A 17-Year-Old Boy Is Evaluated in the Office Due to Progressive

question 581

Multiple Choice

A 17-year-old boy is evaluated in the office due to progressive facial puffiness, fatigue, and decreased appetite for the past month.  Temperature is 36.7 C (98.1 F) , blood pressure is 110/70 mm Hg, pulse is 80/min, and respirations are 18/min.  Physical examination shows periorbital and pretibial edema.  Serum laboratory results are as follows: Urinalysis shows 4+ proteinuria, no red blood cells, and no casts.  A renal biopsy is performed.  Immunofluorescence microscopy shows a diffuse, granular pattern of IgG and C3 along the capillary loops, and electron microscopy shows electron-dense immune deposits along the glomerular basement membrane, findings consistent with membranous nephropathy.  Which of the following additional studies should be performed in this patient?

• A)Antistreptolysin O titers
• B)Audiology evaluation
• C)Echocardiography
• D)Hepatitis B serologies
• E)No additional workup

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Definitions:

Pro-suicide Websites

Online platforms that promote or provide information on methods of suicide, often criticized for their potential to encourage self-harmful behaviors.

Clinical Depression

a more severe form of depression, also known as major depressive disorder, characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities.

Intense Competition

A highly competitive environment where entities vie aggressively for resources, market share, or victory, often leading to significant stress and innovation.

Weakening Family Ties

The gradual reduction of close and supportive relationships among family members, often leading to detachment and strained interactions.