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

Advertisement

The MKSAP Challenge

From the May ACP Observer, copyright 2006 by the American College of Physicians.

Clinical Scenario

A 58-year-old man with a history of congestive heart failure develops psoriatic arthritis. He has chronic stable exertional dyspnea but no chest pain or orthopnea. Medications are warfarin, aspirin, a statin, an angiotensin-converting enzyme inhibitor and a beta-blocker.

On physical examination, pulse rate is 66/min and irregular, respiration rate is 12/min, and blood pressure is 130/60 mm Hg. There is no jugular venous distention, and the lungs are clear to auscultation. An electrocardiogram reveals atrial fibrillation, a previous anterior myocardial infarction and an incomplete left bundle-branch block. An echocardiogram shows a left ventricular ejection fraction of 38%.

Which of the following is a contraindication for initiating infliximab therapy in this patient?

A. Atrial fibrillation
B. Cardiac conduction abnormality
C. Decreased ejection fraction
D. Ischemic heart disease

Answer

Top

This is a printer-friendly version of this page

Print this page  |  Close the preview

Share

 
 

Internist Archives Quick Links

Internal Medicine Meeting Early Registration Discount

Internal Medicine Meeting Early Registration Discount

Register early for Internal Medicine Meeting 2015 in Boston, MA to lock in the lowest possible rate. Learn more or register now!

Are You Using ACP Smart Medicine®?

Are You Using ACP Smart Medicine?

This online clinical decision support tool is a FREE benefit of ACP membership delivering point-of-care access to evidence-based recommendations. Includes more than 500 modules, images and reference tables. Start now or watch the video tour.