Question Bank

IgA nephropathy typically presents with 'synpharyngitic' haematuria (occurring during or shortly after an upper respiratory tract infection). Post-streptococcal glomerulonephritis usually has a longer lag period (1-3 weeks) between infection and renal symptoms.

Severe asthma is defined by any one of: PEF 33-50% predicted, respiratory rate ≥25/min, heart rate ≥110/bpm, or inability to complete sentences in one breath. Life-threatening features would include a silent chest, cyanosis, or PEF <33%.

In severe hyperkalaemia (>6.5 mmol/L) or with ECG changes, the priority is to stabilise the cardiac membrane using 10% IV calcium gluconate. Insulin/dextrose and salbutamol shift potassium into cells but do not stabilise the myocardium.

In accordance with NICE and British Society of Gastroenterology guidelines, any male or post-menopausal female with unexplained iron deficiency anaemia must be referred for urgent (2-week wait) GI investigation to exclude malignancy. While iron supplementation is needed, it must not delay diagnostic investigations. Bone marrow biopsy is not indicated for simple microcytic anaemia.

Clozapine carries a significant risk of agranulocytosis (potentially fatal neutropenia). The Clozapine Patient Monitoring Service (CPMS) mandates Full Blood Count (FBC) monitoring throughout treatment: weekly for the first 18 weeks, fortnightly from week 18 to one year, then monthly for the duration of treatment. Treatment must be stopped immediately if the neutrophil count falls below 1.5 × 10⁹/L (amber alert) or below 0.5 × 10⁹/L (red alert — never restart). Blood glucose, lipids, and weight are also monitored due to metabolic syndrome risk, but FBC is the mandatory safety parameter that governs clozapine supply.

Oesophageal manometry is the gold standard for diagnosing achalasia, classically showing a failure of the lower oesophageal sphincter to relax and lacked peristalsis in the distal oesophagus. Barium swallow provides characteristic signs but is not confirmatory. OGD is necessary to rule out pseudoachalasia/malignancy.

NICE NG185 recommends primary PCI as the preferred reperfusion strategy for STEMI when it can be delivered within 120 minutes of the time at which fibrinolysis could have been given (i.e. door-to-balloon time). With the PCI centre only 60 minutes away, this criterion is met and primary PCI is strongly preferred over fibrinolysis. If the expected door-to-balloon time exceeds 120 minutes — for example due to transfer delays — fibrinolysis should be offered immediately instead, followed by angiography within 3–24 hours. Aspirin 300 mg and anticoagulation should be given to all STEMI patients regardless of reperfusion strategy.

In the UK, 6-monthly liver ultrasound is the recommended primary surveillance modality for HCC in patients with cirrhosis, as per NICE (TA474) and EASL guidelines. Serum AFP is not recommended as a routine standalone screening tool by NICE due to its limited sensitivity and specificity; it may be used adjunctively at the clinician's discretion but is not mandated. CEA is a marker for colorectal cancer; CA19-9 is used in biliary and pancreatic malignancy; liver biopsy is not a surveillance tool. All patients with compensated cirrhosis, regardless of aetiology, should be enrolled in a 6-monthly ultrasound surveillance programme.

Rifampicin causes orange/red discoloration of urine, tears, and sweat. Optic neuritis is associated with ethambutol; peripheral neuropathy with isoniazid; and hyperuricaemia with pyrazinamide.

For the first isolated growth of Pseudomonas aeruginosa in CF patients, the goal is eradication. NICE/UK protocols typically use a combination of oral ciprofloxacin and nebulised antibiotics (like colistimethate or tobramycin) for 3 months.