HY USMLE Q#6 CVS Concepts Step 2CK
Step 2 ck/ 3 level
72 -F is the brought to the ED w/ SOB and chocking since last night. She had a dry cough at night for the past several weeks. She rejected Flu vaccine. Pulse Ox is 84%. Bp 176/103 mmHg. Precordial leads has increase voltage and T wave inversion in leads V5 and V6. Bilateral crackles are heard on lung examination. Loop diuretics are administered but they don't help her.
What is the NBS ?
A. IV Digoxin
B. IV Metroprolol
C. IV milirnon
D. IV nitrogylcerin
E. IV unfractionated heparin
Explanation
72F is the brought to the ED w/ SOB and chocking since last night. She had a dry cough at night for the past several weeks. She rejected Flu vaccine. Pulse Ox is 84%. Bp 176/103 mmHg. Precordial leads has increase voltage and T wave inversion in leads V5 and V6. Bilateral crackles are heard on lung examination. Loop diuretics are administered but they don't help her.
What is the NBS ?
A. IV Digoxin --> Digoxin is a positive inotropic agent used in some patients with chronic heart failure due to left ventricular (LV) systolic dysfunction. However, it has no role in the management of ADHF.
B. IV Metroprolol --> Pulmonary edema due to atrial fibrillation with rapid ventricular response is one ADHF scenario where metoprolol may actually provide benefit (by increasing markedly low ventricular filling times); however, in this patient with normal heart rate and sinus rhythm on ECG, metoprolol is likely to worsen pulmonary edema.
C. IV milirnon Milrinone is a selective phosphodiesterase-3 inhibitor that causes positive inotropy as well as reductions in preload and afterload. It can be useful for ADHF due to LV systolic dysfunction; however, it is associated with increased risk of hypotension and atrial or ventricular arrhythmia, and is typically reserved for severe ADHF that is refractory to other management.
D. IV nitrogylcerin --> Nitro is venodiilator --> decrease preload --> decrease intracardiac filling pressure and improvement in pulmonary edema w/ severe hypertension
E. IV unfractionated heparin --> USe for Acute MI
