WBR0991

Author	[[PageAuthor::Mohamed Moubarak, M.D. [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Emergency Room
Sub Category	SubCategory::Cardiovascular
Prompt	[[Prompt::A 59 year- old male comes to ED complaining of chest pain. The pain started while he was watching TV 30 minutes ago, and radiating to the left shoulder. His pain is dull constant in nature, and it is accompanied by diaphoresis and nausea. EKG is normal, and his Troponin levels are elevated. The patient has been given oxygen, nitrates, morphine, and aspirin. Which of the following is the best next step in managing this patient?]]
Answer A	AnswerA::Thrombolytic
Answer A Explanation	[[AnswerAExp::Incorrect In NSTEMI thrombolytic do not lower mortality. Thrombolytic used only if there is ST segment elevation or a new LBBB within 12 hours of the onset of chest pain.]]
Answer B	AnswerB::Low molecular weight heparin
Answer B Explanation	[[AnswerBExp::Correct In NSTEMI heparin is used routinely.]]
Answer C	AnswerC::Metoprolol
Answer C Explanation	[[AnswerCExp::Incorrect Metoprolol is not used as the first line in NSTEMI]]
Answer D	AnswerD::Order CK-MB
Answer D Explanation	[[AnswerDExp::Incorrect No use to repeat CK-MB now in this case, CK-MB is elevated for 2-3 days]]
Answer E	AnswerE::Stress test
Answer E Explanation	[[AnswerEExp::Incorrect The patient in NSTEMI and no need for stress test in this case.]]
Right Answer	RightAnswer::B
Explanation	[[Explanation::Non ST Segment Elevation Myocardial Infarction (NSTEMI) management is different in that there is no use of thrombolytic, heparin is used routinely, glycoprotein IIb/IIIa lower mortality particularly in those undergoing angioplasty. Educational Objective: References: ]]
Approved	Approved::No
Keyword	[[WBRKeyword::NSTEMI]]
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::