Gyrus Daily Questions; Internal Medicine #6 - 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 09-18-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 720
Threads: 217
Thanked 552 Times in 309 Posts
Reputation: 562
Arrow Gyrus Daily Questions; Internal Medicine #6

A 54-year-old man presents to the emergency department with chest pain. He has had three episodes of chest pain in the past 24 h with exertion. Each has lasted 20–30 min and resolved with rest. His past medical history is significant for hypertension, hyperlipidemia, asthma, and chronic obstructive pulmonary disease. He currently smokes one pack/day of cigarettes. His family history is remarkable for early coronary artery disease in a sibling. Home medications include chlorthalidone, simvastatin, aspirin, albuterol, and home oxygen. In the emergency department, he becomes chest pain–free after receiving three sublingual nitroglycerin tablets and IV heparin. ECG shows 0.8 mm ST-segment depression in V5, V6, lead I and aVL. Cardiac biomarkers are negative. An exercise stress test shows inducible ischemia. Which aspects of this patient’s history add to the likelihood that he might have death, myocardial infarction (MI), or urgent revascularization in the next 14 days?

A. Age
B. Aspirin usage
C. Beta-agonist usage
D. Diuretic usage
Reply With Quote Quick reply to this message
The above post was thanked by:
step_enhancer (09-20-2012)



  #2  
Old 09-18-2012
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,327 Times in 711 Posts
Reputation: 1342
Default

D, probably the only one that doesnt decrease mortality and can probably worsen the O2 demand by decreasing Preload and inducing compensatory tachycardia.
Reply With Quote Quick reply to this message
The above post was thanked by:
cingulate.gyrus (09-18-2012)
  #3  
Old 09-20-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 720
Threads: 217
Thanked 552 Times in 309 Posts
Reputation: 562
Default

The answer is B.



Patients with unstable angina/non-ST-segment elevation myocardial infarction (UA/NSTEMI) exhibit a wide spectrum of risk of death, MI, or urgent revascularization. Risk stratification tools such as the TIMI risk score are useful for identifying patients who benefit from an early invasive strategy and those who are best suited for a more conservative approach. The TIMI risk score is composed of seven independent risk factors: Age ≥65, three or more cardiovascular risk factors, prior stenosis >50%, ST-segment deviation ≥0.5mm, two or more anginal events in <24 h, aspirin usage in the past 7 days, and elevated cardiac markers. Aspirin resistance can occur in 5–10% of
patients and is more common among those taking lower doses of aspirin. Having unstable angina despite aspirin usage suggests aspirin resistance. Use of a beta-agonist and a diuretic do not confer an independent risk for death, MI, or need for urgent revascularization.

Ref Harrison Chap. 238 17t edition
Reply With Quote Quick reply to this message
The above post was thanked by:
rigbbm (04-20-2016), step_enhancer (09-20-2012), XpaezX (09-20-2012)



Reply

Tags
Internal-Medicine-, Step-2-Questions

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
Gyrus Daily Questions; Internal Medicine #5 cingulate.gyrus USMLE Step 2 CK Forum 3 09-20-2012 02:27 AM
Gyrus Daily Questions; Internal Medicine #3 cingulate.gyrus USMLE Step 2 CK Forum 5 09-17-2012 10:42 AM
Gyrus Daily Questions; Internal Medicine #4 cingulate.gyrus USMLE Step 2 CK Forum 2 09-16-2012 05:15 PM
Gyrus Daily Questions; Internal Medicine #2 cingulate.gyrus USMLE Step 2 CK Forum 6 09-15-2012 01:46 AM
Gyrus Daily Questions; Internal Medicine #1 cingulate.gyrus USMLE Step 2 CK Forum 6 09-14-2012 10:06 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)