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 Best of Five 2.221

 

   

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BOF: 2.221

A 63 year old male presents with sudden onset breathlessness. He is a known diabetic well controlled on oral hypoglycaemic agents.

On examination he is noted to be breathless, orthopnoeic, sweating. He has a pulse rate of 120 beats per minute, his BP is 170/100, his JVP is raised, heart sounds are normal with a soft systolic murmur at the apex; on auscultation of his lungs bilateral basal crepitations are heard.

The patient is treated with intravenous furosemide and makes a speedy recovery.

Two days later the patient is changed over to oral furosemide and started on an ACE inhibitor.

Investigations

On admission

Urea 8.6 mmol/L

Creatinine 132 Ámol/L

Sodium 136 mmol/L

Potassium 3.8 mmol/L

One week after admission

Urea 16 mmol/L

Creatinine 240 Ámol/L

Sodium 138 mmol/L

Potassium 4.8 mmol/L

In this patient which one of the following physical signs would point you to the cause of the deteriorating renal function?

a)      Abdominal bruit

b)      Absent left radial pulse

c)      Delayed femoral pulse

d)     Distended bladder

e)      Absent peripheral pulses

 

 

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