BOF: 2.221
A 63 year old male presents with
sudden onset breathlessness. He is a known diabetic well controlled on oral
hypoglycaemic agents.
On examination he is noted to be
breathless, orthopnoeic, sweating. He has a pulse rate of 120 beats per
minute, his BP is 170/100, his JVP is raised, heart sounds are normal with a
soft systolic murmur at the apex; on auscultation of his lungs bilateral basal
crepitations are heard.
The patient is treated with
intravenous furosemide and makes a speedy recovery.
Two days later the patient is changed
over to oral furosemide and started on an ACE inhibitor.
Investigations
On admission
Urea 8.6 mmol/L
Creatinine 132 µmol/L
Sodium 136 mmol/L
Potassium 3.8 mmol/L
One week after admission
Urea 16 mmol/L
Creatinine 240 µmol/L
Sodium 138 mmol/L
Potassium 4.8 mmol/L
In this patient which one of the
following physical signs would point you to the cause of the deteriorating
renal function?
a)
Abdominal bruit
b)
Absent left radial pulse
c)
Delayed femoral pulse
d)
Distended bladder
e)
Absent peripheral pulses
