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USMLE (United States Medical Licensing Examination) Practice Exam 22

Practice exam for USMLE (United States Medical Licensing Examination).

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Question 1 of 1000%
Time remaining120:00
Attempts allowedUnlimited
Difficulty mixE • M • H
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Question 1

MEDIUM

A 27-year-old woman comes to the clinic because of swelling around her eyes and frothy urine for 2 weeks. She has no history of diabetes mellitus. Blood pressure is 132/84 mm Hg. Physical examination shows periorbital edema and 1+ pitting edema of the ankles. Laboratory studies show: serum albumin 2.1 g/dL, total cholesterol 280 mg/dL, and urinalysis with 4+ protein and no hematuria. Which of the following changes at the level of the glomerular filtration barrier most likely explains this patient's findings?

Nephrotic syndrome with heavy proteinuria and hypoalbuminemia is commonly due to increased permeability to albumin from loss of the negatively charged GBM/podocyte slit diaphragm integrity. Bowman's capsule injury is not the typical mechanism of isolated proteinuria, and tubular necrosis causes muddy brown casts and AKI rather than nephrotic-range protein loss.

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