USMLE Forum Archives - USMLE Step 2 CK - IM- Sudden SOB
IM- Sudden SOB
HIV - 01-02-08 13:11
A 58-year-old man is evaluated for acute dyspnea and hypotension of 1-hour’s duration. He was hospitalized for fevers, chills, and weight loss after a routine dental cleaning 2 weeks ago. Blood cultures were positive for gram-positive cocci. Echocardiography showed a mobile, soft-tissue density mass on the aortic valve. Therapy with intravenous vancomycin and gentamicin was begun, and the patient was doing well until this morning.
On physical examination, his heart rate is 108/min, respiration rate is 52/min, and blood pressure is 84/54 mm Hg. The cardiac apex is not displaced, murmurs are not heard, but diffuse crackles are present. After initiation of mechanical ventilation, portable chest radiography shows a normal cardiac silhouette and interstitial edema. Repeat electrocardiography shows sinus tachycardia and T-wave inversion in the inferior and lateral leads. Echocardiography shows severe aortic regurgitation.
Which of the following is the best immediate therapy for this patient?
( A ) Intravenous heparin and a ventilation-perfusion scan
( B ) Intravenous β-blockers and an angiotensin-converting enzyme inhibitor
( C ) Intravenous isoproterenol and nitroprusside
( D ) Intravenous furosemide and an aortic balloon pump
( E ) Left heart catheterization
HIV - 01-02-08 13:11
A 58-year-old man is evaluated for acute dyspnea and hypotension of 1-hour’s duration. He was hospitalized for fevers, chills, and weight loss after a routine dental cleaning 2 weeks ago. Blood cultures were positive for gram-positive cocci. Echocardiography showed a mobile, soft-tissue density mass on the aortic valve. Therapy with intravenous vancomycin and gentamicin was begun, and the patient was doing well until this morning.
On physical examination, his heart rate is 108/min, respiration rate is 52/min, and blood pressure is 84/54 mm Hg. The cardiac apex is not displaced, murmurs are not heard, but diffuse crackles are present. After initiation of mechanical ventilation, portable chest radiography shows a normal cardiac silhouette and interstitial edema. Repeat electrocardiography shows sinus tachycardia and T-wave inversion in the inferior and lateral leads. Echocardiography shows severe aortic regurgitation.
Which of the following is the best immediate therapy for this patient?
( A ) Intravenous heparin and a ventilation-perfusion scan
( B ) Intravenous β-blockers and an angiotensin-converting enzyme inhibitor
( C ) Intravenous isoproterenol and nitroprusside
( D ) Intravenous furosemide and an aortic balloon pump
( E ) Left heart catheterization
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#3
Re: im TheOne - 01-04-08 00:47 Good question wow. Hey HIV, where do you get all these good questions from? Just wondering. Good job btw.
#4
Re: IM- Sudden SOB funtonic - 01-08-08 17:52 ( A ) Intravenous heparin and a ventilation-perfusion scan
#5
Re: IM- Sudden SOB 8401glacieres - 01-09-08 05:00 Intravenous Nitroprusside and Isoprotrenelol to augument forward flow and decrease LV end diastolic pressure. This also helps in borrowing some time so that the patient is prepared for emergency surgery.
Ballon pump is contraindicated in AS.
B-blockers should be used with caution if at all.Many would not prefer them.
#8
Re: IM- Sudden SOB babbu5508 - 07-07-10 21:29 ( A ) Intravenous heparin and a ventilation-perfusion scan .....to know the amount of compromise of the circulation......btw,what's the ans?
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