Renal Urology1. A 51-year-old with type 2 diabetes has eGFR 78 and ACR 8 mg/mmol. Blood pressure is 128/78 mmHg. What disease-modifying treatment should be offered for the albuminuria (if potassium allows)?A. Combination ACE inhibitor plus ARB from day oneB. Spironolactone as first-line for all diabetic albuminuria in GPC. No renin–angiotensin drug because clinic BP is already under 130/80D. An ACE inhibitor or ARBCheck
Renal Urology2. A 64-year-old non-diabetic man has stable CKD G3a. He is not on a statin. What does NICE-aligned primary prevention usually offer?A. Atorvastatin 20 mg dailyB. No statin because CKD is not a lipid indicationC. Simvastatin 80 mg as first-lineD. Ezetimibe monotherapy before any statinCheck
Renal Urology3. A 70-year-old has confirmed eGFR 27 mL/min/1.73 m² (G4) with ACR 4 mg/mmol. What referral is indicated?A. No referral is ever needed until eGFR is below 10B. Nephrology referral because eGFR is below 30C. Routine dermatology for uraemic itch firstD. Immediate renal transplant listing from the GP surgeryCheck
Renal Urology4. A 74-year-old on ramipril for CKD albuminuria has vomiting and reduced urine output. What should he do with ramipril until he is eating and drinking again? The most appropriate action is: Increase ramipril to protect the kidney during dehydrationTRUE. TrueFALSE. FalseCheck
Renal Urology5. A 47-year-old man has a painless episode of visible haematuria. Dipstick is negative for nitrites after a clear MSU. What is the most appropriate cancer-pathway action? Select TWO correct statements.Select all that apply.A. Most appropriate: Suspected-cancer (2WW) urology referral (NG12, age ≥45 with unexplained visible haematuria)B. The following is not the most appropriate next step: Reassure that a single episode never needs investigation for this presentation in this NHS general-practice settingC. Most appropriate: Routine nephrology in 12 months onlyD. Most appropriate: Repeat dipstick yearly without referralCheck
Renal Urology6. A 62-year-old requests a PSA test while completing antibiotics for a culture-proven UTI. What is the most appropriate advice?A. Check PSA today because infection lowers PSA and is the best window for this presentationB. Do not measure PSA during an active or recently treated UTI; defer until after recoveryC. PSA is mandatory on day 1 of every male UTID. A single on-treatment PSA replaces the need for MSUCheck
Renal Urology7. A 55-year-old with a known ureteric stone develops fever, loin tenderness and vomiting. What is the most appropriate action?A. Emergency hospital assessment for an infected obstructed kidney (urological emergency)B. Oral nitrofurantoin at home for 3 daysC. Increase fluids and review after the weekend for this presentation in this NHS general-practice settingD. Community physiotherapy for 'loin strain'Check
Renal Urology8. A 36-year-old man has dysuria and frequency. Dipstick suggests UTI. He is systemically well. What duration of antibiotics does NICE NG109 typically use in men?A. A 3-day course as for uncomplicated female cystitisB. A 7-day course (and send MSU)C. A single 1 g fosfomycin only as routine first-line in all menD. No antibiotics because male UTI is always viralCheck
Renal Urology9. A 44-year-old has pitting oedema, hypoalbuminaemia and heavy proteinuria. What is the most appropriate next step? The most appropriate action is: Urgent nephrology referral for nephrotic syndromeTRUE. TrueFALSE. FalseCheck
Renal Urology10. A 40-year-old man presents with a first lower UTI. Besides examining the genitals and prostate as indicated, which investigation should be sent?A. Midstream urine for cultureB. No urine sample is ever needed in menC. PSA today as a substitute for cultureD. 24-hour urinary cortisol in this clinical contextCheck