Master the board step 3

Cardiology
An 80-year-old woman is admitted to the intensive care unit for acute pulmonary
edema. She has rales to the apices and jugulovenous distention. Her EKG shows
ventricular tachycardia. Which of the following is the best therapy?
a. Synchronized cardioversion
b. Unsynchronized cardioversion
c. Lidocaine
d. Amiodarone
e. Procainamide
Answer: A. Synchronized cardioversion is used when ventricular tachycardia is associated
with acute pulmonary edema. The same answer would be used if the acute pulmonary
edema was associated with the onset of atrial fibrillation, flutter, or supraventricular
tachycardia. Unsynchronized cardioversion is used for ventricular fibrillation or ventricular
tachycardia without a pulse. Medical therapy, such as lidocaine, amiodarone, or procainamide,
can be used for sustained ventricular tachycardia that is hemodynamically stable.
“Synchronized” = Timing
with cardiac cycle
When is nesiritide the answer?
Answer: Nesiritide is a synthetic version of atrial natriuretic peptide that is used for
acute pulmonary edema as a part of preload reduction. It decreases symptoms of
shortness of breath and is not clearly associated with a reduction in mortality. There is
no clear indication that the answer is nesiritide.
When is a BNP level the answer?
Answer: BNP or “brain natriuretic peptide” level is a blood test that can be used to establish
a diagnosis of CHF in a patient who is short of breath. If the presentation is not clear,
a BNP level can be used to help distinguish between pulmonary embolus, pneumonia,
asthma, and CHF. BNP level goes up in CHF but is rather nonspecific. A normal BNP
level excludes CHF.
A patient comes with pulmonary edema. A right heart catheter is placed. Which
of the following readings is most likely to be found?
Cardiac Output
Systemic Vascular
Resistance Wedge Pressure Right Atrial Pressure
a. Decreased Increased Increased Increased
b. Decreased Increased Decreased Decreased
c. Increased Decreased Decreased Decreased
d. Decreased Increased Decreased Increased
Answer:
Cardiac Output
Systemic Vascular
Resistance Wedge Pressure Right Atrial Pressure
a. Decreased Increased Increased Increased
63