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Posttraumatic stress disorder — USMLE Step 3 MCQ

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HardPsychiatryPosttraumatic stress disorderUSMLE Step 3

A patient with HRS-AKI has pulmonary edema, increasing dyspnea and SpO2 87% despite supplemental oxygen after albumin expansion. Which terlipressin plan follows current FDA labeling?

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Correct answer: B — Correct hypoxia and volume overload before initiating terlipressin

The best answer is “Correct hypoxia and volume overload before initiating terlipressin”. Current labeling says not to initiate terlipressin in hypoxia, exemplified by SpO2 below 90%, until oxygenation improves. Volume overload also increases respiratory-failure risk and should be treated before initiation. Monitoring cannot make treatment safe during active hypoxia, a numeric threshold does not negate ongoing pulmonary edema, and a reversible episode does not automatically impose permanent exclusion.

Reference: FDA Prescribing Information: TERLIVAZ (terlipressin), revised 2023: https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/022231s001lbl.pdf