MKSAP Case study: ischemic cardiomyopathy
ACP Internist has brought back its MKSAP quiz. This popular feature was so heavily requested by our readers that we're restoring it in our print edition and ACP InternistWeekly e-mail updates.
Case study:
A 50-year-old black man with ischemic cardiomyopathy presents for a routine follow-up. His medical history is significant for biventricular pacemaker/cardioverter-defibrillator placement and diabetes mellitus. He develops shortness of breath from ascending less than 1 flight of stairs or walking less than 1 block on level ground, a symptom that has been stable. His medications include aspirin, lisinopril, carvedilol, isosorbide mononitrate, furosemide, spironolactone, digoxin, atorvastatin, and insulin. His blood pressure is 105/78 mm Hg and his heart rate is 62/min.
Physical examination reveals clear lungs, a regular cardiac rhythm, grade 2/6 systolic murmur at the apex, and no peripheral edema. A recent echocardiogram showed left ventricular enlargement, severely decreased systolic function (left ventricular ejection fraction, 15%), and mild mitral regurgitation.
Which of the following medications should be added?
A) Amiodarone
B) Clopidogrel
C) Hydralazine
D) Nesiritide
ACP's Medical Knowledge Self-Assessment Program (MKSAP) allows you to:
- Update your knowledge in all areas of internal medicine
- Prepare for ABIM certification or recertification
- Support your clinical decisions in practice
- Assess your medical knowledge with 1,200 multiple-choice questions
To order the latest edition of MKSAP, go online. If you're not already receiving ACP InternistWeekly, contact Customer Service at 800-523-1546, ext. 2600, or direct at 215-351-2600 (M-F, 9 a.m. to 5 p.m. EST) or send an e-mail.
Answer: C) Hydralazine.
The complete MKSAP syllabus and critique on this topic is available to subscribers in Cardiovascular Medicine: Item 121.
Cartoon Caption Contest
The winner of the $100 ACP gift certificate, as chosen randomly among all voters, is Malvinder S. Parmar, FACP, medical director of the Medical Program (Internal Medicine), Timmins and District Hospital, Timmins, Ontario, Canada. Congratulations to all those who submitted captions and voted this year.
"I don't care which one you use; just get it over with."
53.5% of voters overwhelmingly chose this caption among the three top vote getters from 2008. The contest resumes in the Jan. 13 issue of ACP InternistWeekly.
ACP Internist Weekly
From the December 23, 2008 edition
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- Stress leads to unhealthy behaviors that lead to CV disease
- IBS guidelines recommend testing for celiac disease, using anti-depressants
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