USMLE Question of the Week

Diagnosing and Treating Acute Onset Sharp Chest Pain in the Emergency Department

In Episode 57 of Med School Question of the Week for USMLE, Faustine Ramirez, MedSchoolCoach expert tutor, answers this medical school question:

A 72-year-old man presents to the emergency department an hour after the onset of severe chest pain radiating to the back. The pain started suddenly while he was gardening. He has a history of hypertension, coronary artery disease, and prior myocardial infarction. He has smoked one pack of cigarettes per day for as long as he can remember. He appears in moderate distress. Heart rate is 108/min, respiratory rate is 22/min, and blood pressure is 168/102. A grade 2/6 diastolic decrescendo murmur is heard at the right upper sternal border and intensifies when the patient is sitting up and leaning forward. A chest x-ray is shown here. Electrocardiogram shows sinus tachycardia and no ST-segment elevations. Which of the following is the most appropriate initial step in pharmacotherapy?

– Sublingual nitroglycerin
– Intravenous nitroprusside
– Intravenous hydralazine
– Oral aspirin
– Subcutaneous heparin
– Intravenous furosemide
– Intravenous labetalol

Watch to find out!

Faustine Ramirez

Faustine graduated from the University of Washington in Seattle with a B.A. in Medical Anthropology and Global Health. She attends medical school at University of California, San Francisco where she designed and taught a course on clinical reasoning skills, developed curriculum materials for the pre-clinical pediatrics course, and led case-based sessions in pediatrics and infectious disease. She received a 253 on Step 1 and a 266 on Step 2 CK, and she scored in the 90th percentiles on all of her shelf exams.

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