QBDOTW: A 56-year-old Female Recovering at Hospital
Welcome back to MedSmarter’s USMLE Style Question of the Week. Here’s the breakdown of a high-yield Renal question for those preparing for your USMLE Step 1 or just to gain some knowledge. As always you want to begin with reading the last sentence of the vignette first to get an understanding of what the question is asking for.
Question Break Down of the Week:
A 56-year-old female is recovering at the hospital from suspected bacterial pneumonia. Over several days, she develops a fever, rash, dysuria, and urinary urgency. Urinalysis shows a specific gravity of 1.002 with hematuria and mild proteinuria. Renal biopsy shows partial effacement of the tubulointerstitial structures with pronounced edema and infiltration of the interstitium with polymorphonuclear leukocytes, eosinophils, and lymphocytes with papillary necrosis. What is most likely to have caused this condition?
B) Chronic hypertension
C) Lead ingestion
D) Multiple myeloma
E) Wegener’s granulomatosis
The correct answer choice is A: Given the patient’s fever, rash, loss of urine concentrating ability (low specific gravity of urine), and biopsy findings, this patient most likely has acute interstitial nephritis. Acute interstitial nephritis has a variety of causes, but by far the most common is drugs, which include antibiotics such as β-lactams, sulfonamides, quinolones, and rifampin; anticonvulsant drugs; infection with certain strains of bacteria (Streptococcus, Staphylococcus, Legionella); and viruses (Epstein-Barr virus, cytomegalovirus, HIV).
Did you think the answer was different?
Did you think that the correct answer choice was other than D? You can view this video for a deeper discussion of why B, C, D, and E were not the correct answer choices.
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