{"id":3400,"date":"2021-12-15T18:20:00","date_gmt":"2021-12-15T18:20:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3400"},"modified":"2025-10-01T11:40:34","modified_gmt":"2025-10-01T19:40:34","slug":"usmle-step-2-ck-question-of-the-day-scleroderma-renal-crisis","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scleroderma-renal-crisis","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day: Scleroderma Renal Crisis"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><ul class='ez-toc-list-level-4' ><li class='ez-toc-heading-level-4'><ul class='ez-toc-list-level-4' ><li class='ez-toc-heading-level-4'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scleroderma-renal-crisis\/#Check_out_our_free_USMLE%C2%AE_Step_2_Ultimate_Guide\" >Check out our free&nbsp;USMLE\u00ae Step 2 Ultimate Guide!<\/a><\/li><\/ul><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scleroderma-renal-crisis\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scleroderma-renal-crisis\/#B_Initiation_of_captopril_therapy\" >B. Initiation of captopril therapy<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scleroderma-renal-crisis\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scleroderma-renal-crisis\/#A_Initiation_of_propranolol_therapy\" >A. Initiation of&nbsp;propranolol&nbsp;therapy<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scleroderma-renal-crisis\/#C_Initiation_of_methotrexate_therapy\" >C. Initiation of&nbsp;methotrexate&nbsp;therapy<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scleroderma-renal-crisis\/#D_Long-term_dialysis\" >D. Long-term dialysis<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scleroderma-renal-crisis\/#E_Initiation_of_prednisone_therapy\" >E. Initiation of&nbsp;prednisone&nbsp;therapy<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scleroderma-renal-crisis\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scleroderma-renal-crisis\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scleroderma-renal-crisis\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\">A 38-year-old woman comes to the emergency department for evaluation of altered mental status that began five hours ago. She is accompanied by her husband. Past medical history is notable for asthma and diffuse scleroderma. On arrival, her temperature is 37.6\u00b0C (99.7\u00b0F) and blood pressure is 183\/121 mmHg. On physical examination, the patient is oriented to self but neither time nor place. Diffuse thickening of the skin is observed, and contractures are present in the bilateral fingers. Laboratory testing is obtained, and results are as follows:<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Laboratory value<\/strong><\/td><td><strong>Result<\/strong><\/td><\/tr><tr><td>Hemoglobin<\/td><td>10.7 g\/dL<\/td><\/tr><tr><td>Leukocyte Count<\/td><td>7,300\/mm<sup>3<\/sup><\/td><\/tr><tr><td>Platelet Count<\/td><td>80,000\/mm<sup>3<\/sup><\/td><\/tr><tr><td>Blood Urea Nitrogen<\/td><td>35 mg\/dL<\/td><\/tr><tr><td>Creatinine, Serum<\/td><td>2.0 mg\/dL<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following is the next best step in the management of this patient\u2019s condition?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Initiation of propranolol therapy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Initiation of captopril therapy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Initiation of methotrexate therapy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Long-term dialysis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Initiation of prednisone therapy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down for the correct answer!<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-rich is-provider-embed-handler wp-block-embed-embed-handler wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Osmosis Around the World: France\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/U9uwQ_g97NI?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Check_out_our_free_USMLE%C2%AE_Step_2_Ultimate_Guide\"><\/span>Check out our free<a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-2\" target=\"_blank\" rel=\"noreferrer noopener\">&nbsp;USMLE\u00ae Step 2 Ultimate Guide!<\/a><span class=\"ez-toc-section-end\"><\/span><\/h4>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Initiation_of_captopril_therapy\"><\/span>B. Initiation of captopril therapy<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let&#8217;s see why the answer wasn&#8217;t A, C, D or E. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Today&#8217;s incorrect answers are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Initiation_of_propranolol_therapy\"><\/span>A. Initiation of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Antiarrhythmics:_Nursing_Pharmacology\" target=\"_blank\" rel=\"noreferrer noopener\">propranolol<\/a>&nbsp;therapy<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;This patient\u2019s altered mental status, hypertension and elevated blood urea nitrogen and creatinine levels, in the setting of a known history of diffuse scleroderma, raise concern for scleroderma renal crisis. However, treatment with beta-blockers is generally contraindicated, since they can cause vasoconstriction, thereby increasing the risk of developing digital ulcers in patients with scleroderma.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Initiation_of_methotrexate_therapy\"><\/span>C. Initiation of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Immunosuppressants_to_treat_autoimmune_diseases:_Nursing_Pharmacology\" target=\"_blank\" rel=\"noreferrer noopener\">methotrexate<\/a>&nbsp;therapy<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Methotrexate can be used to treat skin thickening and tightening in patients with scleroderma. This patient\u2019s thickened skin and finger contractures are consistent with her known history of scleroderma. However, her hypertension and elevated blood urea nitrogen and creatinine levels raise concern for scleroderma renal crisis, for which methotrexate is not useful.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Long-term_dialysis\"><\/span>D. Long-term dialysis<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Short-term dialysis is used in nearly 50% of patients with scleroderma renal crisis. However, once the patient\u2019s condition has improved and the body is able to regulate blood pressure, dialysis can be discontinued. Long-term dialysis may be indicated in patients who develop end-stage renal disease secondary to scleroderma renal crisis. Currently, not enough is known about this patient&#8217;s prognosis, and therefore, initiating long-term dialysis would be premature.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Initiation_of_prednisone_therapy\"><\/span>E. Initiation of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Immunosuppressants_to_treat_autoimmune_diseases:_Nursing_Pharmacology\" target=\"_blank\" rel=\"noreferrer noopener\">prednisone&nbsp;<\/a>therapy<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Corticosteroids are used in the treatment of many autoimmune and inflammatory conditions. However, they are generally contraindicated in the management of scleroderma renal crisis. This is because glucocorticoids may play a role in the occurrence of scleroderma renal crisis, though the exact mechanism remains unclear.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient is having a&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Scleroderma:_Pathology_review\" target=\"_blank\" rel=\"noreferrer noopener\">scleroderma renal crisis<\/a><\/strong>, which is characterized by&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Hypertension:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">severe hypertension<\/a><\/strong>&nbsp;and&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Acute_kidney_injury_(AKI):_Nursing_Process_(ADPIE)\" target=\"_blank\" rel=\"noreferrer noopener\">acute renal failure<\/a><\/strong>. Over 90% of patients with scleroderma renal crisis have blood pressures exceeding 150\/90 mmHg. Renal failure can present with elevated blood urea nitrogen and creatinine levels. In addition, patients can present with hypertensive encephalopathy,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Heart_failure:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">heart failure<\/a>, and arrhythmias.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The pathophysiology of scleroderma renal crisis is unclear; however, it is believed that the&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Renin-angiotensin-aldosterone_system\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>renin-angiotensin-aldosterone system<\/strong>&nbsp;(RAAS)<\/a>&nbsp;plays an important role. Scleroderma is known to cause damage to small arteries within the kidneys, which subsequently undergo hypertrophy, resulting in relative ischemia. In severe cases, damage to the renal blood vessels can trigger&nbsp;<strong>thrombosis<\/strong>, occluding the glomerular capillaries. This causes rapid deterioration in renal function, resulting in scleroderma renal crisis. Of note, the thrombosis can lead to a&nbsp;<strong>low platelet count<\/strong>&nbsp;on laboratory testing, as well as the presence of&nbsp;<strong>schistocytes<\/strong>&nbsp;on peripheral blood smear.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><a href=\"https:\/\/www.osmosis.org\/learn\/ACE_inhibitors,_ARBs_and_direct_renin_inhibitors\" target=\"_blank\" rel=\"noreferrer noopener\">Angiotensin-converting (ACE) inhibitors<\/a><\/strong>&nbsp;are the first-line treatment for scleroderma renal crisis.&nbsp;<strong>Dialysis<\/strong>&nbsp;can be used in an acute setting in patients with significant kidney injury; however, long-term dialysis is indicated only in patients who develop end-stage renal disease as a result of the injury.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"565\" height=\"245\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/kidnley-and-scleroderma-renal-crisis.png\" alt=\"\" class=\"wp-image-3402\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/kidnley-and-scleroderma-renal-crisis.png 565w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/kidnley-and-scleroderma-renal-crisis.png?resize=300,130 300w\" sizes=\"auto, (max-width: 565px) 100vw, 565px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span><strong>Major Takeaway<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Scleroderma renal crisis is characterized by&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Hypertension:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">severe hypertension<\/a><\/strong>&nbsp;and&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Acute_kidney_injury_(AKI):_Nursing_Process_(ADPIE)\" target=\"_blank\" rel=\"noreferrer noopener\">acute renal failure<\/a><\/strong>. It can present with hypertensive encephalopathy, heart failure, and arrhythmias. Laboratory testing will reveal an&nbsp;<strong>elevated blood urea nitrogen<\/strong>,&nbsp;<strong>elevated creatinine<\/strong>, and&nbsp;<strong>low platelet count<\/strong>.&nbsp;<strong>ACE-inhibitors<\/strong>&nbsp;are the first-line treatment option.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span><strong>References<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Mouthon, L., Bussone, G., Berezne, A., Noel, L., Guillevin, L. (2020) Scleroderma renal crisis.&nbsp;<em>The Journal of Rheumatology<\/em>. 41(6), 1040-1046. Doi:&nbsp;<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24833760\/\" target=\"_blank\" rel=\"noreferrer noopener\">10.3899\/jrheum.131210<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Vidya, P.N., Finnigan, N.A. (2020) \u201cScleroderma and renal crisis\u201d. StatPearls [Internet]. Web Address:&nbsp;<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482424\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482424\/<\/a>.<\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\">\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013\u2013<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><br><strong>Want more &nbsp;USMLE\u00ae Step 2 CK practice questions?&nbsp;<\/strong><\/em><em><strong>Try Osmosis today!&nbsp;<\/strong><\/em><em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">Access your free trial<\/a><\/strong><\/em><em><strong>&nbsp;and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/ace-your-clerkships-banner.png?w=700\" alt=\"\" class=\"wp-image-882\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/ace-your-clerkships-banner.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/ace-your-clerkships-banner.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>A 38-year-old woman comes to the emergency department for evaluation of altered mental status that began five hours ago. She is accompanied by her husband. Past medical history is notable for asthma and diffuse scleroderma. On arrival, her temperature is 37.6\u00b0C (99.7\u00b0F) and blood pressure is 183\/121 mmHg. On physical examination, the patient is oriented [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3401,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[20,32,45],"tags":[],"class_list":["post-3400","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-exam-prep","category-nursing","category-step-2"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 2 CK Question of the Day: Scleroderma Renal Crisis - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scleroderma-renal-crisis\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 2 CK Question of the Day: Scleroderma Renal Crisis - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"A 38-year-old woman comes to the emergency department for evaluation of altered mental status that began five hours ago. She is accompanied by her husband. Past medical history is notable for asthma and diffuse scleroderma. On arrival, her temperature is 37.6\u00b0C (99.7\u00b0F) and blood pressure is 183\/121 mmHg. On physical examination, the patient is oriented [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scleroderma-renal-crisis\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2021-12-15T18:20:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-01T19:40:34+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/scleroderma-renal-crisis.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1080\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Marina Horiates Kerekes, MD &amp; Team\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":[\"Article\",\"BlogPosting\"],\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scleroderma-renal-crisis#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-scleroderma-renal-crisis\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; 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His partner states that he has been increasingly confused over the past 24 hours and appears more lethargic than usual. The patient has a past medical history of cirrhosis due to untreated hepatitis C. 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