Internal-Medicine

164 8: Kidneys
44. A 74-year-old woman has symptoms of shortness
of breath on exertion and waking up at
night. Her physical examination reveals a JVP
at 8 cm, extra third heart sound, lung crackles,
and pedal edema. She is started on furosemide
80 mg/day for heart failure, while further
investigations are performed. (SELECT ONE)
45. A 53-year-old woman is being treated for tuberculosis
with INH and rifampin. (SELECT ONE)
46. A 69-year-old woman is taking large amounts
of aspirin for osteoarthritis, and now complains
of ringing in her ears and nausea. (SELECT
ONE)
Questions 47 through 52
(A)
(B)
(C)
(D)
(E)
nephrogenic DI
central DI
primary polydipsia
solute diuresis
natriuretic syndrome
For each patient with increased urine output,
select the correct diagnosis.
47. A 42-year-old man presents to hospital with
dark black-colored stools and passing out while
getting up. On examination he is diaphoretic,
blood pressure 80/50 mm Hg supine, pulse
120/min, and the DRE is positive for melena.
He is resuscitated in the emergency room. He
has low urine output and develops renal failure
from ATN. A few days later, his urine output
increases to 200 cc/h. (SELECT ONE)
48. A 27-year-old woman presents because she is
feeling unwell. Her examination is normal, but
her serum sodium is 115 mEq/L. Her urine
lytes: sodium 55 mEq/L, osmolality 100
mOsm/L. This condition causes the greatest
amount of medullary washout. (SELECT ONE)
49. A 64-year-old man develops severe diarrhea
after returning from a foreign holiday. He is
hypovolemic clinically and is given normal
saline. His serum sodium is 125 mEq/L and
potassium is 2.5 mEq/L. He develops increased
urine output with urine sodium of 10 mEq/L
and osmolality of 200 mOsm/L. His polyuria
can be caused by hypokalemia. (SELECT ONE)
50. A 34-year-old man is brought for evaluation
because of bizarre behavior. He comments that
he is voiding all the time of clear water-like urine.
He has a past history of schizophrenia for which
he is taking a major tranquilizer. (SELECT ONE)
51. A 38-year-old man is admitted to hospital for
investigation of polyuria and a low serum
sodium concentration. After a fluid deprivation
test, there was no change in his urine
osmolality. He was then given vasopressin
(DDAVP) with no change in urine volume or
urine osmolality after 2 hours. (SELECT ONE)
52. A 67-year-old man is admitted to hospital after
a stroke. He has swallowing difficulties, and a
nasogastric feeding tube is inserted to provide
high protein content nutrition. After starting
the tube feeds, he develops large amounts of
urine output. His serum sodium is normal, and
the urine values are sodium 60 mEq/L and
osmolality 420 mOsm/L. (SELECT ONE)
Questions 53 through 58
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
(J)
(K)
congestive heart failure (CHF)
extrarenal sodium and fluid losses
SIADH
polydipsia
essential hyponatremia
renal failure
endocrine cause of hyponatremia
renal sodium and fluid losses
artifactual
osmotic
impaired diuresis
For each patient with hyponatremia, select the
most likely diagnosis.
53. A 74-year-old man from a nursing home is not
feeling well and is confused. He is not able to
give any reliable history. His serum sodium is
120 mEq/L and osmolality is 265 mOsm/kg.