09-30-2007, 12:46 PM
A 72-year-old white male diabetic presents with a 2-day history of dyspnea and decreased urine
output. Five days ago coronary angiography revealed the absence of coronary artery obstruction
and an ejection fraction of 40%. There has been no chest discomfort since that procedure. He
underwent abdominoperineal resection for anal cancer 3 years ago.
On examination his blood pressure is 180/92 mm Hg. Chest auscultation reveals basilar crackles.
His abdomen is round and nontender.
Laboratory Findings
Plasma creatinine . . . . . . . . . . . . . 3.3 mg/dL (N 0.6“1.5)
BUN . . . . . . . . . . . . . . . . . . . . . . . 42 mg/dL (N 8“25)
Glucose . . . . . . . . . . . . . . . . . . . . . 184 mg/dL
Potassium . . . . . . . . . . . . . . . . . . . 5.6 mEq/L (N 3.5“5.0)
Sodium . . . . . . . . . . . . . . . . . . . . . 136 mEq/L (N 135“145)
EKG . . . . . . . . . . . . . . . . . . . . . . . sinus rhythm without change
All current abnormal laboratory values were normal 7 days ago. Which one of the following
diagnostic tests would carry the greatest risk for this patient?
A) Intravenous pyelography (IVP)
B) Catheterized urine for residual volume
C) A spiral CT scan
D) Ultrasonography of the kidneys and bladder
E) Fractional excretion of sodium
53.
output. Five days ago coronary angiography revealed the absence of coronary artery obstruction
and an ejection fraction of 40%. There has been no chest discomfort since that procedure. He
underwent abdominoperineal resection for anal cancer 3 years ago.
On examination his blood pressure is 180/92 mm Hg. Chest auscultation reveals basilar crackles.
His abdomen is round and nontender.
Laboratory Findings
Plasma creatinine . . . . . . . . . . . . . 3.3 mg/dL (N 0.6“1.5)
BUN . . . . . . . . . . . . . . . . . . . . . . . 42 mg/dL (N 8“25)
Glucose . . . . . . . . . . . . . . . . . . . . . 184 mg/dL
Potassium . . . . . . . . . . . . . . . . . . . 5.6 mEq/L (N 3.5“5.0)
Sodium . . . . . . . . . . . . . . . . . . . . . 136 mEq/L (N 135“145)
EKG . . . . . . . . . . . . . . . . . . . . . . . sinus rhythm without change
All current abnormal laboratory values were normal 7 days ago. Which one of the following
diagnostic tests would carry the greatest risk for this patient?
A) Intravenous pyelography (IVP)
B) Catheterized urine for residual volume
C) A spiral CT scan
D) Ultrasonography of the kidneys and bladder
E) Fractional excretion of sodium
53.