Question Bank

According to UK national DKA guidelines, resolution is defined by pH >7.3, bicarbonate >18 mmol/L, and ketones <0.6 mmol/L. Glucose often normalizes before the metabolic acidosis resolves; therefore, glucose monitoring alone is insufficient for stopping the insulin infusion.

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.

NICE NG203 recommends an ACE inhibitor (such as ramipril) or ARB as first-line antihypertensive therapy for patients with CKD who also have diabetes, when the urine albumin:creatinine ratio (ACR) is ≥3 mg/mmol. For patients with CKD without diabetes, an ACE inhibitor or ARB is recommended when ACR is ≥30 mg/mmol. This patient has diabetes and an ACR of 15 mg/mmol — well above the 3 mg/mmol threshold — making ramipril the correct first-line choice. ACE inhibitors and ARBs are nephroprotective in diabetic CKD by reducing intraglomerular pressure and proteinuria. Amlodipine and thiazides do not have the same renoprotective benefit; spironolactone requires caution in CKD due to hyperkalaemia risk.

NICE NG100 recommends offering first-line conventional DMARDS (cDMARDs) monotherapy, with methotrexate being the standard first choice. Steroids are used as 'bridging therapy' but do not replace DMARDs. Biologics like Infliximab are reserved for patients failing dual cDMARD therapy.

If a bleeding point is clearly visualized in anterior epistaxis (Little's area) and simple pressure fails, silver nitrate cautery is the treatment of choice after applying local anaesthetic. Nasal packing is reserved for cases where the bleeding point cannot be identified or cautery is unsuccessful.

This patient presents with the nephrotic triad (proteinuria >3.5g/day, hypoalbuminaemia, and oedema). In adults, membranous nephropathy is the most common primary cause, whereas minimal change disease is most common in children.

NICE recommends NSAIDs (like naproxen) or colchicine as first-line for acute gout. While colchicine is an option, NSAIDs are often preferred if there are no contraindications; Allopurinol and Febuxostat are urate-lowering therapies (ULT) and should not be initiated during an acute flare.

First-line management for ankylosing spondylitis (axial spondyloarthritis) is regular NSAIDs and structured exercise/physiotherapy. DMARDs like methotrexate are not effective for purely axial disease. TNF-alpha inhibitors like Etanercept are only used if NSAIDs fail.

NICE guidelines recommend either a beta-blocker (e.g., atenolol/bisoprolol) or a calcium channel blocker (e.g., diltiazem/verapamil) as first-line treatment for stable angina. Long-acting nitrates and others are reserved for second-line or combination therapy.

Low pH (<7.35) and high pCO2 (>6.0 kPa) indicate respiratory acidosis (Type 2 failure). The elevated bicarbonate (29 mmol/L) suggests the body has begun to compensate (chronic/partially compensated), but the pH remains acidotic.