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7165 Medicine

A 63-year-old woman with long-standing type 2 diabetes, hypertension, osteoarthritis, and controlled systolic congestive heart failure following a previous anterior myocardial infarction presents for a routine office visit. She denies any significant complaints. The patient faithfully takes her glargine insulin, lisinopril, carvedilol, furosemide, and aspirin. On examination her blood pressure is 122/82, pulse 85, RR 14, with clear lungs, regular heartbeat, and 1+ bilateral pedal edema. You review the chart and find that her baseline creatinine is 1.5 mg/dL with an estimated glomerular filtration (GFR) rate of 42 mL/min. Her laboratory studies drawn early the morning of the visit returns as follows:Na: 138 mEq/LK: 6.0 mEq/LHCO3: 15 mEq/LCl: 120 mEq/LBUN: 20 mg/dLCreatinine: 1.8 mg/dLGlucose: 183 mg/dLYou suspect she has a Type 4 renal tubular acidosis. What is the most common pathophysiologic scenario leading to this acid-base disturbance?

AThe combination of long-standing diabetes and hypertension has led to distal nephron dysfunction inhibiting both acid and potassium secretion.
BThe patient's heart failure has caused decreased renal perfusion resulting in the metabolic abnormalities.
CThe patient has been overtreated with diuretics leading to intravascular volume depletion and acidosis.
DThe patient's aspirin use has led to toxicity in the setting of acute kidney injury and hence the metabolic acidosis.
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7173 Medicine

A pregnant 38 year old mother of two presents at the office concerned about her pregnancy. She is Rh-negative and her husband is Rh-positive. Both of her children are also Rh-negative. She has had two spontaneous aboions and carried a third pregnancy to term, but the child died at bih, diagnosed with erythroblastosis fetalis. The test of choice to determine the presence of circulating anti-Rh antibody in the mother is a(n)

ADirect Coombs test to measure IgG anti-Rh antibody
BDirect Coombs test to measure IgM anti-Rh antibody
CIndirect Coombs test to measure IgG anti-Rh antibody
DIndirect Coombs test to measure IgM anti-Rh antibody
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