An 18-Year-Old Man Comes to the Office Because a College

question 526

Multiple Choice

An 18-year-old man comes to the office because a college physical urinalysis indicated that he had proteinuria.  The patient does not recall having a previous urinalysis.  He denies flank pain, hematuria, dysuria, nocturia, edema, urinary frequency, hypertension, or family history of kidney disease.  His review of systems provides no significant information.  He is in excellent health, with the exception of one or two upper respiratory infections per year.  He takes no medications.  He has no known drug allergies.  He does not use tobacco or illicit drugs and rarely drinks alcohol.  He has no history of a sexually transmitted disease and he is not sexually active.
His blood pressure is 120/76 mm Hg, pulse is 64/min, and respirations are 12/min.  On examination, he appears healthy.  Cardiovascular, pulmonary, and abdominal examinations show no abnormalities.  He has no edema.
The patient's laboratory studies reveal:

Which of the following is the most appropriate course of action?

• A)HIV testing
• B)Kidney biopsy
• C)Kidney CT scan
• D)Spot urine protein/creatinine ratio upon arising and at the end of the day
• E)Urinary protein electrophoresis

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Definitions:

Mental Activity

Any cognitive process that involves thinking, reasoning, learning, and memory.

Operant Behavior

Behavior that is controlled by its consequences, including rewards and punishments, as defined in the theory of operant conditioning.

Successive Approximation

A behavioral strategy that rewards closer and closer approximations to the desired behavior.

Variable-Interval Reinforcement

A reinforcement schedule in operant conditioning where rewards are given after unpredictable time intervals, leading to steady and consistent responses.