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

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.