A 53-year-old man comes to the emergency department because of a 3-day history of intermittent left flank pain and generalized weakness. He also has had decreased urination with some episodes of high urine output. He has a history of hypertension and type 2 diabetes and has taken lisinopril and glyburide for the past 5 years. Ten years ago, he donated a kidney to his brother and underwent right total nephrectomy. The patient does not smoke cigarettes, drink alcohol, or use illicit drugs. BMI is 28 kg/m2. His temperature is 37.3°C (99.3°F), pulse is 91/min and regular, and blood pressure is 131/80 mm Hg. Abdominal examination discloses left-sided flank pain. No abdominal or pelvic masses are palpated. One month ago, serum creatinine concentration was 1.2 mg/dL. Laboratory studies today show:Hemoglobin 14.6 g/dLPlatelet count 300,000/mm3Leukocyte count 11,000/mm3SerumSodium 138 mEq/LPotassium 3.2 mEq/LCreatinine 1.9 mg/dLBlood glucose 91 mg/dLCalcium 9.1 mg/dLMagnesium 1.3 mEq/LUrineProtein traceLeukocyte esterase negativeBacteria noneWBC 2-5/hpfRBC 0-3/hpfCasts noneWhich of the following is the most likely diagnosis?A. Diabetes insipidusB. Diabetic nephropathyC. Obstructive uropathyD. Rapidly progressive glomerulonephritisE. Renal artery stenosisF. Renal cell carcinoma

A 54-year-old man is brought to the emergency department after his family found him on the floor and unresponsive at home.  The patient has a history of hypertension but is not adherent with medical treatment.  He smokes cigarettes and uses cocaine.  Temperature is 36.6 C (97.9 F), blood pressure is 176/98 mm Hg, pulse is 58/min, and respirations are 12/min and irregular.  The patient is unresponsive to deep sternal rub.  The right pupil is widely dilated and unresponsive to light.  There is intermittent extended posturing of the left arm and leg.  Deep tendon reflexes are 4+ in the left extremities, and Babinski sign is present on the left side.  Which of the following is the most likely cause of this patient's current condition? A.Basal ganglia hemorrhage B.Cerebellar hemorrhage C.Medullary ischemic infarction D.Midbrain ischemic infarction E.Occipital cortex ischemic infarctionProceed To Next Item

A 68-year-old male presented to the primary care physician for his annual visit. His past medical history was significant for mildly elevated blood pressure during the prior annual visit. He was in good health, otherwise. He was advised to reduce salt intake and increase physical activity during that visit. On physical examination, his blood pressure is 178/72 mm Hg, with no clinically significant differences between arms or on standing. He has a body mass index of 28.4 kg/m2 (normal: 18-25 kg/m2). The examination is otherwise unremarkable. Urinalysis is normal. The nonfasting blood glucose level is 95 mg/dL (normal: 80-100 mg/dL), serum potassium is 4.2 mEq/L (normal: 3.5-5 mEq/L), and creatinine is 1.2 mg/dL (normal: 0.7-1.4 mg/dL). Which of the following high blood pressure-related conditions would he most likely have?

complaining of excessive urination and constant hunger and thirst. She has no other complaints and no past medical history. Her family history is significant for hypertension, type 2 diabetes mellitus, and hyperlipidemia. She does not smoke but lives a sedentary lifestyle. On examination, she is afebrile with a blood pressure of 134/88 mmHg, heart rate of 84 beats per minute, and respiratory rate of 14 breaths per minute. The rest of her examination is normal. The patient is scheduled for a return visit to have fasting laboratory tests drawn. At her return visit, her blood pressure is 138/86 mmHg. Her fasting glucose is 156 mg/dL, and urine albumin-to-creatinine ratio is 200 mg/g. What is the next step in management for this patient?

An 83-year-old man is transferred to the hospital from his nursing home due to hypotension and confusion. He was previously well until yesterday morning, when the nursing staff observed that he seemed lethargic and spent the day in bed. Later that night, the staff tried to communicate with him but he was not oriented to place or time. His medical history is significant for hypertension, COPD, paroxysmal atrial fibrillation, and urinary incontinence requiring a urethral catheter. He is compliant with medications, has no recent medication changes, and has no sick contacts. On examination, his temperature is 35.4°C, his blood pressure is 68/44 mmHg, his heart rate is 88 beats per minute, and his respiratory rate is 18 breaths per minute. He is lethargic with flat neck veins; his cardiac examination is normal. His lungs are clear to auscultation, and there is no significant abdominal tenderness. His neurologic examination is normal, and his extremities are warm and well perfused. His laboratory values are significant for a leukocyte count of 13,500/mm3 and a serum lactate of 3.9 mmol/L (normal range 0.6 to 2.3 mmol/L). A urinalysis shows significant pyuria. A chest x-ray shows hyperinflated lungs but no focal opacities. Which of the following is the most appropriate next step in management?

A 45-year-old man comes to the emergency department due to a 1-day history of constant upper abdominal pain, nausea, and several episodes of vomiting.  The pain is partially relieved by sitting up or bending forward.  He has also had mild shortness of breath.  The patient's other medical history includes hyperlipidemia and hypertension.  He uses tobacco and alcohol.  There is a family history of coronary artery disease and hypertension.  Temperature is 38.1 C (100.6 F), blood pressure is 110/70 mm Hg, pulse is 114/min, and respirations are 22/min.  There is dullness to percussion and decreased breath sounds at the left lung base.  Abdominal examination shows epigastric tenderness.  Laboratory results are as follows:Hematocrit 44%Leukocytes 16,000/mm3Calcium 7.8 mg/dLGlucose 250 mg/dLWhich of the following plays a principal role in initial management of this patient's current condition? A.Antiplatelet agents B.Broad-spectrum antibiotics C.Calcium gluconate D.Exploratory laparotomy E.Insulin infusion F.Isotonic crystalloids G.Proton pump inhibitors