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Heart failure with reduced ejection fraction — USMLE Step 2 CK MCQ

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ModerateInternal MedicineHeart failure with reduced ejection fractionUSMLE Step 2 CK

A 58-year-old African American man comes to the urgent care clinic because of progressive symptoms. History and focused examination are notable for orthopnea, bibasilar crackles, elevated BNP, and reduced ejection fraction. Temperature is 98.6°F (37.0°C), blood pressure is 126/78 mmHg, pulse is 84/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Focused laboratory studies and initial testing support the clinical pattern described in the stem. Which of the following is the most appropriate pharmacotherapy?

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Correct answer: E — Sacubitril-valsartan, evidence-based beta blocker, mineralocorticoid antagonist, and SGLT2 inhibitor

The vignette describes Heart failure with reduced ejection fraction, supported by orthopnea, bibasilar crackles, elevated BNP, and reduced ejection fraction. Sacubitril-valsartan, evidence-based beta blocker, mineralocorticoid antagonist, and SGLT2 inhibitor is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: ACC/AHA/HFSA 2022 Heart Failure Guideline