A 66-year-old man with a 15-year history of type 2 diabetes mellitus presents to his primary care physician for a routine evaluation. On that visit, his serum creatinine concentration is 2.2 mg/dL, which is elevated from his baseline concentration of 1.3 mg/dL determined 3 years prior. His physician prescribes an angiotensin-converting enzyme (ACE) inhibitor. However, at the follow-up visit, there is no improvement in his creatinine level or urinalysis results. In between visits, he is hospitalized for a mild acute asthma exacerbation and has an arterial blood gas determined, which shows an arterial blood pH of 7.33 and PCO2 of 40 mm Hg.
Other selected laboratory test results are:
Potassium: 5.5 mEq/L
Urine pH: 5.2
Sodium: 140 mEq/L
Bicarbonate: 18 mEq/L
Chloride: 110 mEq/L
Which of the following is the most likely diagnosis?
A. Acute kidney injury
B. Hyperreninemic hyperaldosteronism
C. Type I renal tubular acidosis
D. Type II renal tubular acidosis
E. Type IV renal tubular acidosis
- “Easy to use platform, wide variety of questions with similar difficulty to nbme.” E.C., Vanderbilt University School of Medicine
- “Helps me score really well in NBMEs and my school blocks. My scores went up by 20% just by using Rx.”
- “I think USMLE-Rx is a great way to prepare for step/NBME exam, providing high yield and challenging questions. As well as videos and resources to aid in the learning process.” B.V., Eastern Virginia Medical School
- “USMLE Rx helped me greatly in studying for the Comprehensive Basic Science Exam. My NBME scores went up over 15 points (on the USMLE predicted score) from going through the USMLE-Rx question bank and videos. I am so thankful.” K.S.
- “These questions have helped to prepare me for my med school NBMEs as well as with Step 1 preparation.” A.P., Indiana University School of Medicine
- “The question bank is difficult but highly correlated to material seen on NBME examinations.” K.B., Ross University School of Medicine
- “Very helpful for exams, especially since our school uses NBME exams throughout the first two years. Also beneficial for step 1 prep and review and helps me utilize First Aid effectively.” J.B.
- “I already recommend Rx and the physical FA textbook to all of my classmates and the people in the year below me. The QMax tests represent NBME exams in my courses really well and I feel prepared for my exams after doing these as practice exams.” J.A., Florida International University Medical School
- “Excellent resource—practice questions are great, study materials and videos are good. Integration of first aid and flash facts and questions based on video sections watched is incredible. Extremely helpful for NBME exams and prep.” R.H.
- “Using this resource was essential in facilitating and solidifying my understanding prior to NBME exams during my didactic curriculum, as well as in preparation for Step 1….These videos and the question banks comprised over 95% of my studying during the didactics phase of my curriculum.” J.N., Oregon Health and Science University Medical School