Question of the Week # 346

Posted on April 9, 2012 by Archer USMLE Reviews

346) A 54 year old woman presents to your office with progressively increasing swelling of her bilateral lower extremities and abdominal distension. She denies any fever, cough or shortness of breath. Her medical history is significant for hypertension and osteoarthritis. She takes Enalapril and Hydroclorthiazide for her hypertension and Ibuprofen for osteoarthritis on a daily basis . She denies any rash. On examination, she is afebrile, Blood pressure 130/80 mm Hg and respiratory rate is 18/min . Auscultation reveals reduced breath sounds on both sides. Abdominal exam is remarkable for shifting dullness consistent with ascites. Lower extremities reveal gross edema up until the level of knees. Urinalysis shows no eosinophils or redcells or casts, 3+ proteinuria, no nitrite or leukoesterase. Urine total protein is 6.0 gm/24 hours. Serum total protein 4.0gm% , albumin 2.0gm%. SGOT, SGPT and Alkaline phosphatase are within normal limits. Serum creatinine is o.8mg%. Skin examination si normal with out any rash. Which of the following management options is most appropriate next step for this patient?

A) Discontinue Enalapril

B) Renal Biopsy

C) Discontinue Ibuprofen

D) Furosemide

E) Obtain Anti-Nuclear Antibodies

F) Trial of Corticosteroids

Filed under: Uncategorized, USMLE Test Prep | Tagged: ARCHER NEPHROLOGY, dr.red nephrology lecture, usmle step 3 nephrology |

17 Responses

shru, on April 9, 2012 at 7:27 am said:

B) Renal Biopsy

Reply
- shru, on April 9, 2012 at 5:29 pm said:
  
  oh no its
  C) Discontinue Ibuprofen -next step -NSAIDS can cause Nephrotic Sx!
  
  Reply
roy alonso, on April 9, 2012 at 12:56 pm said:

c

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Amandeep, on April 9, 2012 at 5:19 pm said:

protein>6= nephrotic syndrome

So either d or f or both

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rabia tabasam, on April 9, 2012 at 5:24 pm said:

next step should be to gve relieve to patient i think
so its trial of corticosteroids

Reply
dinesh, on April 9, 2012 at 5:34 pm said:

F

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saeed, on April 9, 2012 at 5:41 pm said:

) Furosemide

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AMK, on April 9, 2012 at 6:49 pm said:

E-corticosteroids would releive edema and heart faliure

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debopam, on April 9, 2012 at 7:44 pm said:

i think its discontinue enalapril and ibruprofen

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Renjith Rahul, on April 9, 2012 at 9:24 pm said:

d

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samir, on April 9, 2012 at 10:07 pm said:

d

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MOHSEN, on April 10, 2012 at 8:47 am said:

B, proteinuria in nephrotic syndrom range, in the chronic htn pts we must emphasis on renal pathology especialy glumerosclerosis, for establish that must do renal biopsy.

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doha haggag, on April 10, 2012 at 2:33 pm said:

f

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preet, on April 10, 2012 at 10:45 pm said:

C.Discontinue Ibuprofen.

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Awsab, on April 11, 2012 at 5:30 am said:

While renal biopsy is required for diagnosis, one must stop Ibuprofen first as the question asks for the next appropriate step.

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sara, on May 1, 2012 at 7:24 am said:

B-in this age for nephrotic range protinuria biopsy should be done i think

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emerald, on November 25, 2013 at 12:46 am said:

Nephrotic syndrome. discontinue ibuprofen. Answer C:

Reply