A 72-year-old man presents with acute chest pain. He has stage 3 chronic kidney disease (CKD) and a 20-year history of T2DM. He is a smoker and has hyperlipidemia and degenerative joint disease. His BP is 135/85 mm Hg, and HR 110/ min. His chest is clear on auscultation. His troponin level is elevated, and electrocardiogram shows anterior ST-segment elevation. The patient is being transported to undergo coronary angiography. What should you recommend be done next?
سؤال مجاني 3 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: D. Administration of intravenous normal saline and N-acetylcysteine
He has CKD and diabetes and is about to receive iodinated contrast, so he is at high risk of contrast-induced nephropathy. Prevention is hydration with isotonic (0.9%) saline before and after contrast; sources also list N-acetylcysteine, though newer evidence shows NAC adds little, and D is still the only option with isotonic saline. Dialysis does not prevent contrast nephropathy, furosemide with 0.45% saline is not the recommended prophylaxis, and doing nothing ignores his risk.
ليش كل خيار صح أو غلط
-
A
ليش غلط
Diuretics are stopped before contrast in at-risk patients; the aim is hydration, not diuresis.
✓ 1. Acute Kidney Injury.pdf · p. 2 -
B
ليش غلط
Dialysis is ineffective at preventing contrast-induced nephropathy.
✓ 1. Acute Kidney Injury.pdf · p. 2 -
C
ليش غلط
CKD with diabetes is a recognised risk factor for contrast-induced nephropathy, so prevention is needed before contrast.
✓ Nephrology 🌷.pdf · p. 10 -
D
ليش صح
For an at-risk patient who needs contrast, the AKI notes advise vigorous hydration and prophylactic N-acetylcysteine; D is the only option that hydrates without adding a diuretic.
✓ 1. Acute Kidney Injury.pdf · p. 2
- المصدر
- 1. Acute Kidney Injury.pdf · p. 2
Nephrology 🌷.pdf · p. 10 - المحاضرة
- Acute Coronary Syndrome · Cardiology · Module B
- ظهر في
- Cardio bank