mrcem2-0150
You evaluate a 75-year-old woman with chronic heart failure.
Which specific beta-blocker is approved for the treatment of chronic heart failure?
MRCEM 2 Category: Cardiology
mrcem2-0151
A 60-year-old woman with a history of congestive cardiac failure is experiencing severe central chest pain when reclining. The pain is relieved by assuming an upright position. She has a documented history of severe coronary artery disease.
What is the SINGLE most probable diagnosis?
mrcem2-0152
A 72 year old male presents to the emergency department with central chest pain. After evaluating the patient and reviewing the tests, your consultant determines that the patient has unstable angina. Your consultant instructs you to contact the bed manager and arrange for the patient’s admission. What crucial finding is necessary to establish the diagnosis of unstable angina?
mrcem2-0153
A 68 year old male presents to the emergency department with central heavy chest pain that began 10 hours ago while the patient was sitting down watching television. The patient has previously refused treatment for high cholesterol and stage 1 hypertension. Physical examination reveals a mildly elevated blood pressure of 156/94 mmHg, but is otherwise unremarkable. The ECG shows ST depression and T wave inversion in leads V1-V3. Initial troponin results are negative, and a second high sensitivity troponin assay performed 3 hours later also returns negative. What is the most likely diagnosis?
mrcem2-0154
You evaluate a 62-year-old woman in the Emergency Room with intense central chest discomfort. She is extremely worried as she experienced a heart attack (MI) 8 weeks ago. Today the pain is sharp and is alleviated by leaning forward. During the examination, her temperature is recorded as 37.9°C and she has pitting edema in both ankles. The ECG shows Q waves in the anterolateral leads.
What is the MOST LIKELY diagnosis in this case?
mrcem2-0155
A 72 year old male presents with central chest pain radiating to the jaw and left arm. The patient is sweating profusely and appears pale. The pain began 4 hours ago. ECG reveals 2-3 mm ST elevation in leads II, III and aVF. 300 mg aspirin has been administered. Transporting the patient to the nearest coronary catheter lab for primary PCI will take 2 hours 45 minutes. What is the most suitable course of action for managing this patient?
mrcem2-0156
A 65 year old male presents to the emergency department with a 3 hour history of severe chest pain that radiates to his left arm and neck. On examination, his chest is clear and his heart sounds are normal with a regular rhythm. No carotid bruits are heard. The following observations are noted:
Blood pressure: 150/90 mmHg
Pulse rate: 88 bpm
Respiration rate: 18 rpm
Oxygen saturation: 97% on room air
Temperature: 37.2ºC
An ECG reveals normal sinus rhythm and a chest X-ray shows no abnormalities. The patient’s pain subsides after receiving buccal GTN (glyceryl trinitrate). Cardiac enzyme tests are pending. What is the most appropriate course of action for this patient?
mrcem2-0157
A 75 year old female is brought to the hospital by paramedics after experiencing a cardiac arrest at home during a family gathering. The patient is pronounced deceased shortly after being admitted to the hospital. The family informs you that the patient had been feeling unwell for the past few days but chose not to seek medical attention due to concerns about the Coronavirus. The family inquires about the likelihood of the patient surviving if the cardiac arrest had occurred within the hospital?
mrcem2-0158
A 60 year old female presents to the emergency department complaining of increasing shortness of breath. The patient reports feeling more fatigued and breathless with minimal exertion over the past few months, but in the past few days, she has been experiencing breathlessness even at rest. She informs you that she has been taking aspirin, ramipril, bisoprolol, and rosuvastatin for the past 5 years since she had a minor heart attack. Upon examination, you observe prominent neck veins, bilateral lung crepitations that are worse at the bases, faint heart sounds, and pitting edema below the knee. The patient’s vital signs are as follows:
Blood pressure: 130/84 mmHg
Pulse rate: 90 bpm
Respiration rate: 23 bpm
Temperature: 37.0ºC
Oxygen saturation: 93% on room air
What would be the most appropriate initial treatment for this patient?
mrcem2-0144
You are managing a 68-year-old woman who has been brought to the resuscitation bay by the ambulance team. The patient experienced sudden dizziness and difficulty breathing while at home. The ambulance crew presents the patient’s ECG for your review. Your plan includes administering atropine to address the patient’s arrhythmia. Which of the following conditions would contraindicate the use of atropine?