Chronic Kidney Disease USMLE Step 1 Practice Question
A 67-year-old woman with acute decompensated heart failure presents with dyspnea and orthopnea. Vital signs: BP 160/95, HR 110, RR 22, SpO2 88%. She receives high-dose intravenous furosemide. Labs reveal creatinine 2.1 mg/dL (baseline 0.9) and BUN 45 mg/dL. The next day she reports bilateral tinnitus and high-frequency hearing loss. She denies recent aminoglycoside use. Which of the following best explains this adverse effect?
Answer choices
- ALoop diuretics decrease uric acid excretion leading to tinnitus
- BLoop diuretics directly injure the optic nerve
- CLoop diuretics irreversibly block muscarinic receptors in the cochlea
- DLoop diuretics cause autoimmune destruction of hair cells
- ELoop diuretics can cause ototoxicity, especially at high dosesCorrect answer
- FLoop diuretics impair potassium reabsorption in the proximal tubule, causing severe hypokalemia that damages the stria vascularis
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