing in all patients. If infection is confirmed, a urine sample should be dipstick tested for blood after antibiotic treatment has been completed. If haematuria persists, further investigation is warranted.

      According to NICE guidelines, urgent referral is necessary for bladder cancer if a person aged 45 and over has unexplained visible haematuria without urinary tract infection or visible haematuria that persists or recurs after successful treatment of urinary tract infection. For renal cancer, urgent referral is necessary if a person aged 45 and over has unexplained visible haematuria without urinary tract infection or visible haematuria that persists or recurs after successful treatment of urinary tract infection.

      In the case of a woman with recurrent UTIs associated with non-visible haematuria each time, urgent referral to a urologist is necessary. It is important to follow these guidelines to ensure timely diagnosis and treatment of potential cancer.

    • This question is part of the following fields:

      • Kidney And Urology
      0
      Seconds
  • Question 30 - A 60-year-old man complains of lower urinary tract symptoms. He has been experiencing...

    Incorrect

    • A 60-year-old man complains of lower urinary tract symptoms. He has been experiencing urinary urgency and occasional incontinence for the past few months. He reports no difficulty with urinary flow, hesitancy, or straining. Prostate examination and urinalysis reveal no abnormalities.

      What medication is most likely to provide relief for his symptoms?

      Your Answer:

      Correct Answer: Antimuscarinic

      Explanation:

      Patients with an overactive bladder can benefit from the use of antimuscarinic drugs. Oxybutynin, tolterodine, and darifenacin are some examples of such drugs that can be prescribed. However, before resorting to medication, it is important to discuss conservative measures with the patient and offer bladder training as an option.

      Lower urinary tract symptoms (LUTS) are a common issue in men over the age of 50, with benign prostatic hyperplasia being the most common cause. However, other causes such as prostate cancer should also be considered. These symptoms can be classified into three groups: voiding, storage, and post-micturition. To properly manage LUTS, it is important to conduct a thorough examination, including urinalysis, digital rectal examination, and possibly a PSA test. The patient should also complete a urinary frequency-volume chart and an International Prostate Symptom Score to guide management.

      For predominantly voiding symptoms, conservative measures such as pelvic floor muscle training, bladder training, and prudent fluid intake can be helpful. If symptoms are moderate or severe, an alpha-blocker may be offered. If the prostate is enlarged and the patient is at high risk of progression, a 5-alpha reductase inhibitor should be considered. For mixed symptoms of voiding and storage, an antimuscarinic drug may be added if alpha-blockers are not effective.

      For predominantly overactive bladder symptoms, moderating fluid intake and bladder retraining should be offered. If symptoms persist, antimuscarinic drugs such as oxybutynin, tolterodine, or darifenacin may be recommended. If first-line drugs fail, mirabegron may be considered. For nocturia, moderating fluid intake at night and furosemide 40 mg in the late afternoon may be helpful. Desmopressin may also be considered.

    • This question is part of the following fields:

      • Kidney And Urology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Kidney And Urology (9/21) 43%
Passmed