27.下列何種臨床情境最不須將雙側尿路阻塞納入鑑別診斷之列？
(A)acute kidney injury accompanied by anuria (B)renal failure with postural hypotension (C)azotemia with metabolic acidosis and hyperkalemia (D)presence of acquired nephrogenic diabetes insipidus
【非選題】 A 28-year-old lady complained of palpitation, fatigue and shortness of breath on climbing
stairs for 6 months. She has been well without major medical problems previously. Review
of history revealed that she started on vegetarian diet for weight reduction without following
a special instruction 3 years ago. Her body weight had in fact not changed and the appetite
remained the same. There had been no abdominal discomfort and the bowel movements
appeared normal. However, she noted heavy menstrual flow in the last 6 months. On
examination, she was pale looking especially over conjunctivae, nail beds and palms. Her
body height was 160 cm, body weight 52 kg, blood pressure 136/70 mmHg, and pulse rate
96/min. A venous hum was audible above the clavicles. A grade 2/6 systolic murmur was
audible along the left parasternal border and a third heart sound was audible at the cardiac
apex. The rest of physical examination was normal. What is your working diagnosis and
how are you going to work up and advise this lady? (20%)
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VIP與詳解卡管理
