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Internal Medicine · MRCP(UK)

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01 · Helix SBAs

A question bank that teaches, not just tests.

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The answer

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Teaching, built in

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Best of fiveQ 27 / 100

A 70-year-old with an acute kidney injury has a potassium of 7.2 mmol/L and peaked T waves on the ECG. What is the single best first drug?

  • AIV calcium gluconate 10%
  • BIV insulin with 50% dextrose
  • CNebulised salbutamol
  • DIV sodium bicarbonate
  • EOral calcium resonium
The question

A real clinical vignette.

Exam-style stems written by doctors, pitched at the depth your exam asks. The decision you will actually face on the day.

Best of fiveQ 27 / 100

A 70-year-old with an acute kidney injury has a potassium of 7.2 mmol/L and peaked T waves on the ECG. What is the single best first drug?

  • AIV calcium gluconate 10%
  • BIV insulin with 50% dextrose
  • CNebulised salbutamol
  • DIV sodium bicarbonate
  • EOral calcium resonium
The answer

Every option, explained.

Not just why the right answer is right. Why each wrong one is wrong, in a line, traced to a primary source.

Best of fiveQ 27 / 100

A 70-year-old with an acute kidney injury has a potassium of 7.2 mmol/L and peaked T waves on the ECG. What is the single best first drug?

  • AIV calcium gluconate 10%Correct answerCalcium stabilises the myocardium within minutes and is the first drug once the ECG changes.
  • BIV insulin with 50% dextroseShifts, not firstInsulin-dextrose drives potassium into cells but does nothing to protect the heart first.
  • CNebulised salbutamolAdjunct onlyA useful adjunct to shift potassium, but not the cardioprotective first step.
  • DIV sodium bicarbonateOnly if acidoticOnly shifts potassium, and only when the patient is acidotic; it is not the first move.
  • EOral calcium resoniumToo slowBinds gut potassium over hours, far too slow for an ECG emergency.
Teaching, built in

Reference cards where they matter.

The numbers, limits and red flags that anchor a topic, on the card with the question. Not buried three chapters deep.

When to act · Hyperkalaemia

Hyperkalaemiawith ECG change

Key fact

Potassium above 6.5, or any ECG change, is a cardiac emergency. Protect the heart before you shift or remove the potassium.

Emergency
K⁺ > 6.5
ECG
peaked T waves
First drug
IV calcium

Red flags

  • Peaked T waves give way to a broad QRS, then a sine wave before arrest.
  • Calcium buys time only; you still have to shift and remove the potassium.
Teaching, built in

Clinical pearls, visuals & more

Clinical pearls, diagrams and formulas ride with the question, so the reasoning sticks, not just the letter you picked.

Clinical pearl

Protect the heart, shift the potassium, then remove it.

StepDrugOnset
ProtectIV calcium gluconateminutes
ShiftInsulin + dextrose15 to 30 min
ShiftSalbutamol nebs15 to 30 min
RemoveDialysis or bindershours
The first move in this case

Calcium first. It does not lower the potassium at all, but it keeps the heart beating while the shifting drugs work.

Your turn

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Your turn

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02 · Ask Helix

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Best of five · Nephrology · Renal physiology
If ACE inhibitors protect the kidney, why does the creatinine rise when I start one?
03 · Community

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