WBR0859

Author	[[PageAuthor::Mohamed Moubarak, M.D. [1]]]
Exam Type	USMLE Step 3
Main Category	Emergency Room
Sub Category	Cardiovascular
Prompt	A 58 year- old male comes to ED complaining of severe chest pain. He mentions a dull pain started 15 min ago all over his chest that radiates to the left shoulder and arm. On examination, the pain doesn’t change with patient position. His temperature is 37 C (98.6 F), heart rate 100/min, blood pressure 140/80 mmHg, and respiratory rate of 19/min. Which of the following is the best next step in managing this patient?
Answer A	EKG
Answer A Explanation	Incorrect The presentation is very clearly a presentation of ischemic pain, and treatment should comes first before the confirmative test, although all are mandatory to be done
Answer B	Echocardiography
Answer B Explanation	Incorrect The presentation is very clearly a presentation of ischemic pain, and treatment should comes first before the confirmative test, although all are mandatory to be done
Answer C	Aspirin
Answer C Explanation	Correct Aspirin, nitrates, oxygen, and morphine always comes first, then we proceed to the rest of investigations like EKG, enzymes etc.
Answer D	Ck-MB & Troponin
Answer D Explanation	Incorrect Ck-MB & Troponin rise after 3-6 hours after the start of chest pain. CK-MB only stays elevated for 1-2 days, while Troponin stay elevated for 1-2 weeks.
Answer E	Consultation
Answer E Explanation	Incorrect Consultation shouldn’t be asked to tell you to give aspirin, oxygen, and nitrates, and to order the rest of investigations.
Right Answer	C
Explanation	Coronary artery disease (CAD) present with chest pain that doesn’t change with body position and respiration. The presentation is very clearly a presentation of ischemic pain, and when the examiners ask about the first step, treatment like aspirin, nitrates, oxygen, and morphine always comes first before the confirmative test, although all are mandatory to be done. Educational Objective: References:
Approved	No
Keyword	[[WBRKeyword::Coronary artery disease]]
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