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6567 Medicine

A 70-year-old man with a history of coronary artery disease presents to the emergency department with 2 hours of substernal chest pressure, diaphoresis, and nausea. He reports difficulty “catching his breath.” An electrocardiogram shows septal T-wave inversion. The patient is given 325 mg aspirin and sublingual nitroglycerin while awaiting the results of his blood work. His troponin I is 0.65 ng/mL (normal <0.04 ng/mL). The physician in the emergency department starts the patient on low-molecular-weight heparin. His pain is 3/10. Blood pressure is currently 154/78 and heart rate is 72. You are asked to assume care of this patient. What is the best next step in management?

AArrange for emergent cardiac catheterization
BBegin intravenous thrombolytic therapy
CAdmit the patient to a monitored cardiac bed and repeat cardiac enzymes and ECG in 6 hours
DBegin intravenous beta-blocker therapy
Medicine
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6569 Medicine

A 24-year-old woman presents with abdominal pain, joint discomfort, and lower limb rash. She was well until 1 week before presentation. On examination, she has a palpable purpuric rash on her legs, nonspecific abdominal discomfort, and no active joints. She has 3+proteinuria, normal WBC, no eosinophils, and elevated creatinine of 1.6 mg/dL. Biopsy of the rash confirms vasculitis with immunoglobulin A (IgA) 3+and C3 (complement 3) deposition on immunofluorescence.For the above patient with vasculitis syndrome, select the most likely diagnosis.

Apolyarteritis nodosa (PAN)
BChurg-Strauss disease
CHenoch-Schonlein purpura
Dvasculitis associated with infectious diseases
Medicine
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