MKSAP 19 "Quiz Me!" Question

Test your medical knowledge each month with questions from The Medical Knowledge Self-Assessment Program® (MKSAP).

MKSAP 19MKSAP has been trusted by internists since 1967 as the best resource for updating knowledge. MKSAP 19, available in Complete, Digital, and Print packages, consists of 11 comprehensive text chapters with related multiple-choice questions. You'll find 1,200 completely new questions to help you identify learning gaps, stay current, and gain the knowledge you need to provide the best possible patient care. MKSAP 19's original and high-quality questions evolve out of case studies and patient scenarios based on the latest evidence.

For more information on MKSAP 19, or to order your copy, visit

MKSAP 19 Q & A

A 57-year-old man is evaluated during a follow-up visit after beginning hydrochlorothiazide 1 month ago. He has hypertension and chronic kidney disease. He has no other medical problems. Medications are lisinopril, 40 mg once daily; amlodipine, 10 mg once daily; and hydrochlorothiazide, 25 mg once daily. The patient maintains a low sodium diet.

On physical examination, blood pressure is 138/86 mm Hg; other vital signs are normal. There is 1+ pitting pretibial edema bilaterally. The remainder of the examination is normal.

Laboratory studies:


22 mEq/L (22 mmol/L)


2.5 mg/dL (221 µmol/L)


5.4 mEq/L (5.4 mmol/L)


135 mEq/L (135 mmol/L)

Estimated glomerular filtration rate 

28 mL/min/1.73 m2

Urine protein-creatinine ratio 

1800 mg/g

Which of the following is the most appropriate treatment?

A: Discontinue hydrochlorothiazide; begin eplerenone
B: Discontinue hydrochlorothiazide; begin furosemide
C: Increase hydrochlorothiazide dose
D: Continue current management

Answer and Critique

Back to the April 2023 issue of ACP IMpact