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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{AO}}
|QuestionAuthor= {{AO}} (Edited by Alison Leibowitz)
|ExamType=USMLE Step 2 CK
|ExamType=USMLE Step 2 CK
|MainCategory=Internal medicine
|MainCategory=Internal medicine
Line 20: Line 20:
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Genitourinary, Genitourinary, Preventive Medicine
|SubCategory=Genitourinary, Genitourinary, Preventive Medicine
|Prompt=A 72-year-old man with a history of COPD, stroke, elevated cholesterol and dementia is brought to the ED by his wife because of fever and shortness of breath of 3 days duration.  He underwent an oral surgical procedure 6 weeks ago.  Vitals revealed T: 36.8C, RR: 22/min, BP: 140/60 mm Hg.   A soft diastolic murmur is heard and gentamicin therapy is initiated.  Two days later, he was discharged but on getting home his wife discovered that he no longer complains when  his grandchild  plays his loud music.  Which of the following should have been done to prevent this?
|Prompt=A 72-year-old man with a history of chronic obstructive pulmonary disease (COPD), stroke, elevated cholesterol, and dementia is brought to the ER by his wife for fever and shortness of breath during past three days.  He underwent an oral surgical procedure 6 weeks ago.  Upon examination, the temperature is 36.8°C, the blood pressure is 140/60 mm Hg, and the respiratory rate is 22 breaths per minute. A soft diastolic murmur is heard and gentamicin therapy is initiated.  Which of the following tests should have been administered in order to monitor the medication's adverse reactions?
|Explanation=[[Gentamicin]] is both nephrotoxic and ototoxic.  Gentamicin is a vestibulotoxin capable of causing permanent loss of equilibrioception and sensorineural hearing loss.  This is caused by damage to the vestibular apparatus of the inner ear usually if taken at high doses or for prolonged periods of time.  Elderly people are at a very high risk because they have a lower [[glomerular filtration rate]] (GFR), thus, it is mandatory to check their creatinine clearance before administering the medication.
|Explanation=[[Gentamicin]] is both nephrotoxic and ototoxic.  Gentamicin is a vestibulotoxin capable of causing permanent loss of equilibrioception and sensorineural hearing loss.  This is caused by damage to the vestibular apparatus of the inner ear usually if taken at high doses or for prolonged periods of time.  Elderly people are at a very high risk because they have a lower [[glomerular filtration rate]] (GFR), thus, it is mandatory to check their creatinine clearance before administering the medication.


Educational Objective: The glomerular filtration rate is reduced in the young and in the elderly, which reduces the clearance of medications in them.  In the elderly, the creatinine clearance must be calculated before the administration of nephrotoxic drugs such as gentamicin.
Educational Objective: The glomerular filtration rate is reduced in the young and in the elderly, which reduces the clearance of medications in them.  In the elderly, the creatinine clearance must be calculated before the administration of nephrotoxic drugs such as [[gentamicin]].
|AnswerA=Check creatine kinase level
|AnswerA=Check creatine kinase level
|AnswerAExp=Incorrect.  [[Creatine Kinase]] level is useful in [[acute coronary syndrome]]
|AnswerAExp= Determining [[Creatine Kinase]] level is useful in [[acute coronary syndrome]]
|AnswerB=Hearing test with a tuning fork
|AnswerB=Hearing test with a tuning fork
|AnswerBExp=Incorrect.  A prior hearing test with a tuning fork has no preventive advantage in this case.
|AnswerBExp= A prior hearing test with a tuning fork has no preventive advantage in this case.
|AnswerC=Check creatinine clearance
|AnswerC=Check creatinine clearance
|AnswerCExp=Correct.  Creatinine clearance is a measure of the glomerular filtration rate.  The glomerular filtration rate is a measure of the renal status.
|AnswerCExp= Creatinine clearance is a measure of the [[glomerular filtration rate]].  The [[glomerular filtration rate]] is a measure of the renal status.
|AnswerD=Chest X-ray
|AnswerD=Chest X-ray
|AnswerDExp=Incorrect.  Chest X-ray is incorrect because the patient has no cardiac or pulmonary pathology in this case.
|AnswerDExp= A chest X-ray is not necessary because the patient has no cardiac or pulmonary pathology.
|AnswerE=Skull X-ray
|AnswerE=Cranium X-ray
|AnswerEExp=Incorrect.  Skull X-ray is required in pathologies involving the skull bone such as fractures.
|AnswerEExp= A cranium X-ray is required in pathologies involving the cranium such as [[Basilar skull fracture|skullbase fractures]].
|RightAnswer=C
|RightAnswer=C
|WBRKeyword=GFR, gentamicin toxicity, nephrotoxicity
|WBRKeyword=GFR, gentamicin toxicity, nephrotoxicity
|Approved=Yes
|Approved=Yes
}}
}}

Latest revision as of 23:44, 27 October 2020
Author [[PageAuthor::Ayokunle Olubaniyi, M.B,B.S [1] (Edited by Alison Leibowitz)]]
Exam Type ExamType::USMLE Step 2 CK
Main Category MainCategory::Internal medicine
Sub Category SubCategory::Genitourinary, SubCategory::Genitourinary, SubCategory::Preventive Medicine
Prompt [[Prompt::A 72-year-old man with a history of chronic obstructive pulmonary disease (COPD), stroke, elevated cholesterol, and dementia is brought to the ER by his wife for fever and shortness of breath during past three days. He underwent an oral surgical procedure 6 weeks ago. Upon examination, the temperature is 36.8°C, the blood pressure is 140/60 mm Hg, and the respiratory rate is 22 breaths per minute. A soft diastolic murmur is heard and gentamicin therapy is initiated. Which of the following tests should have been administered in order to monitor the medication's adverse reactions?]]
Answer A AnswerA::Check creatine kinase level
Answer A Explanation [[AnswerAExp::Determining Creatine Kinase level is useful in acute coronary syndrome]]
Answer B AnswerB::Hearing test with a tuning fork
Answer B Explanation AnswerBExp::A prior hearing test with a tuning fork has no preventive advantage in this case.
Answer C AnswerC::Check creatinine clearance
Answer C Explanation [[AnswerCExp::Creatinine clearance is a measure of the glomerular filtration rate. The glomerular filtration rate is a measure of the renal status.]]
Answer D AnswerD::Chest X-ray
Answer D Explanation AnswerDExp::A chest X-ray is not necessary because the patient has no cardiac or pulmonary pathology.
Answer E AnswerE::Cranium X-ray
Answer E Explanation [[AnswerEExp::A cranium X-ray is required in pathologies involving the cranium such as skullbase fractures.]]
Right Answer RightAnswer::C
Explanation [[Explanation::Gentamicin is both nephrotoxic and ototoxic. Gentamicin is a vestibulotoxin capable of causing permanent loss of equilibrioception and sensorineural hearing loss. This is caused by damage to the vestibular apparatus of the inner ear usually if taken at high doses or for prolonged periods of time. Elderly people are at a very high risk because they have a lower glomerular filtration rate (GFR), thus, it is mandatory to check their creatinine clearance before administering the medication.

Educational Objective: The glomerular filtration rate is reduced in the young and in the elderly, which reduces the clearance of medications in them. In the elderly, the creatinine clearance must be calculated before the administration of nephrotoxic drugs such as gentamicin.
Educational Objective:
References: ]]

Approved Approved::Yes
Keyword WBRKeyword::GFR, WBRKeyword::gentamicin toxicity, WBRKeyword::nephrotoxicity
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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