Cardiology - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 10-20-2011
drnrpatel's Avatar
Guest
 
Steps History: 1+CK+CS
Posts: 441
Threads: 153
Thanked 396 Times in 211 Posts
Reputation: 419
Default Cardiology

A 67-year-old man comes to the emergency department complaining of stuttering chest pain and shortness of breath. He has had similar episodes of pain, which usually occur with exertion, but none have lasted this long and in the past they have always resolved with rest. The patient has numerous cardiac risk factors, including a history of anginal chest pain, a 50-pack-year tobacco history, a family history of coronary heart disease, and dyslipidemia. A workup for acute coronary syndrome in the emergency room includes a set of cardiac enzymes, which are within normal limits, and an electrocardiogram, which shows T-wave inversions and 1-mm ST segment depression in an inferior distribution. The decision is made to anticoagulate the patient while coronary catheterization is being arranged. In choosing between low molecular-weight heparin and unfractionated heparin, which of the following is an argument in favor of unfractionated heparin?
A. Ease of administration
B. Improved cardiac outcomes
C. Lower overall hospital costs
D. Quicker onset of anticoagulation
E. Reversibility of anticoagulation
Reply With Quote Quick reply to this message



  #2  
Old 10-20-2011
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 537
Threads: 80
Thanked 344 Times in 138 Posts
Reputation: 376
Default

E. Reversibility of anticoagulation
Reply With Quote Quick reply to this message
  #3  
Old 10-20-2011
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 175
Threads: 13
Thanked 241 Times in 59 Posts
Reputation: 251
Default

a b c and d are all wrong ( i think )so that leaves e reversability
Reply With Quote Quick reply to this message
 
  #4  
Old 10-20-2011
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 537
Threads: 80
Thanked 344 Times in 138 Posts
Reputation: 376
Default

yeah enoxaparin cannot b reversed with protamine according to step 1 first taid..
Reply With Quote Quick reply to this message
The above post was thanked by:
docnas (10-20-2011)
  #5  
Old 10-20-2011
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 175
Threads: 13
Thanked 241 Times in 59 Posts
Reputation: 251
Default

I used the process of elimination to get that answer thanks for confirming about the irreversability.
Reply With Quote Quick reply to this message
  #6  
Old 10-20-2011
drnrpatel's Avatar
Guest
 
Steps History: 1+CK+CS
Posts: 441
Threads: 153
Thanked 396 Times in 211 Posts
Reputation: 419
Default Answer

The correct answer is E. In general, studies comparing low molecular-weight heparin and unfractionated heparin in acute coronary syndrome favor low molecular-weight heparin. However, one of the advantages of unfractionated compared with low molecular-weight heparin is that the unfractionated can be fully reversed with protamine.

Low molecular-weight heparin is generally given as a subcutaneous twice-daily injection for the treatment of acute coronary syndromes. It is easier to administer (choice A) than unfractionated heparin, which requires a continuous infusion.

Unfractionated heparin, compared with low molecular-weight formulations, has not been associated with improved outcomes (choice B). Indeed, while a mortality benefit has yet to be proven, studies have indicated that low molecular-weight heparin may be associated with improved cardiac outcomes.

Unfractionated heparin is a less expensive medication than low molecular-weight heparin. However, when the administrative costs are factored in, such as the laboratory and nursing costs associated with frequent monitoring of the partial thromboplastin time, unfractionated heparin is associated with higher overall hospital costs (choice C).

Low molecular-weight heparin has more predictable dosing effects and is associated with a quicker onset of anticoagulation (choice D) than is unfractionated heparin.
Reply With Quote Quick reply to this message
The above post was thanked by:
sonu.agarwall (10-21-2011)



Reply

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Cardiology drnrpatel USMLE Step 2 CK Forum 5 10-20-2011 08:04 PM
Screening a an overweight person with strong family history of MI drnrpatel USMLE Step 2 CK Forum 6 10-20-2011 07:55 PM
Cardiology drnrpatel USMLE Step 2 CK Forum 7 10-20-2011 09:32 AM
Cardiology drnrpatel USMLE Step 2 CK Forum 7 10-20-2011 08:23 AM
Cardiology drnrpatel USMLE Step 2 CK Forum 5 10-20-2011 07:11 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)