Rosh Emergency Medicine Practice Test

What is the most appropriate treatment for a patient presenting with cough, chest pain, and difficulty breathing, exhibiting signs of heart failure?

1. Amoxicillin-clavulanate

2. Digoxin

3. Dobutamine

4. Furosemide

The correct answer is: Furosemide

In a patient presenting with cough, chest pain, difficulty breathing, and signs of heart failure, the most appropriate treatment focuses on managing fluid overload, which is a common condition in heart failure. In this context, furosemide is a loop diuretic that helps reduce fluid retention by promoting diuresis, thereby alleviating symptoms such as shortness of breath and peripheral edema. When a patient shows signs of heart failure, they may have congestion due to excess fluid in the lungs (pulmonary congestion) and systemic circulation. Furosemide acts quickly to excrete this fluid, decreasing preload and subsequently improving symptoms related to heart failure. The action of furosemide directly addresses the underlying issue of fluid overload, making it crucial for stabilizing the patient. Other medications listed have their specific uses but do not address the immediate need for fluid management in this scenario. While digoxin can improve heart contractility and may be beneficial in chronic heart failure management, it is not the first step in acute fluid overload situations. Dobutamine is typically reserved for cases of severe heart failure with low cardiac output, particularly when there is cardiogenic shock. Amoxicillin-clavulanate, an antibiotic, would not be relevant unless there is a concurrent