Medicine MCQ Daily

  Nephrology MCQ  Question: A 28-year-old man presents with **sudden onset edema, hematuria, and hypertension** 2 weeks after a **sore throat**. Urine shows **RBC casts**, proteinuria 2 g/day. What is the most likely diagnosis? A. Nephrotic syndrome B. Chronic kidney disease C. Acute post-streptococcal glomerulonephritis (nephritic syndrome) D. Minimal change disease Answer: C. Acute post-streptococcal glomerulonephritis (nephritic syndrome) Explanation (Point-wise): 1. Onset: Symptoms started 1–2 weeks after a **streptococcal infection** (throat/skin). 2. Clinical Features: Sudden edema (periorbital), hematuria (tea-colored urine), and hypertension. 3. Urine Findings: Presence of **RBC casts** confirms **glomerular origin of hematuria**. Proteinuria is usually mild ( 4. Diagnosis: This is classic **post-infectious glomerulonephritis**, a **nephritic syndrome**. ...

  Nephrology MCQ  Question: A 60-year-old man with **diabetes mellitus** presents with **progressive edema and frothy urine**. Urine protein: 4.2 g/day. Serum creatinine: 1.5 mg/dL. What is the most likely diagnosis? A. Minimal change disease B. Focal segmental glomerulosclerosis C. Diabetic nephropathy D. Membranous nephropathy Answer: C. Diabetic nephropathy Explanation: - Diabetic nephropathy is the most common cause of **nephrotic-range proteinuria in adults**. - Clinical features: progressive **proteinuria**, mild **edema**, slowly rising **creatinine**. - Lab hallmark: **proteinuria >3.5 g/day**, often accompanied by **microalbuminuria in early stages**. - Other causes like minimal change disease and FSGS are possible but less likely in older diabetic patients. - Management includes **tight glycemic control, ACE inhibitors/ARBs**, blood pressure control, and monitoring renal f...

Nephrology MCQ  Question: A 50-year-old woman presents with **tea-colored urine, hypertension, and mild edema**. Urine microscopy shows **RBC casts**. Labs: mild proteinuria ( A. Nephrotic syndrome B. Acute post-streptococcal glomerulonephritis (nephritic syndrome) C. Acute tubular necrosis D. Chronic kidney disease Answer: B. Acute post-streptococcal glomerulonephritis (nephritic syndrome) Explanation: Nephritic syndrome presents with hematuria (tea-colored urine), RBC casts, hypertension, and mild proteinuria . This is typically caused by **post-infectious glomerulonephritis**, often after a **streptococcal throat or skin infection**. Key differences from nephrotic syndrome include: Proteinuria is 3.5 g/day in nephrotic syndrome) Presence of RBC casts and hematuria (not seen in nephrotic syndrome) Edema is usually mild and periorbital Management: Supportive care, manage hypertension,...

  Nephrology MCQ Question: A 35-year-old man presents with edema, frothy urine, and fatigue. Laboratory investigations show proteinuria >3.5 g/day, hypoalbuminemia, and hyperlipidemia. What is the most likely diagnosis? A. Acute glomerulonephritis B. Chronic kidney disease C. Nephrotic syndrome D. Acute tubular necrosis Answer: C. Nephrotic syndrome Explanation :  Nephrotic syndrome is defined by proteinuria >3.5 g/day, hypoalbuminemia, edema , and often hyperlipidemia. Clinical features include generalized edema (periorbital first), frothy urine, and fatigue. Common causes: minimal change disease (children), FSGS, membranous nephropathy (adults). Nephritic syndrome shows hematuria, hypertension, and mild proteinuria. Management includes treating underlying cause, salt restriction, diuretics, ACE inhibitors/ARBs, and immunosuppressive therapy for selected causes. Key Laboratory Findings: Parameter...

  Question : A 65-year-old man with chronic systolic heart failure (HFrEF) is started on medical therapy. Which of the following drugs has been shown to reduce mortality in HFrEF? Options: A. Furosemide B. Digoxin C. ACE inhibitors (e.g., Enalapril) D. Nitrates alone ✅ Answer: C. ACE inhibitors (e.g., Enalapril) Explanation : HFrEF (EF <40%) management includes drugs that improve survival, reduce hospitalization, and relieve symptoms. ACE inhibitors / ARBs: Reduce mortality and morbidity. Decrease afterload, inhibit maladaptive RAAS activation, reduce LV remodeling. Beta-blockers (e.g., Carvedilol, Metoprolol succinate): Also improve survival in chronic HFrEF. Reduce sympathetic overdrive, prevent arrhythmias, improve EF over time. Mineralocorticoid receptor antagonists (e.g., Spironolactone): Reduce mortality in selected patients with HFrEF (EF ≤35%). Furosemide (loop diuretic): Symptomatic relief (reduces congestion) but does not improve survival. Digoxin : Improves symptoms a...

  Question : A 70-year-old man presents with exertional dyspnea, chest pain, and syncope. On examination, there is a crescendo-decrescendo systolic murmur at the right upper sternal border radiating to the carotids, and delayed carotid upstroke. What is the most likely diagnosis? Options: A. Mitral regurgitation B. Aortic regurgitation C. Aortic stenosis D. Pulmonic stenosis ✅ Answer: C. Aortic stenosis Explanation : Classic triad of aortic stenosis: Exertional dyspnea (most common presenting symptom due to LV hypertrophy and diastolic dysfunction). Angina (due to increased myocardial oxygen demand). Syncope (especially on exertion, due to fixed cardiac output). Physical exam findings : Systolic ejection murmur: Crescendo-decrescendo, best heard at the right upper sternal border, radiates to the carotids. Delayed and diminished carotid upstroke: “Pulsus parvus et tardus”. LV heave may be present due to left ventricular hypertrophy. Pathophysiology : Progressive calcification of the...