WBR0998

Author	PageAuthor::
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Emergency Room
Sub Category	SubCategory::Cardiovascular
Prompt	[[Prompt::A 62 year-old man comes to ED complaining of acute shortness of breath, fatigue, and worsening exertional dyspnea. He hardly can talk, and mentioned waking up several times at night on sever cough with frothy sputum. He used to sleep on two pillows but now he is using three. The patient has past medical history of hypertension for 15 years, and diabetes mellitus for 20 years. On examination, his BP 90/70, pulse 120, respiratory rate 28, and temperature is 36.9 C (98.5F). Chest examination revealed decreased breath sounds and dullness at both bases with bibasilar rales. Cardiac examination revealed diffuse, laterally and inferiorly displaced apex, with distant heart sounds and S3 gallop. There is a jugular venous distention, with JVP of 12 cm, and oxygen saturation of 83%. Extremities are cool and show 2+ pitting edema in both legs up to the knees. Which of the following has been shown to reduce mortality in patients with this condition?]]
Answer A	AnswerA::Digoxin
Answer A Explanation	[[AnswerAExp::Incorrect Digoxin has been shown to improve symptoms in patients with severe CHF; however, it has no effect on mortality due to its proarrhythmic effect]]
Answer B	AnswerB::Nonsteroidal anti-inflammatory drugs
Answer B Explanation	[[AnswerBExp::Incorrect Nonsteroidal anti-inflammatory drugs don’t reduce mortality in patients with CHF.]]
Answer C	AnswerC::Warfarin
Answer C Explanation	[[AnswerCExp::Incorrect Warfarin should be considered in patients who have a previous history of thromboembolism or atrial fibrillation]]
Answer D	AnswerD::Carvedilol
Answer D Explanation	[[AnswerDExp::Correct Beta-adrenergic antagonists (metoprolol, bisoprolol, and carvedilol) have been proven to reduce mortality in patients with CHF.]]
Answer E	AnswerE::Diltiazem
Answer E Explanation	[[AnswerEExp::Incorrect Calcium channel blockers such as diltiazem should be avoided in patients with impaired left ventricular function due to negative inotropic effects.]]
Right Answer	RightAnswer::D
Explanation	[[Explanation::ACE inhibitors and some beta-adrenergic antagonists (metoprolol, bisoprolol, and carvedilol) have been proven to reduce mortality in patients with CHF. Related to WBR0996 Educational Objective: References: ]]
Approved	Approved::No
Keyword	[[WBRKeyword::Pulmonary edema]], [[WBRKeyword::CHF]]
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::