WBR0201

Author	[[PageAuthor::Ayokunle Olubaniyi, M.B,B.S [1]]]
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Genitourinary, SubCategory::Genitourinary
Prompt	[[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?]]
Answer A	AnswerA::Check creatine kinase level
Answer A Explanation	AnswerAExp::Creatine Kinase level is useful in acute coronary syndromes
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::Chest X-ray is incorrect because the patient has no cardiac or pulmonary pathology in this case.
Answer E	AnswerE::Skull X-ray
Answer E Explanation	AnswerEExp::Skull X-ray is required in pathologies involving the skull bone such as 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: References: ]]
Approved	Approved::Yes
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