#july2020mccqe1
A 56-year-old woman with a history of chronic renal disease presents to the emergency department because of severe, sharp, retrosternal chest pain that radiates to her jaw. The pain worsens when the patient lies down, and she is most comfortable leaning forward and hugging her knees. She takes erythropoietin, furosemide, calcitriol, and sodium polystyrene sulfonate. She is scheduled for dialysis three times per week, but she admits to sometimes missing sessions. She stopped drinking and smoking 20 years ago, and she has no family history of heart or renal problems. Auscultation of the heart reveals a friction rub. Laboratory tests show:
WBC count: 12,000/mm3
Hemoglobin: 10.0 g/dL
Hematocrit: 30.0%
Platelet count: 150,000/mm3
Na+: 141 mEq/L
K+: 4.8 mEq/L
Cl−: 101 mEq/L
HCO −: 22 mEq/L 3
Blood urea nitrogen: 63 mg/dL
Creatinine: 3.2 mg/dL
Glucose: 111 mg/dL
The emergency medicine physician urges the patient to be more compliant with her dialysis, but the patient complains that she is too tired to go to dialysis all of the time and that it is ruining her life. Which of the following is the most likely complication if the patient’s condition remains untreated?
(A) Cardiac tamponade
(B) Decreased jugular venous pressure
(C) Mitral regurgitation
(D) Restrictive cardiomyopathy
(E) Septic shock
A 56-year-old woman with a history of chronic renal disease presents to the emergency department because of severe, sharp, retrosternal chest pain that radiates to her jaw. The pain worsens when the patient lies down, and she is most comfortable leaning forward and hugging her knees. She takes erythropoietin, furosemide, calcitriol, and sodium polystyrene sulfonate. She is scheduled for dialysis three times per week, but she admits to sometimes missing sessions. She stopped drinking and smoking 20 years ago, and she has no family history of heart or renal problems. Auscultation of the heart reveals a friction rub. Laboratory tests show:
WBC count: 12,000/mm3
Hemoglobin: 10.0 g/dL
Hematocrit: 30.0%
Platelet count: 150,000/mm3
Na+: 141 mEq/L
K+: 4.8 mEq/L
Cl−: 101 mEq/L
HCO −: 22 mEq/L 3
Blood urea nitrogen: 63 mg/dL
Creatinine: 3.2 mg/dL
Glucose: 111 mg/dL
The emergency medicine physician urges the patient to be more compliant with her dialysis, but the patient complains that she is too tired to go to dialysis all of the time and that it is ruining her life. Which of the following is the most likely complication if the patient’s condition remains untreated?
(A) Cardiac tamponade
(B) Decreased jugular venous pressure
(C) Mitral regurgitation
(D) Restrictive cardiomyopathy
(E) Septic shock