USMLE Step 2 - Question 16

A 82 year old male with a history of benign prostatic hypertrophy and osteoarthritis presents to the emergency room with an episode of syncope while watching TV. He has felt generally weak for the past 5 days. He denies any chest pains, shortness of breath, or fevers. His medications include tamsulosin and celecoxib. His blood pressure is 115/65, heart rate 40, respirations 12, and he is afebrile. His physical examination reveals normal lung sounds, a regular, bradycardic rhythm with verying intensities of the S1 heart sound, and intermittent large cannon A waves in the jugular venous pulsation. His laboratory studies are normal. His ECG is below. What is the appropriate treatment?

Step2-Q16-PIC2

A. No treatment needed

B. Discontinue tamsulosin

C. Permanent pacemaker implantation

D. Defibrillator implantation

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