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Practical Question Strategy— A 67-Year-Old Man with Cough with Brian Radavansky from MedSchoolTutors | (USMLE Question Dissection)

July 21, 2018

Intro

In this episode we dissect the following practice question with Dr. Brian Radvansky from MedSchoolTutors. 

Question Stem

A 67-year old man presents to the Emergency Department with a 2-day history of progressively worsening cough. He has a history of poorly-controlled hypertension, 30 pack-year smoking history, well-controlled diabetes, and a STEMI 4 years prior. He complains of mild sharp chest pain while coughing, some shortness of breath while walking around his apartment, and lightheadedness when standing up. Vital signs on arrival are HR 114, BP 100/55, RR 26, T 101.9 ℉, SpO2 86% on 4 L nasal cannula. Physical exam is significant for general ill appearance, decreased breath sounds in the right lower chest, tachypnea, tachycardia, and use of accessory muscles of breathing. His is somewhat alert and oriented only to person and place. ABG shows pH 7.29/pCO2 60/pO2 69. EKG shows Q-waves in the inferior leads.

Which of the following is most likely to improve the patient’s clinical status?

  1. Dobutamine
  2. Furosemide
  3. Doxycycline
  4. Vancomycin and Piperacillin-Tazobactam
  5. Pleurocentesis
  6. Aspirin and Heparin

The full post is not yet published. But you can read more high-yield question breakfowns on the MedSchoolTutors excellent blog. 

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Music: "Anaesthetist" off The Mindsweep by Enter Shikari (used with permission).