Cardiac Anatomy, Human Anatomy, USMLE Step 1 - Full Vignette with Extended Explanations

Описание: A 62-year-old woman with a history of vasculitis, progressive hearing loss, and multiple systemic complaints presents to cardiology with exertional chest pressure, fever, and hypoxemia. Given her prior multisystem evaluations and new cardiac findings, what critical anatomic considerations and documentation elements must be addressed before proceeding with coronary angiography involving the right coronary artery, especially near the atrioventricular node artery? How should clinical risk be communicated based on her presentation?

VIDEO INFO
Category: Cardiac Anatomy, Human Anatomy, USMLE Step 1
Difficulty: Easy - Basic level - Suitable for medical students
Question Type: Legal Pitfalls
Case Type: Common Scenario

Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h...

QUESTION
A 62-year-old woman with vasculitis and bilateral progressive hearing loss presents to the cardiology clinic with exertional chest pressure. She is afebrile at triage last night but today reports chills; in clinic her temperature is 39.0 degreesC, pulse 84/min, respirations 62/min, blood pressure 112/41 mm Hg, oxygen saturation 91% on room air. She is a former injection drug user in recovery for 3 years, previously treated for opioid use disorder; she adheres to a high-sodium diet....

OPTIONS
A. Document specific risk of atrioventricular block and potential need for temporary or permanent pacing during right coronary intervention.
B. Record comprehensive risks including bleeding, infection, contrast reactions, stroke, myocardial infarction, arrhythmia, and pacemaker requirement, but omit patient-specific alternatives and dominance-related risks.
C. Proceed with oral consent and note that the procedure is routine and risk free.
D. Have the patient waive all legal claims in lieu of discussing procedural alternatives, coronary dominance implications, conduction injury risk, and peri-procedural pacing contingencies.

CORRECT ANSWER
A. Document specific risk of atrioventricular block and potential need for temporary or permanent pacing during right coronary intervention.

EXPLANATION
The correct answer is "Document specific risk of atrioventricular block and potential need for temporary or permanent pacing during right coronary intervention." Informed consent must disclose material, patient-specific risks and reasonable alternatives. In a right-dominant system targeting an inferior lesion adjacent to the AV nodal artery, iatrogenic AV block is a foreseeable anatomic risk; pacing contingencies should be discussed and documented. This patient s new inferior T-wave inversions and planned RCA intervention make nodal artery proximity salient, and her temperature elevation does not alter the consent requirements.

"Record comprehensive risks including bleeding, infection, contrast reactions, stroke, myocardial infarction, arrhythmia, and pacemaker requirement, but omit patient-specific alternatives and dominance-related risks." fails the requirement to tailor consent to individualized material risks and options. "Proceed with oral consent and note that the procedure is routine and risk free." violates standards; consent must be informed, documented, and acknowledge risks....


Further reading:

Links to sources are provided for optional further reading only. The questions and explanations are independently authored and do not reproduce or adapt any specific third-party text or content.

---------------------------------------------------

Our cases and questions come from the https://EndlessMedical.Academy quiz engine - multi-model platform. Each question and explanation is forged by consensus between multiple top AI models (i.e. Open AI GPT, Claude, Grok, etc.), with automated web searches for the latest research and verified references. Calculations (e.g. eGFR, dosages) are checked via code execution to eliminate errors, and all references are reviewed by several AIs to minimize hallucinations.

Important note: This material is entirely AI-generated and has not been verified by human experts; despite stringent consensus checks, perfect accuracy cannot be guaranteed. Exercise caution - always corroborate the content with trusted references or qualified professionals, and never apply information from this content to patient care or clinical decisions without independent verification.

Clinicians already rely on AI and online tools - myself included - so treat this content as an additional focused aid, not a replacement for proper medical education. Visit https://endlessmedical.academy for more AI-supported resources and cases.

This material can not be treated as medical advice. May contain errors.

---------------------------------------------------