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  #1  
Old 10-29-2012
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Arrow Billy Step 1 Questions # 53

A 25-year-old woman experiences sudden onset of fever, malaise, and nausea. On physical examination, her
temperature is 38.2°C, pulse is 85/min, respirations are 18/min, and blood pressure is 140/90 mm Hg. A routine urinalysis
shows 1+ proteinuria, 4+ hematuria, and no ketones or glucose. RBC casts are seen on microscopic examination of the
urine. A renal biopsy is performed, and light microscopic examination shows marked glomerular hypercellularity with
neutrophils in glomerular capillary loops. Immunofluorescence microscopy shows granular deposition of IgG and C3 in
glomerular capillary basement membranes. Electron microscopy shows electron-dense subepithelial “humps.” What is the
most likely diagnosis?


□ (A) Goodpasture syndrome
□ (B) Systemic amyloidosis
□ (C) Membranous glomerulonephritis
□ (D) Diabetes mellitus
□ (E) Postinfectious glomerulonephritis
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  #2  
Old 10-29-2012
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Default EE

E) postinfectious GN
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Old 10-29-2012
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(E) Postinfectious glomerulonephritis
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Old 10-29-2012
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Quote:
Originally Posted by billy View Post
A 25-year-old woman experiences sudden onset of fever, malaise, and nausea. On physical examination, her
temperature is 38.2°C, pulse is 85/min, respirations are 18/min, and blood pressure is 140/90 mm Hg. A routine urinalysis
shows 1+ proteinuria, 4+ hematuria, and no ketones or glucose. RBC casts are seen on microscopic examination of the
urine. A renal biopsy is performed, and light microscopic examination shows marked glomerular hypercellularity with
neutrophils
in glomerular capillary loops. Immunofluorescence microscopy shows granular deposition of IgG and C3 in
glomerular capillary basement membranes. Electron microscopy shows electron-dense subepithelial “humps.” What is the
most likely diagnosis?


□ (A) Goodpasture syndrome
□ (B) Systemic amyloidosis
□ (C) Membranous glomerulonephritis
□ (D) Diabetes mellitus
(E) Postinfectious glomerulonephritis
Obviously it is EEEE
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  #5  
Old 10-29-2012
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subepithelial “humps.” >>>>post streptococcal glomerulonephritis
-RBC casts
-hematurea+mild proteinurea+HTN
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subepithelial Humps' so going with Option 'E
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  #7  
Old 10-29-2012
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Correct Answer E is correct

Postinfectious glomerulonephritis is one of many causes of a nephritic syndrome characterized by hematuria and
RBC casts. Most children recover completely, but one in six adults may progress to chronic renal failure. Some cases may
occur after a streptococcal pharyngitis (poststreptococcal glomerulonephritis). In other cases, such as this one, the
preceding infection is so mild that patients give no history. Goodpasture syndrome also may produce a nephritic
syndrome, but there is linear deposition of antibody in the glomerular basement membrane. Amyloidosis of the kidney
mainly produces proteinuria without hematuria, as does membranous glomerulonephritis. Nodular and diffuse
glomerulosclerosis are characteristic of diabetic nephropathy.
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