MRCEM 2 Category: Cardiology

mrcem2-0209

A 68 year old male presents to the emergency department by ambulance due to worsening shortness of breath over the past 6 hours. The patient’s wife informs you that he had complained of chest discomfort earlier in the day but attributed it to ‘indigestion’. The patient is visibly breathing rapidly from the end of the bed and examination reveals crackling sounds throughout both lungs with no breath sounds and dullness when tapping the lower parts of the lungs. The following observations are noted:

Blood pressure 100/60 mmHg
Pulse rate 110 bpm
Respiration rate 26 bpm
Oxygen saturation 95% on 15L O2
Temperature 37.2ºC

You diagnose pulmonary edema as a result of acute heart failure secondary to cardiogenic shock. What is the mortality rate associated with this condition during hospitalization?

mrcem2-0210

A 55 year old female presents to the emergency department 3 hours after experiencing severe central chest pain that radiates to the back while gardening. The patient describes the pain as tearing and states it is the worst pain she has ever felt. You note a past medical history of poorly controlled hypertension. The patient’s vital signs are as follows:

Blood pressure 182/98 mmHg
Pulse rate 94 bpm
Respiration rate 22 rpm
Oxygen saturation 97% on room air
Temperature 37.3ºC

An ECG is performed which shows normal sinus rhythm. Chest X-ray reveals a widened mediastinum and an abnormal aortic contour.

What is the most appropriate initial treatment for this patient?

mrcem2-0211

A 72 year old male attends the emergency department complaining of feeling lightheaded, experiencing shortness of breath, and having irregular heartbeats. He states that these symptoms started six hours ago. Upon listening to his chest, clear lung fields are detected but an irregularly irregular pulse is observed. The patient has type 2 diabetes, which is currently controlled through diet. The only medications he takes are:
– Lisinopril 2.5 mg once daily
– Simvastatin 20 mg once daily
There is no history of heart disease, vascular disease, or stroke. The recorded observations are as follows:
– Blood pressure: 148/92 mmHg
– Pulse rate: 86 bpm
– Respiration rate: 15 bpm
– Oxygen saturation: 97% on room air
An ECG is performed, confirming atrial fibrillation. As part of the management, you need to calculate the patient’s CHA2DS2-VASc score.

What is this patient’s score?

mrcem2-0201

A 42-year-old Caucasian man presents with gradually worsening shortness of breath on exertion that has been ongoing for the past four weeks. The breathlessness is worse when lying flat, and he has noticed his ankles have become swollen. This morning he had a small amount of blood in his sputum. He is currently 32 weeks pregnant, and his pregnancy is progressing normally. On examination, you note that he has a tapping apex beat and a low-volume pulse. On auscultation, you note a loud first heart sound and a mid-diastolic murmur at the apex.
What is the SINGLE most likely diagnosis?

mrcem2-0202

You evaluate a 45-year-old Asian man with a heart murmur. During auscultation, you observe a loud first heart sound and a mid-diastolic murmur at the apex. Upon examination, you observe that he has plum-red discoloration of his cheeks.
What is the SINGLE most probable diagnosis?

mrcem2-0197

A 72-year-old woman comes to the Emergency Department complaining of severe chest pain, difficulty breathing, and feeling nauseous for the past hour. The ECG reveals ST-segment elevation in the anterolateral leads. After starting treatment, her condition improves, and the ECG changes indicate signs of resolution.
Which medication is responsible for the rapid restoration of blood flow in this patient?

mrcem2-0198

A 45 year old female patient presents to the emergency department after calling 111 for guidance regarding recent chest discomfort. The patient is worried that she might be experiencing a heart attack. During the assessment, you inquire about the nature of the pain, accompanying symptoms, and factors that worsen or alleviate the discomfort, prior to conducting a physical examination.

Which history would be most suggestive of a acute myocardial infarct (AMI)?

mrcem2-0199

A 45-year-old man presents with palpitations and is found to have atrial fibrillation. You are requested to evaluate his ECG.
Which of the following statements is correct regarding the ECG findings in atrial fibrillation?

mrcem2-0200

A 45-year-old man presents with palpitations and is found to have atrial fibrillation. You are requested to evaluate his ECG.
Which of the following statements is NOT true regarding the ECG in atrial fibrillation?

mrcem2-0196

You are requested to evaluate a teenager who is in resus with a supraventricular tachycardia. The patient is stable hemodynamically but has already received 3 doses of IV adenosine and vagal maneuvers. However, there has been no improvement in their condition.
Based on the current APLS guidelines, what would be the most suitable next course of action in managing this patient?