A 60-year-old morbidly obese man presents with complaints of fatigue, worsening exertional dyspnea, three-pillow orthopnea, lower extremity edema, and cough occasionally productive of frothy sputum. He has a long-standing history of type II diabetes and hypertension. On examination, you note the presence of bibasilar rales, an S3 gallop, jugular venous distention, and 2+ pitting edema in both legs up to the knees.There does not appear to be an arrhythmia present.Which test would be most sensitive for diagnosis of this condition?
Answer(s): D
This patient's presentation is most consistent with pulmonary edema from decompensated CHF. The BNP test has been found to be both sensitive and specific for the diagnosis of CHF. It can be a very useful test to order when a patient is dyspneic to help to determine if CHF is the cause. Troponin, CK- MB, and LDH are markers of damage to cardiac muscle and can be diagnostic in a MI. While MI can be a cause of CHF, and most patients presenting with CHF will have cardiac enzymes drawn as part of their evaluation, cardiac enzymes are neither sensitive nor specific for CHF. Similarly, a CXR can determine the presence of pulmonary edema but not its cause.Acute pulmonary edema secondary to CHF will require management with diuresis for acute symptomatic relief. ACE inhibitors and beta-blockers do decrease mortality and morbidity in CHF; however their use in acute decompensated heart failure is suspected as they may induce hypotension and further cardiogenic shock. Digoxin is used for symptomatic relief either when other modalities fail or when rate control from atrial fibrillation is an issue. In patients with CHF and atrial fibrillation, beta- blockers have shown better effect and reduced morbidity than digoxin. Nevertheless, in the acute setting of decompensated heart failure with pulmonary edema, diuresis is the optimal initial treatment, not digoxin. In chronic heart failure, digoxin is reserved for patients with systolic failure that are symptomatic despite adequate ACE inhibitor and beta-blocker use. Furosemide is effective in treating the acute pulmonary edema associated with CHF by virtue of its potent diuretic action, which rapidly eliminates excess body fluid volume.
A 60-year-old morbidly obese man presents with complaints of fatigue, worsening exertional dyspnea, three-pillow orthopnea, lower extremity edema, and cough occasionally productive of frothy sputum. He has a long-standing history of type II diabetes and hypertension. On examination, you note the presence of bibasilar rales, an S3 gallop, jugular venous distention, and 2+ pitting edema in both legs up to the knees. There does not appear to be an arrhythmia present. Which of the following medications should be given initially?
Answer(s): C
A 60-year-old morbidly obese man presents with complaints of fatigue, worsening exertional dyspnea, three-pillow orthopnea, lower extremity edema, and cough occasionally productive of frothy sputum. He has a long-standing history of type II diabetes and hypertension. On examination, you note the presence of bibasilar rales, an S3 gallop, jugular venous distention, and 2+ pitting edema in both legs up to the knees. There does not appear to be an arrhythmia present. Which of the following has been shown to prolong survival in patients with this condition?
A 60-year-old morbidly obese man presents with complaints of fatigue, worsening exertional dyspnea, three-pillow orthopnea, lower extremity edema, and cough occasionally productive of frothy sputum. He has a long-standing history of type II diabetes and hypertension. On examination, you note the presence of bibasilar rales, an S3 gallop, jugular venous distention, and 2+ pitting edema in both legs up to the knees.There does not appear to be an arrhythmia present.A transesophageal echocardiogram (TEE) is performed which reveals a left ventricular ejection fraction (LVEF) of 30%. Which of the following accurately describes this patient and his condition?
A 70-year-old male is seen in the office for chest pain. He reports that he is getting substernal chest pain, without radiation, when he mows his lawn. The pain resolves with 1015 minutes of rest. He has never had pain at rest. He has no other cardiac complaints and his review of systems is otherwise negative. He has an unremarkable medical history and takes only a baby aspirin a day. On examination, his blood pressure is 160/70, pulse 85, and respiratory rate 16. His cardiac examination is notable for a harsh, 3/6 systolic ejection murmur along the sternal border that radiates to the carotid arteries. His carotid pulsation is noted to rise slowly and is small and sustained. His lungs are clear. The remainder of his examination is normal.Which of the following would be most likely to be seen on an ECG?
Aortic stenosis is one of the most common valvular abnormalities found in adults. It can be congenital -- such as a unicuspid or bicuspid valve--or acquired. In young adults, acquired aortic stenosis is often seen as a consequence of rheumatic fever. This is becoming less common in developed nations. In adults over the age of 65, the most common cause of aortic stenosis is age-related degenerative, calcific aortic stenosis. The valvular cusps are immobilized and the stenosis caused by calcium deposits along the flexion lines of the valves. Acquired aortic stenosis typically has a prolonged asymptomatic period. During this time the stenosis may be found incidentally by auscultation of the characteristic harsh, holosystolic murmur in the aortic valve area that radiates to the carotid arteries. There may also be a slow, small, and sustained arterial pulsation (pulsus parvus and tardus) due to the relative outflow obstruction. The cardinal symptoms of aortic stenosis that signal advancing disease, and increased risk of mortality, are angina, heart failure, and syncope. An ECG will show left ventricular hypertrophy in approximately 85% of symptomatic cases of aortic stenosis.A normal ECG is possible but would be more likely in early, asymptomatic stages. S-T segment elevation would be more consistent with acute cardiac ischemia and Q waves would be more consistent with a completed MI. Low-voltage QRS complexes can be seen in several conditions, including pericardial effusion, COPD, or obesity. When considering the diagnosis of aortic stenosis, the initial diagnostic test of choice would be echocardiography. It would provide information on both the structure (bicuspid, tricuspid, and the like) and the function (valve area, pressures) of the valve. The size and function of the left ventricle can also be determined. If aortic stenosis is found on echocardiogram and the patient is symptomatic, the next test would be cardiac catheterization.This would allow for direct measurement of the pressure gradient across the valve. It would also allow for evaluation of the status of the coronary arteries in order to determine whether CABG would need to be performed along with valve replacement. Exercise stress testing is relatively contraindicated in the setting of symptomatic aortic stenosis. Holter monitoring would only be useful if there were a concomitant arrhythmia. Electrophysiologic studies would not play a role in the typical evaluation of aortic stenosis.
Share your comments for USMLE STEP3 exam with other users:
easy questions
could you please upload ad0-127 dumps
good content
understanding about joins
please upload oracle cloud infrastructure 2023 foundations associate exam braindumps. thank you.
questions made studying easy and enjoyable, passed on the first try!
has anyone recently attended safe 6.0 exam? did you see any questions from here?
question 13 should be dhcp option 43, right?
the buy 1 get 1 is a great deal. so far i have only gone over exam. it looks promissing. i report back once i write my exam.
is this dump good
good ................
passed
yes going good
good questions for practice
need dump and sap notes for c_s4cpr_2308 - sap certified application associate - sap s/4hana cloud, public edition - sourcing and procurement
question 11: d i personally feel some answers are wrong.
nice questions
looking for c1000-158: ibm cloud technical advocate v4 questions
can you share the pdf
admin ii is real technical stuff
could you post the link
hello send me dumps
it is very nice
i gave the amazon dva-c02 tests today and passed. very helpful.
there is an incorrect word in the problem statement. for example, in question 1, there is the word "speci c". this is "specific. in the other question, there is the word "noti cation". this is "notification. these mistakes make this site difficult for me to use.
passed my az-120 certification exam today with 90% marks. studied using the dumps highly recommended to all.
i need it, plz make it available
q47: intrusion prevention system is the correct answer, not patch management. by definition, there are no patches available for a zero-day vulnerability. the way to prevent an attacker from exploiting a zero-day vulnerability is to use an ips.
this is simple but tiugh as well
questão 4, segundo meu compilador local e o site https://www.jdoodle.com/online-java-compiler/, a resposta correta é "c" !
its very useful
i mastered my skills and aced the comptia 220-1102 exam with a score of 920/1000. i give the credit to for my success.
real questions
very helpful assessments