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Old 10-09-2012
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Arrow Gyrus Daily Questions; Internal Medicine #49

A 54-year-old male is referred to your clinic for eval-uation of atrial fibrillation. He first noted the irregular heartbeat 2 weeks ago and presented to his primary care physician. He denies chest pain, shortness of breath, nau-sea, or gastrointestinal symptoms. Past medical history is unremarkable. There is no history of hypertension, dia-betes, or tobacco use. His medications include meto-prolol. The examination is notable for a blood pressure of 126/74 mmHg and a pulse of 64 beats/min. The jugular venous pressure is not elevated. His heart is irregularly ir-regular, with normal S 1 and S 2 . The lungs are clear, and there is no peripheral edema. An echocardiogram shows a left atrial size of 3.6 cm. Left ventricular ejection fraction is 60%. There are no valvular or structural abnormalities.
Which of the following statements regarding his atrial fi-brillation and stroke risk is true?
A. He requires no antiplatelet therapy or anticoagula-tion because the risk of embolism is low.
B. Lifetime warfarin therapy is indicated for atrial fibril-lation in this situation to reduce the risk of stroke.
C. He should be admitted to the hospital for intrave-nous heparin and undergo electrical cardioversion;
afterward there is no need for anticoagulation.
D. His risk of an embolic stroke is less than 1%, and he should take a daily aspirin.
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D. His risk of an embolic stroke is less than 1%, and he should take a daily aspirin.
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B I guess.
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D, he only requires daily aspirin

How do we tackle this kind of question? it is easy

we have to first know the CHADS2 scale, which is necessary to know how to approach patients with chronic a.fib, is a mnemonic
C: CHF.
H: Hypertension.
A: age greater than 75 years
D: Diabetes Mellitus
S2: prior history of stroke/TIA/Thromboembolism.

Score of 1 or less = aspirin.
1-2 is controversial because it can either be aspirin or warfarin with similar results (wont be asked on the exam because controversial stuff is not included in the USMLE)
greater than 2 : Warfarin

It has to be noticed that for the C,H,A,D if present you add a point BUT for the S2: any prior history of anything i mentioned automatically gives 2 points (thats why they put it as a "S2").

Hope it is clear
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D.
as because of low "0" score on CHADS2 scale.
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Quote:
Originally Posted by XpaezX View Post
D, he only requires daily aspirin

How do we tackle this kind of question? it is easy

we have to first know the CHADS2 scale, which is necessary to know how to approach patients with chronic a.fib, is a mnemonic
C: CHF.
H: Hypertension.
A: age greater than 75 years
D: Diabetes Mellitus
S2: prior history of stroke/TIA/Thromboembolism.

Score of 1 or less = aspirin.
1-2 is controversial because it can either be aspirin or warfarin with similar results (wont be asked on the exam because controversial stuff is not included in the USMLE)
greater than 2 : Warfarin

It has to be noticed that for the C,H,A,D if present you add a point BUT for the S2: any prior history of anything i mentioned automatically gives 2 points (thats why they put it as a "S2").

Hope it is clear
Welll explained Anwer is correct..
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D. His risk of an embolic stroke is less than 1%, and he should take a daily aspirin.
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Quote:
Originally Posted by aknz View Post
D. His risk of an embolic stroke is less than 1%, and he should take a daily aspirin.
he is back!
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Quote:
Originally Posted by XpaezX View Post
D, he only requires daily aspirin

How do we tackle this kind of question? it is easy
we have to first know the CHADS2 scale, which is necessary to know how to approach patients with chronic a.fib, is a mnemonic
Score of 1 or less = aspirin.
1-2 is controversial because it can either be aspirin or warfarin with similar results (wont be asked on the exam because controversial stuff is not included in the USMLE)
greater than 2 : Warfarin
Hope it is clear
Thanks for z great concepts
Plz can u explain to me how to manage patient with atrial fibrillation or atrial flutter
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Quote:
Originally Posted by DocSikorski View Post
he is back!
hahhaha

I didn`t refresh the page,posted my answer so thats why
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Quote:
Originally Posted by aknz View Post
hahhaha

I didn`t refresh the page,posted my answer so thats why
I mean, - haven't seen you since step 1 debates
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Quote:
Originally Posted by DocSikorski View Post
I mean, - haven't seen you since step 1 debates
Oh Ya,I was busy but I was silently following the posts and wanted to build up some concepts before start doing my contribution in questions.

BTW I am SHE
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Quote:
Originally Posted by aknz View Post
BTW I am SHE
Darn......now we have to mind our manners :sorry:
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Hahahhaha
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