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NBME F1B1Q30- 72 yo man with increase Urin freq - maritzasf
#1
30. A 72-year-old man comes to the physician because of a 2-month history of urination twice nightly and occasional urinary frequency and urgency. He has a 15-year history of type 2 diabetes mellitus now moderately well controlled with glyburide. His father was diagnosed with prostate cancer at the age of 70 years, and his sister died of complications from systemic lupus erythematosus. His blood pressure is 135/86 mm Hg. Cardiopulmonary examination shows no abnormalities. Abdominal examination shows no suprapubic fullness or tenderness. There is mild enlargement of the prostate with no palpable nodules. His postvoid residual volume is 10 mL. Serum studies show a urea nitrogen (BUN) level of 45 mg/dL and creatinine level of 3.8 mg/dL. Urine dipstick shows 3+ protein. Which of the following is most likely to have prevented progression of this patient's renal disease?

A) Intermittent Foley catheterization

B) Intravenous mannitol therapy

C) Oral cyclophosphamide and prednisone therapy

D) Oral enalapril therapy

E) Oral finasteride therapy

F) Oral prednisone therapy only

G) Oral terazosin therapy
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#2
A,B,C are all incorrect increase cr is due to diabete not BPH and choice c usually use for renal transplant or lupus nephritis which is not the case here
f in correct between d e g terazocin alpha 1 blocker use for htn finasterade 5 alpha reductase inhib use in BPH enala is an ace inhib is good for all diabetic pt but the thing is in higher cr you can not use it so due i will go for D but it is not completely correct
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#3
yes drpred,

The question says:
"Which of the following is most likely to have prevented progression of this patient's renal disease?"

From all the listed options, ACEI are the only one demonstrated to somehow slow the development of diabetic nephropathy.

Improved glycemic control and more effective therapeutic measures to correct hypertension—and with the beneficial effects of ACE inhibitors—can reduce the development of end-stage chronic kidney disease among diabetics. Diabetic nephropathy is initially manifested by proteinuria; subsequently, as kidney function declines, urea and creatinine accumulate in the blood.

[CURRENT Medical Diagnosis and Treatment 2012, Fifty-First Edition]
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#4
can anybody pls send me all the NBME forms, skype id is onlyforusmle.
thanx in advance
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#5
plz anyone
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