A 72-year-old man with a history of hypertension and coronary artery disease presents to the emergency department with acute onset severe dyspnea, orthopnea, and frothy pink sputum. On examination, he is tachypneic, tachycardic, and has bilateral crackles extending halfway up the lung fields. Jugular venous distention is noted. What is the most appropriate initial management step?

The correct answer to the question "A 72-year-old man with a history of hypertension and coronary artery disease presents to the emergency department with acute onset severe dyspnea, orthopnea, and frothy pink sputum. On examination, he is tachypneic, tachycardic, and has bilateral crackles extending halfway up the lung fields. Jugular venous distention is noted. What is the most appropriate initial management step?" is Option B: Administer intravenous furosemide.

The other options — A) Initiate oral metoprolol, C) Perform immediate cardiac catheterization, D) Administer intravenous antibiotics — are incorrect for this USMLE Exam Prep question. As explained above: Acute decompensated heart failure with pulmonary edema requires rapid reduction in preload. Intravenous loop diuretics like furosemide are the cornerstone of initial management, reducing fluid overlo…