Questions of the Week # 15, 16, 17, 18

Q15) A 25 y/o male comes to your office with complaints of dark red colored urine and pain in the legs that started this morning. He has been working out at the local gym excessively for the past three days. He does consume alcohol on weekends but reports having involved in a binge drinking episode that included 10 beers yesterday. On physical examination, he weighs 70kg and he has some tenderness in his calf muscles which he attributes to the excessive squats he performed yesterday. Urine dipstick reveals large blood. If this patient develops acute renal failure , the most likely mechanism would be:

A) Interstitial nephritis due to pigment
B) Glomerulonephritis
C) Acute Tubular necrosis due to pigment deposition
D) Acute Tubular Necrosis due to Ischemia
E) Alcohol related direct toxic injury

q16) Lab studies revealed normal electrolytes and normal creatinine but a CPK of 50,000. His Urine output has been at 70 ml/hr for the past 6 hours. Your first step in the management to prevent development of patient’s Acute Renal Faliure :

A) Intravenos Fluids
B) Furosemide
C) Calcium Gluconate
D) No treatment because serum creatinine is normal
D) Sodium Bicarbonate

q17) The above patient has been adequately treated but his repeat CPK after 2 days is still elevated at 48,000. He complains of increasing pain in his left leg and some tingling and pricking sensations. On examination his left leg was mildly swollen and there was pain on passive stretching of the leg muscles. Dorsalis pedis and posterior tibial pulses are intact. The most likely diagnosis at this time:

A) Deep Vein Thrombosis
B) Cellulitis
C) Compartment Syndrome
D) Edema due to renal failure
E) Congestive Heart Failure

q18) The immediate course of treatment in this condition would be :

A) Anticoagulation with Heparin
B) Antibiotics
C) Emergency Fasciotomy
D) Loop diuretics
E) Elevation of the leg

Copy Rights: Archer USMLE Reviews

13 Responses

  1. 15 C
    16 D
    17 C
    18 C

  2. CACC

  3. C. due to myoglobulin deposition
    A. IV fluids to wash out myoglobulin from tubules
    C. compartment syndrome
    C. Emergency Fasciotomy

  4. C, A, C, C

  5. CACC

  6. cacc

  7. Answers :
    15. C
    16. A
    17. C
    18. C

    Increased CPK and leg pain indicate rhabdomyolysis precipitated by alcohol and heavy exercise. Presence of blood on the Dipstick with out RBC or RBC casts indicate that this is a pigment such as myoglobin. The mechanism of renal failure in rhabdomyolysis is pigment deposition in tubules ( Toxic ATN)

    Though creatinine is normal, rhabdomyolysis can lead to rapid renal failure if not adequately treated. Aggressive IV hydration is helpful in preventing renal failure. There is no role for diuretics or sodium bicarbonate.

    Rhabdomyolysis leads to myoglobin release in to the tissues leading to accumulation of fluid in the comparments. Increased compartment pressure may lead to compartment syndrome and this can be llimb threatening if it is not treated with Emergent Fasciotomy.

  8. CACC-

  9. CACC

  10. long question but short and sweet explanation. 50% correct

  11. # 16 the answer is FLUIDS

    Rabdomyolysis= FLUIDS

    you must get your answer accurATE

  12. i SEE U ANSWERED IT CORRECTLY
    MY MISTAKE

  13. This is a lucky person to be alive .Vigorous exercise and followed by binge drinking is almost fatal…It can cause severe metabolic acidosis before the acute tubular acidosis we are managing him for now

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