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A) Sodium 20%
Karime		 1 20%
B) Calcium 0%
0 0%
C) Glucose 0%
0 0%
D) Potassium 80%
DRFP, usmlekiller, keepgoing, DadooKhan		 4 80%
E) Urea nitrogen 0%
0 0%
F) Triglycerides 0%
0 0%
5 votes



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Author7 Posts
DadooKhan
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10/09/08 - 06:52 AM       #1

A 63-year-old man was admitted to the hospital with a 12 hour history of dyspnea and
bradycardia. The man was taking propranolol, captopril, furosemide and amiloride
because of a previous myocardial infarction, and ibuprofen for osteoarthritis. Physical
examination showed a man in respiratory distress with the following vital signs: blood
pressure 150/86 mm Hg, heart rate 40 bpm, respiration 20 breath/min. A lab analysis was
ordered. Which of the following substances was most likely increased in the patient
serum?

GOGETA
Trying to get in PGY1
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10/09/08 - 06:58 AM       #2

K

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DRFP
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10/09/08 - 09:07 AM       #3

Potassium due to the Dig, its causing Dig tox which leads to Bradycardia

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Karime
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10/09/08 - 09:21 AM       #4

ok thanks nod


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keepgoing
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10/09/08 - 10:25 AM       #5

DRFP wrote:
Potassium due to the Dig, its causing Dig tox which leads to Bradycardia


where digi is given


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DadooKhan
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10/10/08 - 09:03 AM       #6

Answer: D

EXPLANATION:

The history and the signs of the patient (extreme bradycardia) suggest that he was most likely
suffering from hyperkalemia due to several reasons. He received amiloride, a potassium sparing
diuretics, and captopril which indirectly decreases aldosterone formation, so hindering the body
ability to counteract the hyperkalemia (normally a small increase in K+ concentration can
increase aldosterone secretion several folds). The patient was also treated with propranolol and
ibuprofen. Beta blockers can cause hyperkalemia by suppressing renin release and by
decreasing K+ uptake by skeletal muscle, and NSAIDs can cause hyperkalemia by reducing
renal K+ excretion. The patient was also taking furosemide, but the hypokalemic action of the
drug most likely was not enough to counteract all the hyperkalemic actions mentioned above.


P.S. Digi was not mentioned anywhere in the stem.

These Q's are what i've taken from my professor. NBME style questions written by him and a colleague. They're tough, but if you know your pharm, guaranteed they're solvable.

meawanderer
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10/13/08 - 03:40 PM       #7

its really tough to answer









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