06-05-2009, 11:46 PM
A 29-year-old woman, who has been undergoing treatment for hypertension for the past 2 years, comes to the office because of chills and right-sided flank pain. She has had chronic "low back pain" that you have been treating unsuccessfully with nonsteroidal anti-inflammatory drugs. She has never had any diagnostic studies performed to evaluate her hypertension or back pain. She is estranged from her family, but she knows that her mother and brother have been treated for hypertension starting at age 25. She has not spoken to them in 10 years and so she is unaware of any other medical conditions. Her temperature is 38.1 C (100.6 F), blood pressure is 130/90 mm Hg, and pulse is 65/min. On physical examination today there is marked right-sided flank tenderness. Cardiac examination reveals a mid-systolic click. Urinalysis shows pyuria and white blood cell casts. You prescribe a 14-day course of trimethoprim-sulfamethoxazole, schedule a renal ultrasound and a follow-up visit. You tell her to call your office immediately if the symptoms worsen. On the return visit, she says that she feels much better, but still has dull flank pain. Her temperature is 37.0 C (98.6 F). The ultrasound report is in the chart and states that there are 7 cysts in her right kidney and 5 cysts in her left kidney. At this time the most correct statement about her condition is:
A. Her hypertension is unrelated to the kidney disease
B. Long-term treatment with trimethoprim-sulfamethoxazole will eradicate the cysts
C. She has a 20% chance of developing end-stage renal disease by age 70
D. She is at an increased risk for developing colonic diverticular disease with perforation
E. There is a 70% chance that she has an intracranial aneurysm and will suffer from a subarachnoid hemorrhage
A. Her hypertension is unrelated to the kidney disease
B. Long-term treatment with trimethoprim-sulfamethoxazole will eradicate the cysts
C. She has a 20% chance of developing end-stage renal disease by age 70
D. She is at an increased risk for developing colonic diverticular disease with perforation
E. There is a 70% chance that she has an intracranial aneurysm and will suffer from a subarachnoid hemorrhage