WBR0372

Author	PageAuthor::Mahmoud Sakr M.D.
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Cardiovascular
Prompt	[[Prompt::47 y/o African American male patient comes to the emergency department with severe chest pain radiating to his left jaw for 45 minutes. He describes his pain as constant, and dull in nature. It is accompanied by diaphoresis and nausea. He admits to smoking 2 packs of cigarettes per day. His Blood pressure is 145/92, Pulse is 103, RR 18, and temperature is 96.7. He received oxygen, aspirin and IV morphine upon arrival. His EKG only shows ST segment depression in leads 2,3,AVF. His cardiac markers are normal. What is the most appropriate next step in management.]]
Answer A	AnswerA::IV benzodiazepines
Answer A Explanation	AnswerAExp::IV benzodiazepines are reasonable in a case of cocaine induced MI or significant anxiety. No such history of here.
Answer B	AnswerB::IV alteplase
Answer B Explanation	AnswerBExp::PCI have been proven superior to IV thrombolytics and are now rarely used unless PCI is not available or arrival to a PCI lab would not be timely. Therefore it would not be the next step in management here.
Answer C	AnswerC::SC low molecular weight heparin
Answer C Explanation	[[AnswerCExp::Correct! This patient is likely having a non-STEMI given the presentation and EKG changes. He would benefit from the medical therapy mentioned and also from anticoagulation. Therefore, a dose of SC low molecular weight heparin would be the most important next step in management.]]
Answer D	AnswerD::Cardiac catheterization
Answer D Explanation	AnswerDExp::If the patient was having a STEMI, then this answer would be correct, however no signs of ST elevation mentioned, therefore anticoagulation and further cardiac workup is reasonable here.
Answer E	AnswerE::Cardiology consultation
Answer E Explanation	AnswerEExp::Cardiology consultation may eventually be needed, however it is not the next step in management.
Right Answer	RightAnswer::C
Explanation	[[Explanation::This patient is likely having a non-STEMI given the presentation and EKG changes. He would benefit from the medical therapy mentioned and also from anticoagulation. Therefore, a dose of SC low molecular weight heparin would be the most important next step in management. Cardiac markers should be obtained, if they are positive, then a definite diagnosis of MI will be made and consultation with a cardiologist is warranted for further intervention. Educational Objective: References: ]]
Approved	Approved::Yes
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