دانشجویان پزشکی 87 کرمان
A76-year-old male presents to the emergency room.He had influenza and now presents with diffuse muscle pain and weakness. His past medical history is remarkable for osteoarthritis, for which he takes ibuprofen.Physical examination reveals a blood pressure of 130/90 with no orthostatic change. The only other finding is diffuse muscle tenderness. Laboratory data includes:
BUN: 30 mg/dL
Creatinine: 6 mg/dL
K: 6.0 meq/L
Uric acid: 18 mg/dL
Ca: 6.5 mg/dL
PO4: 7.5 mg/dL
CPK: 28,000 IU/L
Urine output: 40 mL/h
1-Which is the most likely diagnosis?
a. Nonsteroidal anti-inflammatory drug–induced acute renal failure (ARF)
b. Volume depletion
c. Rhabdomyolysis-induced ARF
d. Urinary tract obstruction
2- Which diagnostic test is most useful for this patient?
a. Urine sodium
c. Renal ultrasound
d. Urine uric acid–urine creatinine ratio
3- For this patient, which of the following is the initial therapy?
c. Natriuretic peptide
d. Alkaline diuresis
4- For this patient, which of the following would be a specific indication to start dialysis?
a. BUN rises to >90 mg/dL
b. Urine output falls to <10 mL/h
c. Pericardial friction rub develops
d. Hematocrit falls to <30%
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