WBR0356

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 52 year old female presented to urgent care with acute chest pain associated with nausea, and vomiting, which radiated to her left arm for the last 30 minutes. Electrocardiogram reveals ST segment elevation in II, III, aVF . Aspirin was administered. A medical center with a catheterization laboratory was within 30 minutes distance. What is the most appropriate step in the management of this patient?]]
Answer A	AnswerA::Immediately start thrombolysis
Answer A Explanation	AnswerAExp::'''Incorrect''' Thrombolysis would be the answer when we cannot arrange for a catheterization laboratory within 90 minutes.
Answer B	AnswerB::Start Heparin
Answer B Explanation	AnswerBExp::'''Incorrect''' Heparin is part of the initial treatment of Non ST elevation myocardial infarction after aspirin administration
Answer C	AnswerC::Start beta blockers
Answer C Explanation	AnswerCExp::'''Incorrect''' Beta blockers are important in the management of myocardial infarction but not time specific
Answer D	AnswerD::Immediately transfer the patient to the medical center
Answer D Explanation	AnswerDExp::Door to balloon time for angioplasty should be less than 90 minutes. The decision of whether to perform thrombolysis or angioplasty depends on whether or not a sufficiently low door to balloon time can be achieved
Answer E	AnswerE::Start Statins
Answer E Explanation	AnswerEExp::'''Incorrect''' Statins are important in lipid management with mortality benefits in Myocardial infarction patients but not time specific.
Right Answer	RightAnswer::D
Explanation	[[Explanation::Management of myocardial infarction depends on the time between the onset of symptoms and arrival in the ER. Typical “door to needle time” (for thrombolysis) is said to be 30 minutes but the mortality benefit extends until 12 hours after the onset of pain. Thombolysis is considered the best option only when angioplasty is not feasible. Otherwise angioplasty is the best treatment and typical door to balloon time is less than 90 minutes. In this case, the onset of pain was 30 minutes ago and time of travel to the medical center with a catheterization lab is 30 minutes, so the patient could undergo catheterization with less than a 90 minute door to balloon time. Thus, the best choice here is to transfer the patient immediately to the nearest medical center Educational Objective: Door to needle time for thrombolysis ought to be under 30 minutes but its mortality benefit extends until 12 hours after pain onset. Door to balloon time for angioplasty should be less than 90 minutes. The decision of whether to perform thrombolysis or angioplasty depends on whether or not a sufficiently low door to balloon time can be achieved. References: Page 67, 68, 69 Master the boards step 2 CK second edition Educational Objective: References: ]]
Approved	Approved::Yes
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