A 65-year-old man has 5 days of dyspnea and paroxysmal nocturnal dyspnea. He has hypertension and a history of post-operative deep venous thrombosis after surgery for tibial fracture 3 year and received 6 months of anticoagulation. He has a 30-pack-year smoking history. Blood pressure it 122/ mmHg and pulse is 110/min and regular. Oxygen saturation is 90% on room air. Lung auscultation reveals bibasilar crackles and scattered wheezes. Which of the following is the most appropriate step in management of this patient?
سؤال مجاني 7 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: C. Intravenous furosemide
PND, bibasilar crackles, tachycardia and hypoxia point to acute decompensated heart failure / pulmonary oedema; the wheeze is "cardiac asthma", so salbutamol and steroids are a trap. Diuretics (IV furosemide) are the most important intervention because they reduce preload. Digoxin takes weeks to work and is not used acutely. The DVT 3 years ago was treated, and this picture is not one of PE, so therapeutic anticoagulation is not indicated.
ليش كل خيار صح أو غلط
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A
ليش غلط
Asthma is only part of the differential of acute dyspnea in acute decompensated HF (with PE and pneumonia). PND with bibasilar crackles points to HF, so bronchodilators and steroids are not the treatment.
✓ Step-Up To Medicine 6th (HF).pdf · p. 11 -
B
ليش غلط
Digoxin takes several weeks to work and is not indicated in the acute setting.
✓ Heart failure عبدالرحمن✅.pdf · p. 18 -
C
ليش صح
In acute decompensated HF with pulmonary congestion, diuretics treat the volume overload and are the most important intervention.
✓ Heart failure عبدالرحمن✅.pdf · p. 18 -
D
ليش غلط
Metoprolol is a chronic HFrEF therapy shown to reduce mortality over time. It is not the acute step for pulmonary congestion, which is diuretics.
✓ Step-Up To Medicine 6th (HF).pdf · p. 9 -
E
ليش غلط
Anticoagulation (heparin, DOACs, warfarin) prevents thrombus propagation in proximal DVT, usually for 3-6 months. His DVT was treated years ago, and the current picture is acute heart failure.
✓ 12• Venous Thromboembolism [Notes].pdf · p. 9
- المصدر
- Heart failure عبدالرحمن✅.pdf · p. 18
Step-Up To Medicine 6th (HF).pdf · p. 11 - المحاضرة
- Acute Pulmonary Oedema · Cardiology · Module B
- ظهر في
- Respi bank