skip to main content

Schizophrenia — USMLE Step 2 CK MCQ

Instant feedback + full explanation. One question, done properly.

HardPsychiatrySchizophreniaUSMLE Step 2 CK

A woman with rapidly progressive diffuse systemic sclerosis develops blood pressure 214/118 mm Hg, retinal hemorrhages, schistocytes and creatinine 3.4 mg/dL. Captopril is started, but creatinine rises to 4.2 mg/dL over 48 hours while blood pressure improves. What is the best medication decision?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Continue and rapidly titrate the ACE inhibitor while managing renal failure

This is scleroderma renal crisis: abrupt malignant hypertension, acute kidney injury and microangiopathic hemolysis in diffuse systemic sclerosis. Short-acting ACE inhibition should be rapidly titrated and continued even if creatinine initially rises or dialysis becomes necessary, because delayed renal recovery is possible and survival is substantially improved. ARBs do not have equivalent evidence. High-dose glucocorticoids can precipitate or worsen renal crisis. Diuretics may be needed for pulmonary edema but do not replace ACE inhibition and can further stimulate renin when used indiscriminately.

Reference: NCBI Bookshelf: Scleroderma and renal crisis. https://www.ncbi.nlm.nih.gov/books/NBK482424/