Test plan area: Health Promotion and Maintenance

Difficulty level: Intermediate

The clinical most obvious manifestation of kidney stones is:

Choice A reason: Identification of a significant amount of protein in the urine (proteinuria) is an abnormal finding that can indicate underlying kidney problems. Proteinuria can be a sign of kidney disease, as the kidneys normally prevent large amounts of protein from entering the urine. When protein is detected in the urine, it suggests that the kidneys' filtering mechanism may be damaged. This condition requires further clinical assessment to determine the underlying cause and appropriate treatment.

Choice B reason: It is incorrect to assume that proteinuria will resolve itself without intervention. While some causes of proteinuria, such as temporary increases due to fever or intense physical activity, may be benign and resolve on their own, persistent or significant proteinuria is often indicative of a more serious underlying condition. Ignoring the presence of protein in the urine without further investigation could lead to worsening kidney function or other complications.

Choice C reason: While staying hydrated by drinking 1-2 liters of water per day is generally good advice for overall health, it is not a specific solution for proteinuria. Proper hydration can help maintain kidney function, but it does not address the underlying cause of protein in the urine. Clinical assessment and targeted treatment are necessary to manage proteinuria effectively.

Choice D reason: Dismissing proteinuria as nothing to be worried about is not appropriate. Significant protein in the urine is a clinical finding that warrants further investigation. It could be a sign of kidney disease, diabetes, hypertension, or other health issues that require medical attention. Early diagnosis and management are crucial to prevent potential complications and preserve kidney health.

Choice A reason: Cataract development is a common issue in people with diabetes due to the high blood sugar levels that affect the lens of the eye. However, it is not the primary cause of visual impairment. Cataracts cause the lens to become cloudy, leading to blurred vision, but the impact is generally less severe compared to the microvascular complications of diabetes.

Choice B reason: Exophthalmos, or bulging of the eye, is not typically associated with diabetes. It is more commonly seen in conditions like Graves' disease, an autoimmune disorder affecting the thyroid. Therefore, while it is important to be aware of various conditions that can impact eye health, exophthalmos is not a primary complication of diabetes.

Choice C reason: Abnormal metabolism in the lens can contribute to the formation of cataracts, but it is not the main reason for diabetic visual impairment. The primary issue in diabetes-related visual impairment is damage to the small blood vessels in the retina, not just changes in the lens metabolism.

Choice D reason: Microvascular changes in the eye, particularly diabetic retinopathy, are the primary cause of visual impairment in people with diabetes. High blood sugar levels can damage the blood vessels in the retina, leading to leakage, swelling, and the formation of new, abnormal blood vessels. This can result in significant vision loss and even blindness if not properly managed. Regular eye examinations and control of blood glucose levels are crucial in preventing and managing diabetic retinopathy.