WBR0375

Author	[[PageAuthor::Rim Halaby, M.D. [1], Alison Leibowitz [2] (Reviewed by Alison Leibowitz)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Renal
Prompt	[[Prompt::A 68-year-old Caucasian male, with a significant history of alcoholism, presents to the ER with an altered mental status and is unable to provide further history. Upon physical examination you observe fetor hepaticus, spider nevi, gynecomastia, and that his stomach is severely distended with shifting dullness. Following appropriate work-up, you diagnose him with hepatic cirrhosis and closely follow the standard treatment for his condition. Upon discharge, you prescribe the patient with spironolactone, for moderate ascites. The patient should be monitored for which of the following electrocardiogram (ECG) finding after initiation of spironolactone?]]
Answer A	AnswerA::Two independent rhythms of P and QRS complexes
Answer A Explanation	[[AnswerAExp::A third degree AV block is not typically associated with spironolactone therapy. AV blockades are often observed in patients receiving beta and calcium channel blockers.]]
Answer B	AnswerB::“Saw tooth” appearance
Answer B Explanation	[[AnswerBExp::A “Saw tooth” appearance is a characteristic description of atrial flutter. Spironolactone is not commonly associated with atrial flutter.]]
Answer C	AnswerC::Peaked T waves
Answer C Explanation	[[AnswerCExp::Peaked T waves on ECG are characteristic of hyperkalemia, a common side effect of spironolactone therapy.]]
Answer D	AnswerD::ST-segment elevation in leads I and aVL
Answer D Explanation	AnswerDExp::ST-segment elevation is not typically associated with in myocardial infarction.
Answer E	AnswerE::Prolonged PR interval
Answer E Explanation	AnswerEExp::
Right Answer	RightAnswer::C
Explanation	[[Explanation::Spironolactone, a competitive aldosterone receptor antagonist, is an effective treatment for patients with severe heart failure and ascites due to hepatic failure. Following initiation of spironolactone therapy, serum potassium concentrations should be periodically measured, monitoring for hyperkalemia, a common adverse reaction. Hyperkalemia is a potential side effect of spironolactone therapy, resulting from the inhibition of aldosterone’s physiologic activity, the excretion of potassium (often, spironolactone is described as a “potassium-sparing” diuretic). A typical ECG finding in patients with hyperkalemia is peaked T waves. Educational Objective: Spironolactone, a competitive aldosterone receptor antagonist, is an effective treatment for patients with hepatic failure and ascites. Hyperkalemia is a common side effect of spironolactone therapy, manifesting with peaked T waves on ECG. References: Nappi JM, Sieg A. Aldosterone and aldosterone receptor antagonists in patients with chronic heart failure. Vasc Health Risk Manag. 2011;7:353-363. Biecker E. Diagnosis and therapy of ascites in liver cirrhosis. World J Gastroenterol. 2011;17(10):1237-1248.]]
Approved	Approved::Yes
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