The Internal Medicine Board Exam exam validates essential knowledge and skills required for certification or licensure in this field.
A 68-year-old man who is a patient in the emergency room woke up with palpitations, chest pain, dyspnea, and vertigo. He claims his heart is "beating," but he has no history of heart disease or high blood pressure. His pulse is quick and erratic, his blood pressure is 85/60 mmHg, and crackles can be heard at the bases of his lungs. His standard laboratory tests, including a troponin level, are expected. His EKG reveals atrial fibrillation with a 130-beat-per-minute ventricular response. Which course of action is ideal?
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A
Delayed cardioversion after anticoagulation
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B
Immediate cardioversion
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C
Intravenous beta-blocker
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D
Intravenous digoxin