WBR0375
| Author | [[PageAuthor::Rim Halaby, M.D. [1], Alison Leibowitz [2] (Reviewed by Alison Leibowitz)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathology |
| Sub Category | SubCategory::Renal |
| Prompt | [[Prompt::A 68-year-old Caucasian male, with a significant history of alcoholism, presents to the ER with an altered mental status and is unable to provide further history. Upon physical examination you observe fetor hepaticus, spider nevi, gynecomastia, and that his stomach is severely distended with shifting dullness. Following appropriate work-up, you diagnose him with hepatic cirrhosis and closely follow the standard treatment for his condition. Upon discharge, you prescribe the patient with spironolactone, for moderate ascites. The patient should be monitored for which of the following electrocardiogram (ECG) finding after initiation of spironolactone?]] |
| Answer A | AnswerA::Two independent rhythms of P and QRS complexes |
| Answer A Explanation | AnswerAExp::Third degree AV block is not commonly associated with spironolactone therapy. AV blockade is commonly seen in patients receiving beta blockers and calcium channel blockers. |
| Answer B | AnswerB::“Saw tooth” appearance |
| Answer B Explanation | AnswerBExp::“Saw tooth” appearance is the characteristic description of atrial flutter. Spironolactone is not commonly associated with atrial flutter. |
| Answer C | AnswerC::Peaked T waves |
| Answer C Explanation | AnswerCExp::Peaked T waves on ECG is characteristic of hyperkalemia, a common side effect of spironolactone therapy. |
| Answer D | AnswerD::ST-segment elevation in leads I and aVL |
| Answer D Explanation | AnswerDExp::ST-segment elevation is seen in myocardial infarction |
| Answer E | AnswerE::Prolonged PR interval |
| Answer E Explanation | AnswerEExp::Prolonged PR interval is characteristic of first degree AV block. Spironolactone does not commonly cause first degree AV blockade. |
| Right Answer | RightAnswer::C |
| Explanation | [[Explanation::Spironolactone, a competitive aldosterone receptor antagonist, is an effective treatment for patients with severe heart failure and ascites due to hepatic failure. Following initiation of spironolactone therapy, serum potassium concentrations should be periodically measured, monitoring for hyperkalemia, a common adverse reaction. Hyperkalemia is a potential side effect of spironolactone therapy, resulting from the inhibition of aldosterone’s physiologic activity, the excretion of potassium (often, spironolactone is described as a “potassium-sparing” diuretic). A typical ECG finding in patients with hyperkalemia is peaked T waves. Educational Objective: Spironolactone, a competitive aldosterone receptor antagonist, is an effective treatment for patients with hepatic failure and ascites. Hyperkalemia is a common side effect of spironolactone therapy, manifesting with peaked T waves on ECG. Biecker E. Diagnosis and therapy of ascites in liver cirrhosis. World J Gastroenterol. 2011;17(10):1237-1248.]] |
| Approved | Approved::Yes |
| Keyword | |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |