WBR0026

Author	PageAuthor::Raviteja Reddy Guddeti MBBS, Aarti Narayan MBBS (Reviewed by Gonzalo Romero)
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Pharmacology, MainCategory::Internal medicine
Sub Category	SubCategory::Cardiology, SubCategory::Cardiovascular
Prompt	[[Prompt::A 35-year-old female presents to the ER with fever, weakness and pleuritic chest pain. The pain is relieved by sitting up and leaning forward. The patient states this pain gets worse when I take a deep breath, I try not to breath as much. Upon physical examination, her vital signs are within normal range. Auscultation of the heart reveals a friction rub. An EKG is performed and is depicted below: What is the best initial therapy for this patient?]]
Answer A	AnswerA::Colchicine
Answer A Explanation	[[AnswerAExp::Colchicine may be used to prevent recurrences. This pharmacological agent is used for the treatment of acute gout. It binds to tubulin inhibiting microtubule polymerization.]]
Answer B	AnswerB::NSAIDs
Answer B Explanation	AnswerBExp::NSAIDs is the correct answer. NSAIDs, such as ibuprofen, naproxen or indomethacin, are the best initial therapy for acute pericarditis.
Answer C	AnswerC::Morphine
Answer C Explanation	[[AnswerCExp::Morphine is not the first drug of choice for acute pericarditis.]]
Answer D	AnswerD::Prednisone
Answer D Explanation	[[AnswerDExp::Oral prednisone is used in acute pericarditis in addition to NSAIDs when pain persists, but is not the best initial therapy to use.]]
Answer E	AnswerE::Diuretics
Answer E Explanation	[[AnswerEExp::Diuretics are used in the initial management of patients with chronic constrictive pericarditis, prior to surgical management.]]
Right Answer	RightAnswer::B
Explanation	[[Explanation::This patient;s presentation is classic for acute pericarditis. NSAIDs, such as ibuprofen, naproxen or indomethacin, are the best initial therapy for acute pericarditis. Management requires treatment for the underlying cause. The majority of cases, the specific cause of pericarditis is not identified, therefore they are assumed to be caused by Coxsackie B virus and treated with NSAIDs. Colchicine has been proved to decreased the recurrences. Educational Objective: NSAIDs, such as indomethacin and aspirin, are the best initial therapy for acute pericarditis. Colchicine decreases recurrences. References: Master the Boards for Step 2CK, 2013 edition, page 99]]
Approved	Approved::Yes
Keyword	WBRKeyword::NSAIDs, WBRKeyword::Pericarditis, WBRKeyword::Cardiology, WBRKeyword::Pharmacology
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::