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Old 10-10-2012
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Arrow Billy Step 1 Questions # 24

A 68-year-old woman has had increasing dyspnea and orthopnea for the past year. She does not report any chest pain. On physical examination, her temperature is 36.9°C, pulse is 77/min, respirations are 20/min, and blood pressure is 140/90 mm Hg. On auscultation of the chest, diffuse crackles are heard in all lung fields. No murmurs or gallops are heard, and the heart rate is regular. A chest radiograph shows prominent borders on the left and right sides of the heart. Coronary angiography shows 60% proximal occlusion of the right coronary and circumflex arteries, and 50% occlusion over the first 3 cm of the left anterior descending artery. Echocardiography shows no valvular abnormalities, but there is decreased left ventricular wall motion and an ejection fraction of 33%. Laboratory studies show serum glucose of 81 mg/dL, creatinine of 1.6 mg/dL, total cholesterol of 326 mg/dL, triglyceride of 169 mg/dL, and troponin I of 1 ng/mL. Which of the following pharmacologic agents is most likely to be beneficial in the treatment of this patient?


□ (A) Amiodarone
□ (B) Glyburide
□ (C) Nitroglycerin
□ (D) Propranolol
□ (E) Simvastatin
□ (F) Alteplase
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is it simvastatin to prevent further occlusion to the cardiac vessel...
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mostly E) simvastatin...but not sure

thanks
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I would choose D) Propranolol, because she has congestive heart failure and beta blockers are known for decreasing the myocardial work and have an effect on long time mortality. Her heart rate is good so I think propranolol with be the most beneficial for her.
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Default my answer :)

(E) Simvastatin
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□ (A) Amiodarone
□ (B) Glyburide
□ (C) Nitroglycerin
□ (D) Propranolol
□ (E) Simvastatin
□ (F) Alteplase[/QUOTE]

Considering his cholesterol and TG.
I would go for e. simvastatin.



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Correct Answer E is correct

This patient has findings suggestive of an “ischemic” cardiomyopathy from coronary atherosclerosis, but she does
not seem to have an acute coronary syndrome. The major identifiable risk factor in this case is hypercholesterolemia, and
the HMG-CoA reductase inhibitors (the “statin” drugs) are helpful. Amiodarone is used to treat intractable arrhythmias.
Glyburide is used in the treatment of type 2 diabetes mellitus, but this patient is not hyperglycemic. Nitroglycerin is used to
treat angina. Propranolol is a β-blocker that has been used to treat hypertension, and it may exacerbate bradycardia and
congestive heart failure. Alteplase (tissue plasminogen activator) is used early in treatment of coronary thrombosis to help
re-establish coronary blood flow
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Quote:
Originally Posted by Teona View Post
I would choose D) Propranolol, because she has congestive heart failure and beta blockers are known for decreasing the myocardial work and have an effect on long time mortality. Her heart rate is good so I think propranolol with be the most beneficial for her.
Hey nice point. Even I remember doing a question regarding this concept.
But in this case I think as b blockers increases TG. So I would say. Propranolol will pre dispose this patient for increased risk of AMI.
Anyways u might be right thou.. ;-)


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Cardiovascular-, Pathology-, Pharmacology-, Step-1-Questions

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