WBR0451

Author	Neeraja Danda M.B.B.S
Exam Type	USMLE Step 2 CK
Main Category	Internal medicine
Sub Category	Cardiovascular
Prompt	A 46 year old female presents to the emergency room with severe dyspnea. Vitals include a pulse rate of 100/min, blood pressure 100/70 mm Hg and respiratory rate 26 /min. Past medical history is significant for hypertension, and hypothyroidism. Her current medications include once daily doses of 100 mcg thyroxine, and 100mg of atenolol. She works as a receptionist, eats meat and cheese for most of the meals and does not exercise. Upon evaluation, congestive heart failure is diagnosed. Which of the following is not associated with a mortality benefit in heart failure?
Answer A	Metoprolol
Answer A Explanation	Incorrect Metoprolol, carvedilol and bisoprolol in beta blockers offer a clear mortality benefit in heart failure.
Answer B	Spirinolactone
Answer B Explanation	Incorrect Spirinolactone and eplirinone are potassium sparing diuretics and have a mortality benefit in heart failure.
Answer C	Angiotensin converting enzyme inhibitors
Answer C Explanation	Incorrect Angiotensin converting enzyme inhibitors and angiotensin receptor blockers offer a mortality benefit in cardiac failure patients.
Answer D	Implantable defibrillator
Answer D Explanation	Incorrect Implantable defibrillator and biventricular pace maker are two devices used in heart failure when ejection fraction drops below 35% both are associated with mortality benefits.
Answer E	Digoxin
Answer E Explanation	Digoxin is only used to control symptoms of heart failure but has no mortality benefit
Right Answer	E
Explanation	Metoprolol, sprinilactone , angiotensin converting enzyme inhibitors , angiotensin receptor blockers, implantable defibrillator and biventricular pace makers are associated with decreased mortality in heart failure patients. However, digoxin is only used to control symptoms of heart failure but has no mortality benefit. Educational Objective:Digoxin and diuretics are used in heart failure just to control symptoms, but do not confer a mortality benefit. References: Page 79,80,81 Master the boards Step 2 CK second edition Educational Objective: References:
Approved	Yes
Keyword	Digoxin, Heart failure
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