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686 Medicine

A 65-year-old man, with a 45-pack-per-year history of smoking, presents with hematuria and flank pain. He reports no fever, chills, or dysuria, but he has lost 15 lb. On examination the abdomen is soft, no mass is felt, and there is no flank tenderness on percussion. His hemoglobin (Hb) is 18.5 g/dL, and his liver enzymes are normal. A CT scan of the abdomen reveals a mass in the left kidney with involvement of the renal vein. Which of the following is the most likely diagnosis?

Arenal cyst
Brenal cell carcinoma
Crenal metastases
Drenal abscess
Medicine
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691 Medicine

A 70-year-old diabetic and hypeensive patient was being investigated for angina and a coronary angiogram was performed. Two days later, he developed fever and abdominal discomfo and dyspnea and a mottled skin rash. His great toe appeared black. His BP increased to 180/100. His creatinine was found to have risen from a pre-angiography level of 1.2 to 3.6 mg/dl. He has eosinophilia. Which one of the following statements is TRUE regarding this condition?

AN-acetylcysteine would have prevented this condition
BThis is contrast-induced nephropathy
CHeparin is the treatment of choice
DKidney biopsy will show micro-vessel occlusion with a cleft in the vessel
Medicine
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