Family Medicine Question of the Week: Nephrology

Kicking off Nephrology Week with a practice question for the ABFM Board from the Knowmedge QVault. Follow us on twitter @Knowmedge throughout the week for additional questions and tips as you prep for the boards!

A 42-year-old woman presents with altered mental status. According to her husband, she has been getting progressively more confused and sleepy over the past few weeks. Her oral intake has decreased due to profound nausea. She also seems to stumble, and she has had several falls at home. Her past medical history is significant for breast cancer. She underwent lumpectomy and radiation therapy; she completed therapy 1 year ago. She has not had any medical contact for the past 8 months. Physical exam reveals a somnolent, but arousable, woman in no acute distress. Heart and lung exam are unremarkable. Neurologic exam is nonfocal; however, there is general hypotonicity and decreased deep tendon reflexes.

Vital signs are as follows:

  • BP 110/65 mm Hg,
  • Pulse 55,
  • Respiration 12
  • Temperature is 37° C (98.6° F).
  • ECG shows a sinus bradycardia with a 1° AV block, a nonspecific intraventricular conduction delay, and a short QT interval.
  • CXR reveals cardiomegaly with clear lungs. Multiple lytic lesions are visible in the humerus and ribs.

  • What electrolyte disorder is most likely causing her constellation of symptoms?


    A. Hypokalemia
    B. Hyperkalemia
    C. Hypocalcemia
    D. Hypercalcemia
    E. Hypomagnesemia

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