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Panic disorder — USMLE Step 2 CK MCQ

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HardPsychiatryPanic disorderUSMLE Step 2 CK

A woman receiving hemodialysis has extremely painful retiform purpuric plaques with central necrosis on the thighs. Calcium-phosphate product is elevated, and biopsy confirms calcification and thrombosis of dermal arterioles. Which management bundle is most appropriate?

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Correct answer: A — Give IV sodium thiosulfate, optimize mineral balance, and provide wound care

Calciphylaxis is a painful, high-mortality calcific thrombotic arteriolopathy in advanced kidney disease. Management is multidisciplinary: optimize calcium-phosphate and dialysis parameters, stop contributing drugs such as warfarin when feasible, provide meticulous wound and infection care, control pain, and commonly administer intravenous sodium thiosulfate. Warfarin is a risk factor rather than treatment. Extra calcium worsens mineral burden. Debridement is individualized to tissue viability and infection, and topical steroids do not address vascular calcification or thrombosis.

Reference: NCBI Bookshelf: Calciphylaxis. https://www.ncbi.nlm.nih.gov/books/NBK519020/