EKG in end-stage renal disease! - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 10-18-2011
drnrpatel's Avatar
Guest
 
Steps History: 1+CK+CS
Posts: 441
Threads: 153
Thanked 394 Times in 211 Posts
Reputation: 417
EKG EKG in end-stage renal disease!

A 49-year-old diabetic man with end-stage renal disease comes to clinic complaining of bilateral leg and arm pain. He describes the pain as a diffuse, crampy pain that is constant in nature. He has also been extremely weak, and states he has trouble moving his lower extremities. The patient admits to having skipped his last two dialysis visits, as he has been depressed about “needing to be hooked up to a machine.” Vital signs are: temperature 36.7 C (98 F), blood pressure 168/108 mm Hg, pulse 98/min, respirations 20/min. Physical examination shows periorbital edema and 3+ pitting edema of the lower extremities. Neurologic examination reveals diffuse muscle weakness with 4 out of 5 upper extremity strength and 3 out of 5 lower extremity strength. Which of the following electrocardiogram findings is consistent with this patient’s most likely electrolyte disturbance?

A. Diffuse ST elevation, diffuse PR segment depressions
B. Flattened T waves, prominent U waves
C. Large S wave in lead I, Q wave in lead III, and an inverted T wave in lead III
D. Peaked T waves, wide QRS complexes, and loss of the P wave
E. Short QT interval
Reply With Quote Quick reply to this message



  #2  
Old 10-18-2011
USMLE Forums Addict
 
Steps History: Not yet
Posts: 192
Threads: 0
Thanked 47 Times in 40 Posts
Reputation: 57
Default

i m with e

renal osteodystrophy?
Reply With Quote Quick reply to this message
  #3  
Old 10-19-2011
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 85
Threads: 9
Thanked 74 Times in 34 Posts
Reputation: 84
Default

I Think miniakos is right. The guy has hypercalcemia.
There is Psychiatric moans - depression; musculoskeletal symptoms - bones; etc

he will have short QT interval so answer is E
Reply With Quote Quick reply to this message
  #4  
Old 10-19-2011
drnrpatel's Avatar
Guest
 
Steps History: 1+CK+CS
Posts: 441
Threads: 153
Thanked 394 Times in 211 Posts
Reputation: 417
Default Answer

The correct answer is D. Muscle cramps in a patient who misses dialysis is a classic presentation of hyperkalemia. Symptoms of hyperkalemia include muscle cramps, weakness, ascending paralysis, respiratory failure, and arrhythmias. EKG findings include progression from peaked T waves and a slightly widened QRS complex to loss of P waves and a sinusoidal EKG tracing.
Diffuse ST elevation and diffuse PR segment depressions (choice A)are seen in pericarditis. Pericarditis may be caused by uremia. However, this patient does not have symptoms of pericarditis. Classic presentation would include a friction rub, positional chest pain, and a pleuritic component to the pain.
Flattened T waves and prominent U waves (choice B) are common findings of hypokalemia. Hypokalemia is commonly caused by excessive diuresis or dialysis.
The pattern of large S wave in lead I, Q wave in lead III, and an inverted T wave in lead III (choice C) is classic for pulmonary embolus. While it is highly specific, it is rarely seen. The most common EKG findings associated with pulmonary embolus are nonspecific ST segment and T-wave abnormalities, tachycardia, and right axis deviation.
Short QT interval (choice E) as an isolated EKG finding is often associated with hypercalcemia. There is no reason to suspect this patient has hypercalcemia.
Reply With Quote Quick reply to this message
The above post was thanked by:
drZoe (01-07-2013), pass7 (10-19-2011)
  #5  
Old 10-19-2011
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 85
Threads: 9
Thanked 74 Times in 34 Posts
Reputation: 84
Default

Thanks for answer,it make sense. I quickly read past the fact that he missed dialysis.
Reply With Quote Quick reply to this message
  #6  
Old 10-19-2011
pass7's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS+3
Posts: 406
Threads: 30
Thanked 140 Times in 108 Posts
Reputation: 150
Default

Quote:
Originally Posted by OzoneZone234 View Post
I Think miniakos is right. The guy has hypercalcemia.
There is Psychiatric moans - depression; musculoskeletal symptoms - bones; etc

he will have short QT interval so answer is E
Renal Osteodystrophy will have Hypocalcemia , the very cause leading to 2ndary hyperparathyroidism???
Reply With Quote Quick reply to this message
  #7  
Old 10-19-2011
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 85
Threads: 9
Thanked 74 Times in 34 Posts
Reputation: 84
Default

Quote:
Originally Posted by pass7 View Post
Renal Osteodystrophy will have Hypocalcemia , the very cause leading to 2ndary hyperparathyroidism???
Yep, thats right and wil thus give prolonged QT in that case
Reply With Quote Quick reply to this message



Reply

Tags
EKGs-, Electrolytes-, Internal-Medicine-, Nephrology-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Cystic renal dysplasia versus infant polycystic kidney disease? HaipengWang USMLE Step 1 Forum 0 10-12-2011 01:04 AM
superimposed preeclampsia or chronic renal disease drzamzam USMLE Step 3 Forum 0 10-11-2011 08:31 AM
Abnormal renal disease in lethargic man usmle2011 USMLE Step 1 Forum 10 08-04-2011 09:58 AM
Renal disease (RBCs in urine) aktorque USMLE Step 1 Forum 20 03-12-2011 10:12 AM
Colon CA and Renal Disease aktorque USMLE Step 1 Forum 5 02-20-2011 12:55 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)