endocrine
HIV - 01-13-08 20:56

A 47-year-old woman who is visiting from Australia
comes to the
physician because of increasing urine output over the
past month. She has had
no dysuria or hematuria. She has a history of chronic
headaches,
peptic ulcer disease, and urinary tract infections.
An evaluation 18 months
ago for headaches, including CT scan of the head,
showed no
abnormalities; treatment with ibuprofen and phenacetin
was initiated at that time,
and her headaches have been well controlled. Her
temperature is 37.1 C
(98.8 F), blood pressure is 140/82 mm Hg, pulse is
78/min, and
respirations are 14/min. Examination shows no
abnormalities. Laboratory
studies show:


Hematocrit 32%
Mean corpuscular volume 88 µm3
Serum
Glucose 130 mg/dL
Creatinine 1.7 mg/dL
Urine
Protein 2+
WBC 8–10/hpf
RBC none
Bacteria none
Nitrates none

Test of the stool for occult blood is negative. Which
of the following
is the most appropriate next step in management?

A
) Intravenous pyelography

B
) Discontinue current medication

C
) Antibiotic therapy for recurrent urinary tract
infections

D
) Insulin therapy for diabetes mellitus

E
) Upper endoscopy