WBR0713

Author	PageAuthor::William J Gibson
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Cardiovascular
Prompt	[[Prompt::A 30-year-old male competitive triathlete is brought to the emergency room after collapsing during a training run. He reports severe chest pain that radiates down his left arm. EKG shows ST-elevation in lead V1-V6 and cardiac enzymes are elevated. Routine labs are significant for a hematocrit of 65%. What is the most likely cause of this patient’s condition?]]
Answer A	AnswerA::Cocaine use
Answer A Explanation	[[AnswerAExp::Incorrect: Cocaine use has been associated with adverse cardiovascular effects and can cause ACS, but the hematocrit of 65% is indicative of erythropoietin injection.]]
Answer B	AnswerB::Erythropoietin injection
Answer B Explanation	[[AnswerBExp::Correct: This patient has most likely been self-administering erythropoietin as a performance enhancing drug.]]
Answer C	AnswerC::Familial hypercholesterolemia
Answer C Explanation	[[AnswerCExp::Incorrect: Familial hypercholesterolemia is characterized by very high LDL cholesterol and early cardiovascular disease running in families.]]
Answer D	AnswerD::Hypertrophic cardiomyopathy
Answer D Explanation	[[AnswerDExp::Incorrect: Hypertrophic cardiomyopathy is a leading cause of sudden cardiac death in young athlets, but in this case the hematocrit of 65% is indicative of erythropoietin injection.]]
Answer E	AnswerE::Polycythemia vera
Answer E Explanation	[[AnswerEExp::Incorrect: Polycythemia vera can cause similar presentation, but in this case of triathlete the hematocrit of 65% is indicative of erythropoietin injection.]]
Right Answer	RightAnswer::B
Explanation	[[Explanation::This patient has most likely been self-administering erythropoietin (EPO) as a performance enhancing drug. EPO is a naturally-occurring growth factor that stimulates the formation of RBCs. Easily injected under the skin, pharmaceutical EPO can boost hematocrit for six weeks or longer. EPO is also not free of health hazards: excessive use of the hormone can cause polycythemia, a condition where the level of RBCs in the blood is abnormally high. This causes the blood to be more viscous than normal, a condition that strains the heart and causes ACS. Some elite athletes who died of heart failure—usually during sleep, when heart rate is naturally low—were found to have unnaturally high RBC concentrations in their blood as in this case. Educational Objective: This patient has most likely been self-administering erythropoeitin as a performance enhancing drug. Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Blood doping
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::