WBR0355

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 50 year old male presented to the emergency department with severe substernal chest pain for the last 30 minutes. Electrocardiogram reveals ST segment elevation in leads V1 and V2. His past medical history is significant for rheumatoid arthritis and an episode of anaphylaxis when treated with aspirin for his arthritic pain.What is the next best step in managing this patient?]]
Answer A	AnswerA::Angioplasty
Answer A Explanation	AnswerAExp::'''Incorrect''' Angioplasty is the best management option for ST elevation Myocardial infarction , but management should begin with an anti platelet aggregate to prevent further clot formation
Answer B	AnswerB::Aspirin
Answer B Explanation	AnswerBExp::'''Incorrect''' Aspirin should not be used here as the patient had anaphylaxis .
Answer C	AnswerC::Thrombolysis
Answer C Explanation	AnswerCExp::'''Incorrect''' Thrombolysis is the best treatment option in ST elevation infarctions when an angiogram is not feasible. However, an antiplatelet agent should be the first step in the management of patients with MI. .
Answer D	AnswerD::Clopidogrel
Answer D Explanation	AnswerDExp::Clopidogrel is the next best alternative for the initial management of myocardial Infarction when the patient has contraindications for the use of Aspirin
Answer E	AnswerE::Cardiac enzymes
Answer E Explanation	[[AnswerEExp::Incorrect Cardiac enzymes start rising after an hour of Infarction , so not the best next step here. On the base of electrocardiogram findings and patient history there is enough evidence to begin therapy for MI, starting with an antiplatelet agent.]]
Right Answer	RightAnswer::D
Explanation	[[Explanation::Aspirin is always the best Initial therapy for myocardial Infarction unless the patient has contraindications, such as aspirin allergy. This patient has an aspirin allergy, as evidenced by anaphylaxis upon exposure previously. Antiplatelet therapy is still necessary, and the best choice for this patient is Clopidogrel . Clopidogrel blocks platelet aggregation by irreversibly inhibiting the ADP receptor on platelets. Educational Objective: Clopidogrel is the next best alternative for the initial management of myocardial Infarction when the patient has contraindications for the use of Aspirin, such as allergy and anaphylaxis. References: Page 64, 68 Master the boards step 2 CK second edition Educational Objective: References: ]]
Approved	Approved::Yes
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