ERES Bonaerense Medicina Practice Questions - Buenos Aires Province Health Residencies Examination (Examen De Residencias Del Sistema De Salud Bonaerense - ERES Medicina) Exam

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A 67-year-old woman with a history of ischemic cardiomyopathy (left ventricular ejection fraction 30%) presents to the emergency service with severe dyspnea, orthopnea, and pink frothy sputum. Physical examination reveals blood pressure 180/100 mmHg, heart rate 110 bpm, respiratory rate 32 breaths/min, oxygen saturation 84% on room air, bilateral pulmonary crackles extending to the upper lung fields, and jugular venous distension. What is the most appropriate immediate therapeutic combination?

High-dose intravenous beta-blocker (metoprolol) bolus and rapid isotonic crystalloid infusion (2000 mL normal saline) Intravenous furosemide, sublingual/intravenous nitroglycerin, and non-invasive positive pressure ventilation (CPAP/BiPAP) Immediate endotracheal intubation, intravenous dopamine infusion, and low-dose spironolactone Intravenous digoxin bolus, oral enalapril, and continuous loop diuretics via subcutaneous route

Correct Answer:

Intravenous furosemide, sublingual/intravenous nitroglycerin, and non-invasive positive pressure ventilation (CPAP/BiPAP)

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