A 55-Year-Old Man Comes to the Office Due to a Week

question 985

Multiple Choice

A 55-year-old man comes to the office due to a week of nausea and generalized weakness.  He also has had muscle cramps for the past 3 days.  The patient has a history of type 2 diabetes mellitus diagnosed 2 years ago, hypertension diagnosed 10 years ago, and hyperlipidemia.  The patient has been on a stable medication regimen of metformin, lisinopril, and rosuvastatin for 2 years.  He does not use tobacco, alcohol, or illicit drugs.  Temperature is 37 C (98.6 F) , blood pressure is 160/98 mm Hg, pulse is 84/min, and respirations are 18/min.  The mucous membranes are moist.  Bilateral basal crackles are present.  The abdomen is soft and nontender.  Bilateral 2+ lower extremity edema is present.  Laboratory results are as follows: Urine sodium is 70 mEq/L.  Renal ultrasound shows normal-sized kidneys with no evidence of hydronephrosis.  Which of the following is the most likely cause of this patient's current condition?

• A)Decreased cardiac output
• B)Drug-induced interstitial nephritis
• C)Glomerulonephritis
• D)Intravascular volume depletion
• E)Progression of diabetic nephropathy
• F)Renal tubular injury

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Definitions:

Workplace Stressors

Various factors or conditions in the workplace that can cause stress, such as high workload, time pressures, or difficult working conditions.

Severe Strain

A high level of stress or pressure that significantly impacts an individual's physical or psychological well-being.

Medium-Sized Organizations

Companies that occupy a middle ground in terms of revenue, employees, and scale, falling between small and large enterprises.

Accident Involvement

The occurrence of incidents resulting in injury, damage, or harm, which may require investigation or intervention.