Congenital Heart Disease USMLE Step 1 Practice Question
A 2-week-old premature infant (32 weeks gestation) presents with increased work of breathing. Vital signs show BP 68/38 mmHg, HR 160/min, RR 48/min, SpO2 98% on room air. Physical examination reveals a continuous "machinery" murmur at the infraclavicular region, widened pulse pressure, and bounding pulses. Chest X-ray demonstrates pulmonary edema. Echocardiography confirms left-to-right ductal shunting. The infant has no cyanosis. Which medication would be most appropriate to initiate?
Answer choices
- AFurosemide alone
- BIndomethacin or ibuprofenCorrect answer
- CProstaglandin E1
- DCaptopril
- EDigoxin for rate control
- FSildenafil for pulmonary vasodilation
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