MRCEM 2 Category: Cardiology

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A 28-year-old woman comes in with a one-week history of occasional dizzy spells and feeling generally under the weather. She experienced one brief episode where she fainted. She was diagnosed with systemic lupus erythematosus four months ago and has been prescribed high-dose ibuprofen. During the examination, she has swelling in her hands and feet but no other notable findings. Her EKG shows broad QRS complexes and tall peaked T waves.
Which ONE blood test will confirm the diagnosis?

mrcem2-0231

A 70-year-old diabetic smoker presents with central chest pain that radiates to his left shoulder and jaw. He is given 300 mg aspirin and morphine, and his pain subsides. The pain lasted approximately 90 minutes in total. His ECG shows normal sinus rhythm. He is referred to the on-call medical team for admission, and a troponin test is scheduled at the appropriate time. His blood tests today reveal a creatinine level of 298 micromoles per litre.
Which of the following medications should you also consider administering to this patient?

mrcem2-0220

Your hospital’s neurology department is currently evaluating the utility of a triple marker test for use in diagnosing patients with suspected stroke. The test will use brain natriuretic peptide (BNP), neuron-specific enolase (NSE), and S100B protein.
How long after a stroke do levels of glial fibrillary acidic protein (GFAP) start to increase?

mrcem2-0221

Your hospital’s oncology department is currently evaluating the utility of a triple marker test for use in risk stratification of patients with suspected breast cancer. The test will use estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2).
How long after tumor formation do ER levels start to increase?

mrcem2-0222

Your hospital’s pediatrics department is currently evaluating the utility of a triple marker test for use in risk stratification of patients with a suspected heart condition. The test will use troponin I, myoglobin, and heart-type fatty acid-binding protein (HFABP).
How long after a heart event do troponin I levels reach their highest point?

mrcem2-0223

A 30-year-old woman presents with a severe ‘tearing’ abdominal pain that radiates to her lower back. A diagnosis of aortic dissection is suspected.
Which of the following would be the LEAST likely risk factor for aortic dissection?

mrcem2-0213

A 72 year old male is brought to the emergency department by his daughter due to sudden confusion, severe headache, and problems with coordination. Upon initial assessment at triage, the patient’s blood pressure is found to be significantly elevated at 224/126 mmHg. You suspect the presence of hypertensive encephalopathy. What is the primary treatment option for this condition?

mrcem2-0214

You are called to a cardiac arrest in a child in the Emergency Department.
Which SINGLE statement regarding resuscitation in children is true?

mrcem2-0215

You conduct a cardiovascular examination on a 62-year-old man who complains of palpitations. He informs you that he has a known heart valve issue. During auscultation, you observe a faint second heart sound (S2).
What is the most probable cause of this finding?

mrcem2-0216

You conduct a cardiovascular examination on a 62-year-old man who complains of shortness of breath. He informs you that he has a known heart valve issue. During auscultation, you observe a significantly split second heart sound (S2).
What is the most probable cause of this finding?