Rosh Internal Medicine Boost Practice Exam

A 32-year-old man comes to the emergency department with shortness of breath and palpitations. Given his condition, which is the next best treatment after vagal maneuvers fail?

1. Adenosine 6 mg IV

2. Amiodarone 300 mg IV

3. Atropine 0.5 mg IV

4. Synchronized cardioversion

The correct answer is: Adenosine 6 mg IV

In the scenario described, where a 32-year-old man is experiencing shortness of breath and palpitations, it is likely that he is facing a supraventricular tachycardia (SVT) episode. Vagal maneuvers are typically the first step in managing such arrhythmias; however, if these maneuvers are ineffective, the next best step is the administration of adenosine. Adenosine acts rapidly and is particularly effective for treating certain types of SVT, especially those involving reentrant circuits, as it temporarily causes a complete block of conduction through the atrioventricular (AV) node. This can interrupt the arrhythmia and allow the heart to reset to normal sinus rhythm. The intravenous (IV) administration of 6 mg of adenosine is the appropriate initial dose, with the option to escalate to a higher dose if necessary. The other treatment options are generally not the immediate next step after unsuccessful vagal maneuvers in this specific context. Amiodarone is an antiarrhythmic drug that is more often used in the case of ventricular tachycardia or in situations where other treatments have failed, particularly in cases involving more complex arrhythmias or hemod