NMS Q&A Family Medicine

118 NMS Q&A Family Medicineof malignant hypertension. Malignant hypertension is amore time-urgent emergency that carries 50% mortalityif not treated.15. The answer is E. The patient had suffered from aparaneoplastic syndrome associated with the renal cellcarcinoma, for which the tumor is noted. In cases of paraneoplasticsyndromes, the patient becomes ill and manifestssymptoms related to a humeral manifestation of theprimary tumor that causes systemic symptoms, unrelatedto metastases. Renal cell carcinoma may be thus associatedwith symptoms experienced by the patient in thevignette as well as fever alone, erythrocytosis, thrombocytosis,coagulopathy, and amyloidosis.16. The answer is A. Acetaminophen is the only analgesicamong the choices given that it does not cause analgesicnephropathy. Aspirin, ibuprofen, and naproxen are allnonsteroidal anti-inflammatory drugs. In all cases, tubulointerstitialinflammation and papillary necrosis arefound on pathologic examination.17. The answer is C. Acetylcysteine (Mucomyst), 600 mg,orally twice 12 hours before and after a dye load, given beforeradiocontrast media along with infusion of 0.45% salinesolution, has been found to result in a relative risk of elevationof creatinine of 0.11 to 0.18 and an absolute risk reductionof 19%. In a control group given 0.45% saline only,creatinine rose to 0.5 mg/dL in 9 of 42 control subjects.ReferencesJohnson CA , Levey AS , Corsh J , et al. Clinical practice guidelinesfor kidney disease in adults. Part I: Definition, disease stages,evaluation, treatment, and risk factors . Am Fam Physician .2004 ; 70 : 869 – 876 .Johnson CA , Levey AS , Corsh J , et al. Clinical practice guidelinesfor kidney disease in adults. Part II: Glomerular filtrationrate, proteinuria, and other markers . Am Fam Physician .2004 ; 70 : 1091 – 1097 .Neeham ED . Management of acute renal failure . Am Fam Physician. 2005 ; 72 : 1739 – 1746 .Snively CS , Gutierez C . Chronic kidney disease: Preventionand treatment of complications . Am Fam Physician . 2004 ;70 : 1921 – 1930 .Watnick S , Morrison G . Kidney . In: Tierney LM , McPhee SJ , PapadakisMA , eds. Current Diagnosis and Treatment . 43rd ed .New York : McGraw-Hill/Appleton & Lange ; 2004 : 863 – 898 .