L********a
发帖数: 576 | 1 A 42 year old man is admitted to the local hospital with a diagnosis of deep
vein thrombosis. On physical exam, he has bilateral pitting edema of the
lower extremities. On standard chemistry testing, his albumin is 2.5g/dl.
During further interview, the patient states that this past year he noticed
he had more "cold" than usual. A 24 hour urinalysis shows 4 g of protein
with no hematuria or red blood cells. If a renal biopsy is performed, which
of the following findings would be expected?
A) Normal glomeruli with fused epithelial foot processes
B) Tubular necrosis
C) Crescents in the glomeruli
D) Mesangial cell proliferation
E) Antibody deposition in the basement membrane |
n***h
发帖数: 364 | 2 My answer is D.
该患者诊断： Nephrotic syndrome 。 依据：1） proteinuria 2）no hematuria.
另外容易形成静脉血栓（DVT）. PT has more cold is related to low albumin.
So B can be excluded first.
C(RPGN) and D(GOOD pasture) belong to Nephritic syndrome, should have
hematuria, so could be excluded ,too.
Answer A is Minimal Change Disease, a disease of nephrotic syndrome ,
but
usually affects children (peak incidence at 2–3 years of age).
So my answer is D(Membranoproliferative glomerulonephritis). |
L********a
发帖数: 576 | 3 The answer in Kaplan is A. I don't know why. But IgA nephritis should be hematuria only, this patient also have proteinuria. |
n***h
发帖数: 364 | 4 我还是认为A项选择是指：Minimal Change Disease。 但为什么选A?
Minimal Change Disease usually affects children,但这个患者都42了。 |
R****0
发帖数: 138 | 5 A is right, Minimal change disease, mainly loss albumin, not globulins,
patient had just "cold", no obvious infections. It can also occur in adults
but accounts for less than 20% of adults diagnosed with nephrotic syndrome. |
n***h
发帖数: 364 | 6 我觉得这就是kaplan和uw的差距。
minimal change disease 80% 发生在儿童青少年，但此题干却给了一个42岁的患者，
出题者是想拿这个做干扰你的判断么？ 有些低级。
做过uw的，你可能发现很多关于SLE的题，This disease occurs nine times more
often in women than in men, especially in women in child-bearing years ages
15 to 35,也就是说男性也有。但是没见哪道关于SLE的题干给出一个男性患者。 |
z****o
发帖数: 368 | 7 我还是不知道怎么选到a的，难道说因为没有更严重的感染，就不是globulin低，就应
该是minimal
change disease?我是不是漏掉了什么帮助解题的点？
我觉得A和D就症状不能区分，都是nephrotic sybdrome, 唯一的区分就只有流行病学了
。我同意
nerth.
adults
【在 R****0 的大作中提到】
: A is right, Minimal change disease, mainly loss albumin, not globulins,
: patient had just "cold", no obvious infections. It can also occur in adults
: but accounts for less than 20% of adults diagnosed with nephrotic syndrome.
|
c*******s
发帖数: 399 | 8 mesangial proliferation cause nephritic syndrome, the patient presents with
nephrotic sydrome
【在 z****o 的大作中提到】
: 我还是不知道怎么选到a的，难道说因为没有更严重的感染，就不是globulin低，就应
: 该是minimal
: change disease?我是不是漏掉了什么帮助解题的点？
: 我觉得A和D就症状不能区分，都是nephrotic sybdrome, 唯一的区分就只有流行病学了
: 。我同意
: nerth.
:
: adults
|
c*******s
发帖数: 399 | 9 mesangial proliferative (canuse more nephritic syndrom)
.
【在 n***h 的大作中提到】
: My answer is D.
: 该患者诊断： Nephrotic syndrome 。 依据：1） proteinuria 2）no hematuria.
: 另外容易形成静脉血栓（DVT）. PT has more cold is related to low albumin.
: So B can be excluded first.
: C(RPGN) and D(GOOD pasture) belong to Nephritic syndrome, should have
: hematuria, so could be excluded ,too.
: Answer A is Minimal Change Disease, a disease of nephrotic syndrome ,
: but
: usually affects children (peak incidence at 2–3 years of age).
: So my answer is D(Membranoproliferative glomerulonephritis).
|
n***h
发帖数: 364 | 10 Yes, you are right, D is mesangial proliferative,not
membranoproliferative glomerulonephritis.
【在 c*******s 的大作中提到】
: mesangial proliferative (canuse more nephritic syndrom)
:
: .
|
g*******n
发帖数: 319 | 11 答案是A,感觉这题有4个提示:
1.DVT:暗示病人有服用aspirin史； NSAID is one of the secondary causes of
Minimal change disease;
2.proteinuria: nephrotic syndrom;
3.low albumin: MCD is characterized with selectively loss of albumin
4.preceded by respiratory infection |
c*******s
发帖数: 399 | 12 dvt 不是说暗示aspirin 史（ 这个就太隐晦了）， 而是nephrotic syndrome
本身容易有DVT的倾向
nerth 说的是正确的
【在 g*******n 的大作中提到】
: 答案是A,感觉这题有4个提示:
: 1.DVT:暗示病人有服用aspirin史； NSAID is one of the secondary causes of
: Minimal change disease;
: 2.proteinuria: nephrotic syndrom;
: 3.low albumin: MCD is characterized with selectively loss of albumin
: 4.preceded by respiratory infection
|
S******9
发帖数: 2837 | 13 A is the correct answer
微小病变以蛋白尿为主，一般不伴有血尿，且高脂血症，临床很常见深部静脉血栓；上
感诱发临床症状加重。
其他几个都会出现肉眼或镜下血尿 |
l********y
发帖数: 2295 | 14 我今天也做到这个题目了。
觉得病人应该是membranuous glomerulonephritis的可能性大。 |
