View source for WBR0361

{{WBRQuestion
|QuestionAuthor=Neeraja Danda M.B.B.S
|ExamType=USMLE Step 2 CK
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|Prompt=A 60 year old male who developed sudden chest pain associated with excessive sweating while having his lunch is brought to the emergency department . Electrocardiogram shows ST segment depression in leads V2-V4. Aspirin, Oxygen, Morphine and nitrates are given.Which of the following therapeutics are associated with a major mortality benefit in this patient?

|Explanation=Heparin, Glycoprotein IIb, IIIa inhibitors like Abciximab, tirofiban , Epifibatide and Angioplasty offer a significant mortality benefit in this patient.

'''Educational Objective:''' Heparin, Glycoprotein IIb, IIIa inhibitors like Abciximab, tirofiban , Epifibatide and Angioplasty offer great mortality benefits in ST depression or Non ST elevation myocardial infarction.

'''References:''' page 49 Master the boards Step 3 2009 edition, Page 69 Master the boards Step 2 CK second edition

|AnswerA=Thrombolysis

|AnswerAExp='''Incorrect''' Thrombolysis is never the treatment of choice in Non ST elevation or ST depression Myocardial infarction
|AnswerB=Exercise tolerance testing
|AnswerBExp='''Incorrect''' Exercise tolerance testing is performed to assess if the patient’s heart muscle getting enough oxygen in exertion. It  does not confer any mortality benefit.
|AnswerC=Nitroglycerine
|AnswerCExp='''Incorrect''' Nitroglycerine is useful but does not have clear mortality benefits
|AnswerD=Heparin, Glycoprotein IIb, IIIa inhibitors
|AnswerDExp='''Incorrect''' Option D is also correct but E includes angioplasty as well which makes it the best option
|AnswerE=Heparin, Glycoprotein IIb , IIIa inhibitors and Angioplasty
|AnswerEExp=Heparin, Glycoprotein IIb, IIIa inhibitors like Abciximab, tirofiban , Epifibatide and Angioplasty offer a significant mortality benefit in Non ST elevation myocardial infarction or ST depression infarctions.
|RightAnswer=E
|Approved=Yes
}}