WBR0358

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 55 year old female who underwent total abdominal hysterectomy 10 days ago presented to urgent care with acute chest pain associated with nausea, and vomiting that has radiated to the left arm for 45 minutes. Electrocardiogram reveals ST segment elevation in V2-V4 . Aspirin was given. A medical center with a catheterization laboratory was in one hour distance. What is the most appropriate step in further managing this patient?]]
Answer A	AnswerA::Transport her to the medical center
Answer A Explanation	AnswerAExp::In this situation anticipated door to balloon time is greater than 90 minutes which typically favors thrombolytic therapy. However, transfer to the medical center for angioplasty is correct in this case becase thrombolysis is contraindicated
Answer B	AnswerB::Start tPA
Answer B Explanation	AnswerBExp::'''Incorrect''' tPA is contraindicated as the patient undergone total abdominal hysterectomy within last 2 weeks
Answer C	AnswerC::Start calcium channel blockers
Answer C Explanation	AnswerCExp::'''Incorrect''' Calcium channel blockers are mainly used in managing Prinzmetal’s angina and Cocaine related myocardial infarction.
Answer D	AnswerD::Start Glycoprotein IIb, IIIa Inhibitors
Answer D Explanation	AnswerDExp::'''Incorrect''' Glycoprotein IIb, IIIa inhibitors offer mortality benefits in ST depression myocardial infarction
Answer E	AnswerE::Measure Cardiac enzymes
Answer E Explanation	AnswerEExp::'''Incorrect''' Cardiac enzymes start to rise one hour after pain onset. They should be measured but arranging for angioplasty is the best next step here
Right Answer	RightAnswer::A
Explanation	[[Explanation::In this case, the anticipated door to balloon time is greater than 90 minutes which typically favors thrombolytic therapy. However, transfer to the medical center for angioplasty is correct in this case because thrombolysis is contraindicated. Contraindications for thrombolysis include major bleeding ( melena, brain hemorrhage), major surgery within last 2 weeks , and blood pressure over 180/110 .In these situations, angioplasty is the best choice even if door to balloon times exceed 90 minutes. Educational Objective: Contraindications for thrombolysis include major bleeding (melena, brain hemorrhage), major surgery within last 2 weeks, and blood pressure over 180/110 , In these situations, angioplasty is the best choice even if door to balloon times exceed 90 minutes. References: Page 67, 68,69 Master the boards step 2 CK second edition Educational Objective: References: ]]
Approved	Approved::Yes
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