WBR0192

Author	Mahmoud Sakr M.D.
Exam Type	USMLE Step 3
Main Category	Emergency Room
Sub Category	Cardiovascular, Biostatistics/ Epidemiology
Prompt	A 72-year-old male patient presents with progressive dyspnea on exertion, orthopnea and increasing lower extremities pitting edema for several days. On chest exam, he’s found to have bilateral rales. Heart exam is positive for an S3 gallop. Jugular venous distention is evident on inspection of the neck. Chest xray shows cardiomegaly and bilateral pleural effusions. Diagnosis of CHF is made and decision was made by the ER physician to start IV furosemide, IV nitroglycerin and IV digitalis. Use of IV digitalis in this patient has been proven to do which of the following:
Answer A	Reduction in overall mortality and lower healthcare costs
Answer A Explanation	Digitalis does not improve mortality, but it decreases hospitalizations, therefore lowers healthcare costs.
Answer B	Reduction in hospitalizations and lower healthcare costs
Answer B Explanation	Digitalis has been tested in several RCTs and there’s a general consensus that it does not improve mortality, but it decreases hospitalizations and reduces healthcare costs.
Answer C	Reduction in hospitalizations and higher healthcare costs
Answer C Explanation	Digitalis decreases hospitalizations and therefore lowers costs.
Answer D	Reduction in hospitalizations and higher overall mortality
Answer D Explanation	Digitalis decreases hospitalizations and has no effect on mortality
Answer E	Increase in hospitalizations and no effect on overall mortality
Answer E Explanation	Digitalis does not improve mortality, but it decreases hospitalizations.
Right Answer	B
Explanation	Digitalis has been tested in several RCTs and there’s a general consensus that it does not improve mortality, but it decreases hospitalizations and reduces healthcare costs. Educational Objective: References:
Approved	Yes
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