Repeated USMLE Questions Step 2 CK- 331

A 22 year old man presents to the emergency room complaining of sudden onset of shortness of breath and palpitation for 2 hours. He had similar episodes in the past which resolved by breath holding. His past medical, surgical and family histories are unremarkable. He takes no medication. ECG reveals supraventricular tachycardia. Carotid massage on the right side fails to subside this attack.

What is the most likely next step in management?

A- Try carotid massage on the left side

B- IV procainamide

C- IV adenosine

D- IV succinylcholine

E- IV lidocaine

Answer






Paroxysmal supraventricular tachycardia is the most common arrhythmia with a rapid heart rate. If regular nonpharmacological procedures as breath holding, Valsalva maneuver or carotid massage fail, IV adenosine is the first drug of choice to reverse this attack.

The correct answer is C