skip to main content

Pediatric obesity with metabolic comorbidities — USMLE Step 3 MCQ

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

HardPediatricsPediatric obesity with metabolic comorbiditiesUSMLE Step 3

A 58-year-old man with decompensated cirrhosis develops creatinine 2.7 mg/dL from a baseline of 0.9 mg/dL. Diuretics are stopped, infection and shock are excluded, urinalysis is bland, renal ultrasound is normal, and creatinine does not improve after 2 days of albumin expansion. Oxygen saturation is 97% on room air and there is no pulmonary edema. Which treatment is most appropriate?

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

Reveal the answer and explanation

Correct answer: E — Begin terlipressin with albumin and monitor closely for respiratory compromise

The best answer is “Begin terlipressin with albumin and monitor closely for respiratory compromise”. Failure to respond to albumin after exclusion of structural, obstructive, infectious, and shock causes supports HRS-AKI. Terlipressin plus albumin can reverse the functional renal vasoconstriction, but hypoxia and respiratory failure must be monitored because the drug is contraindicated in ongoing hypoxia. Diuretics and ACE inhibition worsen effective perfusion, low-dose dopamine is ineffective, and dialysis is a bridge rather than disease-specific reversal.

Reference: FDA Terlivaz Prescribing Information: https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/022231s000lbl.pdf