American College of Physicians: Internal Medicine — Doctors for Adults ®

Advertisement

The MKSAP Challenge

From the April ACP Observer, copyright © 2004 by the American College of Physicians.

Clinical scenario

A 56-year-old postmenopausal woman is brought to the emergency department by ambulance because of the onset of severe substernal burning pain and progressive dyspnea beginning 3 hours ago. She has taken four sublingual nitroglycerin tablets belonging to her husband, and continues to have severe chest pain.

On physical examination, her respiration rate is 30/min, her pulse rate is 108/min, her blood pressure is 80/60 mm Hg, and her oxygen saturation is 90% on an oxygen face mask. She appears anxious. Her jugular venous pressure is 15 mm Hg. She has inspiratory crackles three-quarters up both lung fields. She has an S3 gallop with no murmur.

Her electrocardiogram shows sinus tachycardia with 3-mm ST-segment elevation in leads V2-6. She is given a chewable aspirin and intravenous heparin, and is started on dopamine.

What is the most appropriate management for this patient?

A. Urgent coronary angiography and possible coronary revascularization
B. Immediate thrombolysis
C. Placement of an intra-aortic balloon pump
D. Intravenous nitroglycerin
E. Intravenous beta-blocker

Answer

Top

This is a printer-friendly version of this page

Print this page  |  Close the preview

Share

 
 

Internist Archives Quick Links

ACP JournalWise

Reviews of the World's Top Medical Journals—FREE to ACP Members!

New CME Option: Internal Medicine 2014 RecordingsACP JournalWiseSM is mobile optimized with optional email alerts! Get access to reviews from over 120 of the world’s top medical journals alerting you to the highest quality, most clinically relevant new articles based on your preferred areas of specialty. ACP Members register your FREE account now!

New CME Option: Internal Medicine 2014 Recordings

New CME Package

New CME Option: Internal Medicine 2014 RecordingsIncludes 75 of the most popular sessions in internal medicine and the subspecialties. Stream the sessions, answer brief quizzes and earn CME credit. See details.