1. A 65-year-old man with a history of hypertension,

diabetes, and chronic kidney disease presents to the clinic

with fatigue, dyspnea, and edema. His blood pressure is

180/100 mmHg, his blood glucose is 250 mg/dL, and his

serum creatinine is 3.5 mg/dL. What is the most

appropriate initial management for this patient?

A) Start intravenous furosemide and insulin

B) Refer to nephrology for dialysis evaluation

C) Adjust his antihypertensive and antidiabetic medications

D) Order an echocardiogram and a chest x-ray

Answer: C) Adjust his antihypertensive and antidiabetic

medications

Rationale: This patient has poorly controlled hypertension

and diabetes, which are the main risk factors for chronic

kidney disease. The first step in managing his condition is

to optimize his blood pressure and blood glucose levels,

which may improve his symptoms and slow down the

progression of kidney damage. Intravenous furosemide and

insulin may be indicated in cases of acute decompensated

heart failure or diabetic ketoacidosis, respectively, but there

is no evidence of these conditions in this patient. Referral

to nephrology for dialysis evaluation may be necessary in

the future, but it is not the first priority at this stage. An

echocardiogram and a chest x-ray may help to assess the

cardiac function and rule out pulmonary causes of dyspnea,

but they are not essential for the initial management.