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  #1  
Old 07-27-2011
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Question The greatest mortality decrease in this patient

A 55 y/o patient comes to the hospital with 1 to 2 hours of crushing substernal chest pain and ST-segment depression in V2-V4. He has a history of peptic ulcer disease and diabetes. He currently has melena. Which of the following will result in the greatest decrease in mortality?

(A) Angioplasty
(B) Metoprolol
(C) Captopril
(D) Nitrates
(E) Emergency bypass
(F) Tirofiban
(G) Aspirin
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Old 07-27-2011
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(C) Captopril is the answer

(A) Angioplasty for st elvation

(B) Metoprolol not use b blocker in dm

(D) Nitrates no benfit in mortality


(F) Tirofiban decrease mortality in st depression but use bf angography or stenting but he is pU so we dont use it (inhibit pletlets aggregate )
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Old 07-27-2011
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Quote:
Originally Posted by miss patho View Post
(C) Captopril is the answer

(A) Angioplasty for st elvation

(B) Metoprolol not use b blocker in dm

(D) Nitrates no benfit in mortality


(F) Tirofiban decrease mortality in st depression but use bf angography or stenting but he is pU so we dont use it (inhibit pletlets aggregate )
I must add that aspirin would be the correct answer in absence of melena.

Very tricky question!
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Old 07-28-2011
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Quote:
Originally Posted by podebrad View Post
A 55 y/o patient comes to the hospital with 1 to 2 hours of crushing substernal chest pain and ST-segment depression in V2-V4. He has a history of peptic ulcer disease and diabetes. He currently has melena. Which of the following will result in the greatest decrease in mortality?

(A) Angioplasty
(B) Metoprolol
(C) Captopril
(D) Nitrates
(E) Emergency bypass
(F) Tirofiban
(G) Aspirin
Its a NSTEMI from left anterior descending artery. i would say the greatest mortality decrease would be from an emergency bypass CABG.
although almost all of them decrease mortality.
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Old 07-28-2011
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i think its Aspirin...isn't it contraindicated in active bleeding???pt has history of peptic ulcer..
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Old 07-28-2011
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Default Answer with Explanation

Yes guys. I also thought this was a tricky question. I was lost.....

Answer:

(A) Angioplasty

Explanation:

The patient is presenting with unstable angina and a major contraindication to the use of anticoagulants. Angioplasty is the better way to open the artery and prevent further clot formation. Aspirin, heparin, thrombolytics, and the glycoprotein IIb/IIIa inhibitors, such as tirofiban or eptifibatide, cannot be used in patients with serious gastrointestinal bleeding. Beta-blockers will improve mortality but not as much as opening up the blood vessel with angioplasty. Emergency bypass is only performed in the rare case in which anticoagulants and angioplasty either don't work or are contraindicated and the patient is having worsening chest pain and signs of progression to congestive failure
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Old 07-28-2011
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Quote:
Originally Posted by busterbee View Post
i think its Aspirin...isn't it contraindicated in active bleeding???pt has history of peptic ulcer..
aspirin dont decrease mortality be careful
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Quote:
Originally Posted by podebrad View Post
Yes guys. I also thought this was a tricky question. I was lost.....

Answer:

(A) Angioplasty

Explanation:

The patient is presenting with unstable angina and a major contraindication to the use of anticoagulants. Angioplasty is the better way to open the artery and prevent further clot formation. Aspirin, heparin, thrombolytics, and the glycoprotein IIb/IIIa inhibitors, such as tirofiban or eptifibatide, cannot be used in patients with serious gastrointestinal bleeding. Beta-blockers will improve mortality but not as much as opening up the blood vessel with angioplasty. Emergency bypass is only performed in the rare case in which anticoagulants and angioplasty either don't work or are contraindicated and the patient is having worsening chest pain and signs of progression to congestive failure
y not captopril ????? from where this q
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Old 07-28-2011
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Quote:
Originally Posted by miss patho View Post
aspirin dont decrease mortality be careful

Aspirin decreases mortality the most in Acute coronary syndrome...

but regarding this particular Q with peptic ulcer history it's contraindicated...as podebrad says angioplasty will be most appropriate if there's contraindication to ASA use
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Originally Posted by busterbee View Post
Aspirin decreases mortality the most in Acute coronary syndrome...

but regarding this particular Q with peptic ulcer history it's contraindicated...as podebrad says angioplasty will be most appropriate if there's contraindication to ASA use
u r right in chronic angina best mortality benfit is aspirin and b blocker
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  #11  
Old 07-28-2011
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Quote:
Originally Posted by miss patho View Post
y not captopril ????? from where this q
These are few questions that I found in the library of my institution. It says easy but tricky...
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