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4008 Medicine

A 70-year-old woman is seen by her physician for evaluation of severe headaches. She noted these several weeks ago, and they have been getting worse. Although she has not had any visual aura but she has been intermittently losing vision in her left eye for the last few days. She denies new weakness or numbness, but she does repo jaw pain with eating. Her past medical history includes coronary aery disease requiring a bypass grafting 10 years prior, diabetes mellitus, hyperlipidaemia, and mild depression. Full review of symptoms is notable for night sweats and mild low back pain paicularly prominent in the morning. Which of the following is the next most appropriate step?

AAspirin 975 mg orally daily
BMeasurement of erythrocyte sedimentation rate
CImmediate initiation of glucocoicoid
DReferral for temporal aery biopsy
Medicine
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4009 Medicine

A 52-year-old man complains of impotence. On physical examination, he has an elevated jugular venous pressure, S3 gallop, and hepatomegaly. He also appears tanned, with pigmentation along skin folds. He has joint pain and bony overgrowth primarily affecting the second and third metacarpophalangeal joints bilaterally. The plasma glucose is 250 mg/dL, and liver enzymes are elevated. Which of the following studies will help establish the diagnosis?

ADetection of nocturnal penile tumescence
BDetermination of iron saturation
CDetermination of serum copper
DDetection of hepatitis B surface antigen
Medicine
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4012 Medicine

A 14-year-old boy presents to the hospital with severe leg swelling that started 2 weeks ago. He also notes feeling tired and having little energy to play sports with his friends. His past medical history is negative and he is not taking any medications.On examination, his blood pressure is 163/96 mm Hg, and there is pedal edema up to his knees, as well as periorbital edema. His remaining clinical exam is normal. A urinalysis is positive for 3+ proteinuria and on 24-hour urine collection the total protein excretion is 5.4 grams/day. He undergoes a renal biopsy and there are no changes seen on light microscopy, but electron microscopy shows foot process fusion and no deposits on the membranes. Which of the following is the most likely diagnosis?

Amesangial proliferative glomerulonephritis
Bminimal change disease
Cfocal glomerulosclerosis
Dmembranous glomerulonephritis
Medicine
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