A 39-Year-Old Man Comes to the Physician with 3 Weeks

question 127

Multiple Choice

A 39-year-old man comes to the physician with 3 weeks of progressive pedal edema.  The edema is mild on awakening in the morning but gets worse as the day progresses.  He has no shortness of breath, lower-extremity pain or warmth, or history of heart or liver disease.
His blood pressure is 155/96 mm Hg and pulse is 72/min.  Jugular venous pressure is normal. Cardiopulmonary, abdominal, and neurologic examinations are within normal limits.  There is soft, 2+ pitting edema of his legs below the knees.
After initial evaluation, the patient undergoes renal biopsy, which is consistent with focal segmental glomerular sclerosis.
Angiotensin-converting enzyme inhibitor therapy is most likely to delay progression of this patient's renal disease in the presence of which of the following additional findings?

• A)Daily protein excretion > 1 g
• B)Glomerular filtration rate < 60 mL/min
• C)Hemoglobin level < 10 g/dL
• D)High plasma renin/aldosterone ratio
• E)LDL cholesterol > 130 mg/dL

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Definitions:

Breach of Warranty

The failure to fulfill the terms of a promise or guarantee made about the quality or functionality of a product or service.

40,000 Mile Warranty

A guarantee provided, typically by a vehicle manufacturer, covering repairs and certain maintenance for up to 40,000 miles of vehicle use.

Breached Contract

Occurs when one party to a contract fails to fulfill its legal obligations as specified in the agreement, thereby violating the contract.

Private Sale

A transaction of goods or property conducted directly between individuals without the involvement of an intermediary or public auction.