Question for you guys :o) -

[ArchivalUser]

ankur

A.

[ArchivalUser]

Sunny

what is the answer TAC

[ArchivalUser]

river

Ok, checked book,SSc with renal crisis is an emergency and should be aggressively treated with ACE inhibitor.until the patient's blood pressure is controlled.

while calcium channel blockers are most widely used in this disease.
( Cecil Essentials of Medicine)

Thx for the discuss.

[ArchivalUser]

Ce

the answer is C

[ArchivalUser]

Matthew

consider the patient has severe headache, which seems a main symptom in this case because she came to the ER for H/A. so B and C are contraindications since they cause H/A too.

[ArchivalUser]

TAC

Let me know when you guys want to know the right answer. :o)

TAC

[ArchivalUser]

none(first)

hey TAC , please post the answer.

[ArchivalUser]

TAC

Hey! This is a tricky question isn't it? It tricked me as well. I got this question from the Blueprints book, and the official answer is A. Here's the explanation:

Know the treatment for scleroderma renal crisis! This patient with known scleroderma presents with new onset renal failure and accelerated hypertension, consistent with the clinical diagnosis of scleroderma renal crisis. It is more common early in the course of the disease (first few years) and in the diffuse variant of scleroderma. The typical features of nonspecific headache, malaise, and nause are accompanied by oliguric renal failure and accelerated hypertension. Urine analysis results are usually benign but may show a microangiopathic hemolytic anemia (not seen here). No further workup is needed , and prompt treatment is indicated. ACE inhibitors have dramatically reduced the mortality from this condition, and they are the treatment of choice, even in the acute setting. Nitroprusside is used in the treatment of hypertensive urgency, but it does not address the underlying physiology of scleroderma renal crisis. Nifedipine is not used in this setting and may precipitously drop the blood pressure in the acutely hypertensive patient. Immunosupression with prednisone or D-penicillamine is not indicated.

[ArchivalUser]

Sunny

Is BP of diastolic 120, with headache is not hypertensive urgency and then as per your explanation should we not use nitroprusside?

[ArchivalUser]

TAC

Sunny; I marked nitroprusside as well, but I didnt know there was such a thing as "scleroderma renal crisis". According to the books, ACE inhibitors should be used because they markedly lower the mortality in those patients, and address the physiopathology behind the accelerated hypertension, which is the acute kidney disease. I think this is an exception to the general guidelines, and that is why I wanted to post this question. Hope everyone learned from it, like I did.

:o)

TAC