In this episode we dissect the following practice question with Dr. Brian Radvansky from MedSchoolTutors.
A 24-year old female with no past medical history presents to her primary care doctor complaining of a fever.
The fever started two days ago, though she was unable to take temperatures at home and has just felt “hot.” Review of systems is positive for fatigue, arthralgia, and decreased urine output in the last day or so.
She recently completed a course of trimethoprim-sulfamethoxazole for an uncomplicated urinary tract infection. Vital signs are temperature 101.3F, heart rate 104 bpm, blood pressure of 114/74, and respiratory rate of 18. Physical exam is significant for a diffuse, non-pruritic maculopapular rash on the torso, but is otherwise normal. Lab studies show the following:
Sodium 141 mEq/L
Potassium 4.4 mEq/L
Chloride 99 mEq/L
Bicarbonate 23 mEq/L
BUN 30 mg/dl
Creatinine 2.1 mg/dl
Glucose 102 mg/dl
Urinalysis shows pyuria w/many eosinophils and no bacteria. What is the most likely etiology of this patient’s chemistry abnormalities?
A. Decreased renal perfusion secondary to dehydration
B. Post-obstructive nephropathy
C. Granulomatosis with polyangiitis (Wegener’s disease)
D. Sloughing of tubular epithelium into the tubule
E. Allergic immune response in the renal interstitium
You can read the full blog post, “A Young Woman with Fever and Oliguria” on the MedSchoolTutors blog.
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Music: “Anaesthetist” off The Mindsweep by Enter Shikari (used with permission).