A 70-year-old man with a history of heart failure with reduced ejection fraction (HFrEF) presents to the emergency department with progressively worsening dyspnea, orthopnea, and lower extremity edema over the past 3 days. On examination, he has bilateral crackles, an S3 gallop, and jugular venous distention. His blood pressure is 160/90 mmHg. What is the most appropriate initial pharmacologic management?

The correct answer to the question "A 70-year-old man with a history of heart failure with reduced ejection fraction (HFrEF) presents to the emergency department with progressively worsening dyspnea, orthopnea, and lower extremity edema over the past 3 days. On examination, he has bilateral crackles, an S3 gallop, and jugular venous distention. His blood pressure is 160/90 mmHg. What is the most appropriate initial pharmacologic management?" is Option B: Intravenous furosemide.

The other options — A) Oral metoprolol, C) Intravenous norepinephrine, D) Oral spironolactone — are incorrect for this USMLE Exam Prep question. As explained above: This patient presents with acute decompensated heart failure due to volume overload. Intravenous loop diuretics like furosemide are the mainstay of initial treatment to reduce preload, alleviate pulm…