WBR0353
| Author | PageAuthor::Neeraja Danda M.B.B.S |
|---|---|
| Exam Type | ExamType::USMLE Step 2 CK |
| Main Category | MainCategory::Internal medicine |
| Sub Category | SubCategory::Cardiovascular |
| Prompt | [[Prompt::A 65 year old female patient came to the emergency department with severe chest pain for the last one hour associated with excessive sweating and dyspnea. She describes the pain as dull and radiating to her left arm. She has a history of hypertension and diabetes mellitus for the last 20 years .Electrocardiogram shows ST segment elevation in V1 and V2 . What is the most appropriate next step in the management?]] |
| Answer A | AnswerA::Angiogram and Angioplasty |
| Answer A Explanation | AnswerAExp::'''Incorrect''' Angiogram and angioplasty also offer a mortality benefit and should be performed within 90 minutes in ST elevation myocardial infarction. However, aspirin must be given first. |
| Answer B | AnswerB::Oxygen, Nitrates, Morphine |
| Answer B Explanation | AnswerBExp::'''Incorrect''' Oxygen, Nitrates, Morphine are also part of the standard of care for myocardial infarction but do not lower mortality. |
| Answer C | AnswerC::Echocardiogram |
| Answer C Explanation | AnswerCExp::'''Incorrect''' Echocardiogram does not play any immediate role in managing Myocardial infarction. |
| Answer D | AnswerD::Aspirin |
| Answer D Explanation | AnswerDExp::Aspirin is the best initial therapy in all cases of myocardial infarction unless the patient has contraindications |
| Answer E | AnswerE::Clopidogrel |
| Answer E Explanation | AnswerEExp::'''Incorrect''' Clopidogrel is used in patients with contraindications to Aspirin use such as rare instances of aspirin allergy |
| Right Answer | RightAnswer::D |
| Explanation | [[Explanation::Aspirin is the best initial therapy in all cases of myocardial infarction unless the patient has contraindications. Aspirin inhibits platelet aggregation and thus prevents occlusive thrombus formation in blood vessels.Aspirin is associated with a significant mortality benefit and is the most appropriate next step in this patient
Educational Objective: Aspirin inhibits platelet aggregation and thus further clot formation in coronary vessels.It offers a significant mortality benefit in both ST segment elevation myocardial infarction and unstable angina.It should be the first drug to be given to all patients with myocardial infarction. References: Page 64, 68 Master the boards Step 2 CK second edition |
| Approved | Approved::Yes |
| Keyword | |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |