Audio Qbank – HY USMLE Q #402 – Internal medicine / Surgery

A 45-year-old man comes to the physician because of a 3-week history of swelling of his legs. He has history of IV drug use and has hepatitis B and C. His blood pressure is 170/95. Physical examination shows no abnormalities. Laboratory studies and a blood smear are shown:

Hemoglobin                                                           10 g/dL
Platelets                                                                   200,000/μL
Serum urea nitrogen                                         20 mg/dL
Creatinine                                                               2.2 mg/dL
AST                                                                              60 U/L (NR 5-40)
ALT                                                                               70 U/L (NR 7-56)
Urine blood                                                             2+
Urine protein                                                         3+

Which of the following is the next best step in diagnosis?

Bone marrow aspiration
CT scan of the abdomen
Genetic testing
Liver biopsy
Renal biopsy