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I just encountered this question in USMLE Rx:
A patient with a known allergy to sulfa drugs presents to the emergency department with severe shortness of breath and rapid, shallow breathing. A pulmonary examination reveals bilateral crackles halfway up from the bases, and x-ray film of the chest shows pulmonary vascular redistribution and bilateral interstitial markings. The attending physician chooses to treat the patient with a high dose of a diuretic agent. Subsequently, the patient develops muscle weakness and difficulty hearing his wife's voice.
Which of the following diuretics did the physician most likely administer?
A) Acetazolamide
B) Ethacrynic acid
C) Furosemide
D) Hydrochlorothiazide
E) Spironolactone
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When I read this question, I thought it was obvious that because the patient has a sulfa allergy, that ethacrynic acid would be the appropriate diuretic to use. Not hard.
However, notice that after the physician administers the diuretic, the patient develops ototoxic effects.
My assumption was that the physician must have administered furosemide instead of ethacrynic acid, because if he had correctly administered the latter, then the ototoxic effects, and patient's condition as a whole, would not have been exacerbated!
Furthermore, USMLE Rx says the answer is ethacrynic acid, not furosemide. Their reasoning is that because the patient has a sulfa allergy, furosemide is not the correct drug to use. Once again, this was never debated, but the vignette suggests the physician unknowingly administered furosemide, thereby causing the patient more harm.
Am I missing something, or is this question just not written well?
A patient with a known allergy to sulfa drugs presents to the emergency department with severe shortness of breath and rapid, shallow breathing. A pulmonary examination reveals bilateral crackles halfway up from the bases, and x-ray film of the chest shows pulmonary vascular redistribution and bilateral interstitial markings. The attending physician chooses to treat the patient with a high dose of a diuretic agent. Subsequently, the patient develops muscle weakness and difficulty hearing his wife's voice.
Which of the following diuretics did the physician most likely administer?
A) Acetazolamide
B) Ethacrynic acid
C) Furosemide
D) Hydrochlorothiazide
E) Spironolactone
--------
When I read this question, I thought it was obvious that because the patient has a sulfa allergy, that ethacrynic acid would be the appropriate diuretic to use. Not hard.
However, notice that after the physician administers the diuretic, the patient develops ototoxic effects.
My assumption was that the physician must have administered furosemide instead of ethacrynic acid, because if he had correctly administered the latter, then the ototoxic effects, and patient's condition as a whole, would not have been exacerbated!
Furthermore, USMLE Rx says the answer is ethacrynic acid, not furosemide. Their reasoning is that because the patient has a sulfa allergy, furosemide is not the correct drug to use. Once again, this was never debated, but the vignette suggests the physician unknowingly administered furosemide, thereby causing the patient more harm.
Am I missing something, or is this question just not written well?