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{{WBRQuestion | {{WBRQuestion | ||
|QuestionAuthor=Raviteja Reddy Guddeti MBBS, Aarti Narayan MBBS | |QuestionAuthor=Raviteja Reddy Guddeti MBBS, Aarti Narayan MBBS (Reviewed by Gonzalo Romero) | ||
|ExamType=USMLE Step 2 CK | |ExamType=USMLE Step 2 CK | ||
|MainCategory=Pharmacology, Internal medicine | |MainCategory=Pharmacology, Internal medicine | ||
| Line 20: | Line 20: | ||
|MainCategory=Pharmacology, Internal medicine | |MainCategory=Pharmacology, Internal medicine | ||
|SubCategory=Cardiology, Cardiovascular | |SubCategory=Cardiology, Cardiovascular | ||
|Prompt=A 35 year old | |Prompt=A 35-year-old female presents to the ER with fever, weakness and pleuritic chest pain. The pain is relieved by sitting up and leaning forward. The patient states ''this pain gets worse when I take a deep breath, I try not to breath as much''. Upon physical examination, her vital signs are within normal range. Auscultation of the heart reveals a friction rub. An EKG is performed and is depicted below: <br> [[File:PtaDepressionPericarditis.png|700px]] <br> What is the best initial therapy for this patient? | ||
|Explanation= | |Explanation=This patient;s presentation is classic for acute pericarditis. NSAIDs, such as ibuprofen, naproxen or indomethacin, are the best initial therapy for acute pericarditis. Management requires treatment for the underlying cause. The majority of cases, the specific cause of pericarditis is not identified, therefore they are assumed to be caused by Coxsackie B virus and treated with NSAIDs. Colchicine has been proved to decreased the recurrences. | ||
|AnswerA=Colchicine | |AnswerA=Colchicine | ||
|AnswerAExp=Colchicine may be used to prevent recurrences. | |AnswerAExp=[[Colchicine]] may be used to prevent recurrences. This pharmacological agent is used for the treatment of acute gout. It binds to tubulin inhibiting microtubule polymerization. | ||
|AnswerB=NSAIDs | |AnswerB=NSAIDs | ||
|AnswerBExp=NSAIDs is the correct answer. | |AnswerBExp=NSAIDs is the correct answer. NSAIDs, such as ibuprofen, naproxen or indomethacin, are the best initial therapy for acute pericarditis. | ||
|AnswerC=Morphine | |AnswerC=Morphine | ||
|AnswerCExp=Morphine is not the first drug of choice for acute pericarditis. | |AnswerCExp=[[Morphine]] is not the first drug of choice for acute pericarditis. | ||
|AnswerD=Prednisone | |AnswerD=Prednisone | ||
|AnswerDExp=Oral prednisone is used in acute pericarditis in addition to NSAIDs when pain persists, but is not the best initial therapy to use. | |AnswerDExp=Oral [[prednisone]] is used in acute pericarditis in addition to NSAIDs when pain persists, but is not the best initial therapy to use. | ||
|AnswerE=Diuretics | |AnswerE=Diuretics | ||
|AnswerEExp=Diuretics are used in the initial management of patients with chronic constrictive pericarditis, prior to surgical management. | |AnswerEExp=[[Diuretics]] are used in the initial management of patients with chronic constrictive pericarditis, prior to surgical management. | ||
|EducationalObjectives=NSAIDs, such as indomethacin and aspirin, are the best initial therapy for acute pericarditis. | |||
Colchicine decreases recurrences. | |||
|References=Master the Boards for Step 2CK, 2013 edition, page 99 | |||
|RightAnswer=B | |RightAnswer=B | ||
|WBRKeyword=NSAIDs, Pericarditis, Cardiology, Pharmacology | |||
|Approved=Yes | |Approved=Yes | ||
}} | }} | ||
Latest revision as of 23:05, 27 October 2020
| Author | PageAuthor::Raviteja Reddy Guddeti MBBS, Aarti Narayan MBBS (Reviewed by Gonzalo Romero) |
|---|---|
| Exam Type | ExamType::USMLE Step 2 CK |
| Main Category | MainCategory::Pharmacology, MainCategory::Internal medicine |
| Sub Category | SubCategory::Cardiology, SubCategory::Cardiovascular |
| Prompt | [[Prompt::A 35-year-old female presents to the ER with fever, weakness and pleuritic chest pain. The pain is relieved by sitting up and leaning forward. The patient states this pain gets worse when I take a deep breath, I try not to breath as much. Upon physical examination, her vital signs are within normal range. Auscultation of the heart reveals a friction rub. An EKG is performed and is depicted below:  What is the best initial therapy for this patient?]] |
| Answer A | AnswerA::Colchicine |
| Answer A Explanation | [[AnswerAExp::Colchicine may be used to prevent recurrences. This pharmacological agent is used for the treatment of acute gout. It binds to tubulin inhibiting microtubule polymerization.]] |
| Answer B | AnswerB::NSAIDs |
| Answer B Explanation | AnswerBExp::NSAIDs is the correct answer. NSAIDs, such as ibuprofen, naproxen or indomethacin, are the best initial therapy for acute pericarditis. |
| Answer C | AnswerC::Morphine |
| Answer C Explanation | [[AnswerCExp::Morphine is not the first drug of choice for acute pericarditis.]] |
| Answer D | AnswerD::Prednisone |
| Answer D Explanation | [[AnswerDExp::Oral prednisone is used in acute pericarditis in addition to NSAIDs when pain persists, but is not the best initial therapy to use.]] |
| Answer E | AnswerE::Diuretics |
| Answer E Explanation | [[AnswerEExp::Diuretics are used in the initial management of patients with chronic constrictive pericarditis, prior to surgical management.]] |
| Right Answer | RightAnswer::B |
| Explanation | [[Explanation::This patient;s presentation is classic for acute pericarditis. NSAIDs, such as ibuprofen, naproxen or indomethacin, are the best initial therapy for acute pericarditis. Management requires treatment for the underlying cause. The majority of cases, the specific cause of pericarditis is not identified, therefore they are assumed to be caused by Coxsackie B virus and treated with NSAIDs. Colchicine has been proved to decreased the recurrences. Educational Objective: NSAIDs, such as indomethacin and aspirin, are the best initial therapy for acute pericarditis.
Colchicine decreases recurrences. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::NSAIDs, WBRKeyword::Pericarditis, WBRKeyword::Cardiology, WBRKeyword::Pharmacology |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |