Generalised pruritis (itching) is a feature of following conditions except?

SCTIMST Staff Nurse - 2016

Medical & Surgical Nursing

Hard

Appeared in: SCTIMST Staff Nurse - 2016

Explanation

Nephritis is inflammation of the kidneys and is not a direct cause of generalized pruritus.
Pruritus related to renal issues, known as uremic pruritus, is a hallmark of advanced chronic kidney disease (CKD) or end-stage renal disease (ESRD).
The itching in CKD is caused by the systemic accumulation of uremic toxins, which does not occur in simple, uncomplicated nephritis.

Option A: Drug allergies are a very common cause of generalized pruritus, often accompanied by urticaria (hives), due to systemic histamine release.
Option B: Generalized pruritus is a classic constitutional 'B symptom' of Hodgkin's Lymphoma, along with fever and night sweats. It can be severe and is an important diagnostic clue.
Option D: Obstructive jaundice leads to cholestasis (impaired bile flow), causing bile salts to deposit in the skin. This is a well-known cause of severe, generalized pruritus.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain This question tests the knowledge of systemic diseases that can manifest with generalized pruritus (itching) as background academic context rather than a clinical decision trigger.
A key nursing responsibility is to recognize that generalized pruritus without an obvious skin rash can be a red flag for a serious underlying systemic illness.
A thorough nursing assessment, including a detailed history of new medications, associated symptoms (like jaundice, fever, weight loss), is crucial for identifying the potential cause.
What if? If the option was 'Chronic Kidney Disease' instead of 'Nephritis', it would be a correct cause of pruritus, making it a distractor and changing the answer to the question.

How to Approach the Question

First, identify the negative framing of the question by spotting the keyword 'except'. This means you are looking for the option that does NOT cause the symptom.
The symptom in question is 'generalised pruritis' (itching).
Evaluate each option to determine if it is a known cause of generalized itching.
Recall that drug reactions, certain cancers (like lymphoma), and liver problems (like jaundice) are classic causes of pruritus.
Critically evaluate the term 'Nephritis'. Differentiate it from 'Chronic Kidney Disease' or 'Uremia'. Recognize that simple inflammation (nephritis) is different from systemic failure (uremia), and the itching is associated with the latter.
The option that does not fit the pattern of causing generalized pruritus is the correct answer.

Concept Tested & Keywords

Concept Tested: This question tests the knowledge of systemic diseases that can manifest with generalized pruritus (itching).
Stem keywords: Generalised pruritis, itching
Lead-in keywords: except
Negative lead-in flag: This is a negative-lead question where you must identify the option that is an exception.

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E6 Medicine Davidson Principles Practice 24e p. 1239-1241

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