A 72-year-old man comes to the office for follow-up 2 weeks after starting lisinopril because of headache and increased blood pressure. He has a history of coronary artery disease, hypertension, peripheral artery disease, and hyperlipidemia. In addition to lisinopril, he takes amlodipine, metoprolol, atorvastatin, and low-dose aspirin. He quit smoking 5 months ago; he previously smoked 1 pack of cigarettes daily for the past 40 years. BMI is 25 kg/m2. His pulse is 84/min and regular, and blood pressure is 165/94 mm Hg. Lower extremity pulses are 2+ on the left and 1+ on the right. There is no peripheral edema. Cardiopulmonary auscultation discloses clear breath sounds bilaterally and no murmurs or gallops. The abdomen is nontender to palpation with no distention. Laboratory studies from today and 2 weeks ago are shown:  Today 2 Weeks AgoSodium (mEq/L) 137 142Potassium (mEq/L) 3.9 3.1Chloride (mEq/L) 101 98Bicarbonate (mEq/L) 25 30Creatinine (mg/dL) 2.1 1.4Glucose (mg/dL) 95 82Which of the following studies is most likely to confirm the underlying cause of these symptoms?A. Dexamethasone suppression testB. Kidney biopsyC. Measurement of plasma and urine metanephrine concentrationsD. Measurement of serum aldosterone concentrationE. Renal Doppler ultrasonographyF. Urinalysis

A 30-year-old man comes to the office for follow-up of hypertension. Two weeks ago, his blood pressure was 160/95 mm Hg when taken at a community health fair. He denies chest pain and headache but has experienced some muscle pain and weakness. He has no significant medical history and does not take any medications. Family history is remarkable for coronary artery disease and hypertension. He does not smoke cigarettes or use illicit drugs. He drinks approximately 2-3 alcoholic beverages monthly. Today, his pulse is 84/min and blood pressure is 152/90 mm Hg. BMI is 24 kg/m2. His mucous membranes are moist. Cardiopulmonary examination is normal. There is no papilledema. Laboratory results show:Serum   Na+ 141 mEq/L   K+ 2.6 mEq/L   Ca2+ 9.3 mg/dLGlucose 82 mg/dLCreatinine 0.9 mg/dLThyroid-stimulating hormone 2.0 μU/mLWhich of the following is the most appropriate next step in the evaluation of this patient?

A 53-year-old man comes to the emergency department because of a 3-day history of intermittent left flank pain and generalized weakness. He also has had decreased urination with some episodes of high urine output. He has a history of hypertension and type 2 diabetes and has taken lisinopril and glyburide for the past 5 years. Ten years ago, he donated a kidney to his brother and underwent right total nephrectomy. The patient does not smoke cigarettes, drink alcohol, or use illicit drugs. BMI is 28 kg/m2. His temperature is 37.3°C (99.3°F), pulse is 91/min and regular, and blood pressure is 131/80 mm Hg. Abdominal examination discloses left-sided flank pain. No abdominal or pelvic masses are palpated. One month ago, serum creatinine concentration was 1.2 mg/dL. Laboratory studies today show:Hemoglobin 14.6 g/dLPlatelet count 300,000/mm3Leukocyte count 11,000/mm3SerumSodium 138 mEq/LPotassium 3.2 mEq/LCreatinine 1.9 mg/dLBlood glucose 91 mg/dLCalcium 9.1 mg/dLMagnesium 1.3 mEq/LUrineProtein traceLeukocyte esterase negativeBacteria noneWBC 2-5/hpfRBC 0-3/hpfCasts noneWhich of the following is the most likely diagnosis?A. Diabetes insipidusB. Diabetic nephropathyC. Obstructive uropathyD. Rapidly progressive glomerulonephritisE. Renal artery stenosisF. Renal cell carcinoma

A 45-year-old female is brought to the ED complaining of fatigue. The patient has been feeling extremely weak over the past few days. Today she stood up and almost fainted, prompting her visit. She has had cough, rhinorrhea, and nasal congestion for the past week. Today she also began having nausea, vomiting, and severe abdominal pain. Past medical history is significant for hypertension, CKD, and SLE. Home medications are lisinopril, hydroxychloroquine, and prednisone 20 mg daily. Vitals: Temperature 38.5°C, BP 85/55 mm Hg, HR 126. In general, she appears weak and lethargic. Her heart sounds are tachycardic, regular, without murmurs. Her lungs have occasional rhonchi but no wheezing. Her abdomen is diffusely tender throughout without rebound tenderness. Labs: Na 124 mEq/L, K 5.3 mEq/L, Cr 3.0 mg/dL (baseline 1.8). Hgb is 11.1 g/dL. The patient is diagnosed with Influenza A and started on IV fluids. After 2 L of crystalloid fluids her blood pressure is 90/60 mm Hg. What is the most appropriate next step?Ask StudybuddyGroup of answer choicesMRI pituitaryCT adrenal glandsCortisol levelCosyntropin stimulation testIV hydrocortisone

The nurse is assessing a group of clients prescribed lithium. The client at most significant risk for lithium toxicity is a client withA. asthma taking both long- and short-acting bronchodilators.B. chronic migraine headaches and was newly prescribed naproxen.C. hypertension newly prescribed clonidine transdermal patch.D. hypothyroidism and was recently prescribed levothyroxine.

complaining of excessive urination and constant hunger and thirst. She has no other complaints and no past medical history. Her family history is significant for hypertension, type 2 diabetes mellitus, and hyperlipidemia. She does not smoke but lives a sedentary lifestyle. On examination, she is afebrile with a blood pressure of 134/88 mmHg, heart rate of 84 beats per minute, and respiratory rate of 14 breaths per minute. The rest of her examination is normal. The patient is scheduled for a return visit to have fasting laboratory tests drawn. At her return visit, her blood pressure is 138/86 mmHg. Her fasting glucose is 156 mg/dL, and urine albumin-to-creatinine ratio is 200 mg/g. What is the next step in management for this patient?