 |  nbme 2 Q, please explain your answer
|
|
| Author | 7 Posts |
nadiabarati
|
Dec 28, 06 - 08:37 [+] [-] #1
A 47-year-old woman who is visiting from Australia
comes to the
physician because of increasing urine output over the
past month. She has had
no dysuria or hematuria. She has a history of chronic
headaches,
peptic ulcer disease, and urinary tract infections.
An evaluation 18 months
ago for headaches, including CT scan of the head,
showed no
abnormalities; treatment with ibuprofen and phenacetin
was initiated at that time,
and her headaches have been well controlled. Her
temperature is 37.1 C
(98.8 F), blood pressure is 140/82 mm Hg, pulse is
78/min, and
respirations are 14/min. Examination shows no
abnormalities. Laboratory
studies show:
Hematocrit 32%
Mean corpuscular volume 88 µm3
Serum
Glucose 130 mg/dL
Creatinine 1.7 mg/dL
Urine
Protein 2+
WBC 8–10/hpf
RBC none
Bacteria none
Nitrates none
Test of the stool for occult blood is negative. Which
of the following
is the most appropriate next step in management?
A
) Intravenous pyelography
B
) Discontinue current medication
C
) Antibiotic therapy for recurrent urinary tract
infections
D
) Insulin therapy for diabetes mellitus
E
) Upper endoscopy
|
| gilbert
Forum Junior
Topics: 16
Posts: 45
|
B, interstitial nephritis?
|
| smal
Forum Guru
Topics: 140
Posts: 727
|
B seems to be the only likely possiblity
___________________
remedy for weakness is not brooding over it ,but thinking of strength.
|
| prasannakumar
Forum Senior
Topics: 24
Posts: 55
|
A.. In analgesic nephropathy IVP reveals a ring defect
|
| Akeen
Forum Newbie
Topics: 1
Posts: 37
|
C. Discontinue.
First step medication induced interstitial nephritis is suspected is o stop the medication.
___________________
I never give up or lose faith.
|
| Akeen
Forum Newbie
Topics: 1
Posts: 37
|
Anything about "Australia" in this question?
___________________
I never give up or lose faith.
|
| prathapdoctor
Forum Elite
Topics: 12
Posts: 406
|
I think its analgesic induced nephropathy, first step must be discontiinuation of analgesic then the diagnosis has to be confirmed by IVP.
|
|
| |
| | | | | | | |
You don't have permission to post.
|
