USMLE Forum Archives - USMLE Step 3 - which one
which one
bingousmle - 07-15-10 01:31
A 60-year-old man comes to your clinic for follow-up. He has no new complaints. He has a history of hypothyroidism and mild asthma. His medications include levothyroxine and albuterol. The patient has been smoking two packs of cigarettes a day for 30 years. His physical examination is unremarkable. Results of laboratory studies are as follows: sodium concentration, 126 mEq/L; potassium concentration, 3.8 mEq/L; chloride concentration, 96 mEq/L; bicarbonate level, 24 mEq/L; blood urea nitrogen (BUN), 6 mg/dl; glucose and creatinine levels, normal; serum osmolality, 258 mOsm/L; urinary sodium, 56 mEq/L; urinary osmolality, 360 mOsm/kg. Thyroid function tests are within normal limits. Which of the following interventions is most likely to normalize this patient's sodium level?
A. Increasing the dose of levothyroxine
B. Restricting fluid intake
C. Administering intravenous normal saline
D. Starting a thiazide
e anything
bingousmle - 07-15-10 01:31
A 60-year-old man comes to your clinic for follow-up. He has no new complaints. He has a history of hypothyroidism and mild asthma. His medications include levothyroxine and albuterol. The patient has been smoking two packs of cigarettes a day for 30 years. His physical examination is unremarkable. Results of laboratory studies are as follows: sodium concentration, 126 mEq/L; potassium concentration, 3.8 mEq/L; chloride concentration, 96 mEq/L; bicarbonate level, 24 mEq/L; blood urea nitrogen (BUN), 6 mg/dl; glucose and creatinine levels, normal; serum osmolality, 258 mOsm/L; urinary sodium, 56 mEq/L; urinary osmolality, 360 mOsm/kg. Thyroid function tests are within normal limits. Which of the following interventions is most likely to normalize this patient's sodium level?
A. Increasing the dose of levothyroxine
B. Restricting fluid intake
C. Administering intravenous normal saline
D. Starting a thiazide
e anything
The correct answer and explanation will be available after you answer.
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#3
Re: which one babbu5508 - 07-16-10 00:14 My answer is: b.
i'm not sure about the answer...but by exclusion i felt it to be restriction of fluid intake...hope its right..
#6
Re: which one
bingousmle - 07-17-10 02:05 My answer is: b.
hyponatremia is with a concentrated urine and increased urine osmolality which are indicative of SIADH.. given the smoking history it is likely.. as a result of some lung malignancy
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