MRCEM 2 Category: Cardiology

mrcem2-0180

A 65 year old male is brought to the emergency department following a fall which occurred while the patient was getting out of bed. The patient complains of feeling dizzy as he got out of bed before experiencing tunnel vision and briefly losing consciousness. The patient is certain he only blacked out for a few seconds as the time on the bedside clock had not changed. The patient informs you that he has had several similar episodes over the past few months when getting out of bed, but most of the time he only feels dizzy and doesn’t faint. He denies any loss of bladder or bowel control or biting his tongue. An ECG is performed which shows normal sinus rhythm. You note the patient takes the following medication:
Lisinopril 10 mg OD
Fluoxetine 20 mg OD

What is the most likely diagnosis?

mrcem2-0181

A 72 year old male is brought to the emergency department by ambulance after experiencing severe chest pain while walking his dog. The patient complains of feeling nauseated and states that the pain spreads to his neck. An ECG is conducted, revealing ST elevation in leads I and AVL. Which coronary artery is most likely blocked?

mrcem2-0182

You are asked to assess a 68-year-old male in the resuscitation room due to bradycardia. The patient complained of increased shortness of breath, dizziness, and chest discomfort. The recorded vital signs are as follows:

Parameter Result
Blood pressure 80/52 mmHg
Pulse rate 40 bpm
Respiration rate 18 rpm
SpO2 98% on 12 liters Oxygen

You are concerned about the possibility of this patient progressing to asystole. Which of the following indicators would suggest that this patient is at a high risk of developing asystole?

mrcem2-0183

A 60-year-old woman presents with complaints of fatigue and difficulty breathing. During the examination, you observe a pansystolic murmur that is most prominent at the apex and radiates to the axilla. The murmur is more pronounced during expiration.
What is the SINGLE most probable diagnosis?

mrcem2-0171

A 42 year old male comes to the emergency department with a sudden onset of ‘tearing’ pain in the middle of his chest that extends to the center of his back. The patient is tall and has a slender physique. Additionally, you observe that the patient has elongated arms and fingers. During the chest examination, you notice a prominent protrusion of the sternum (pectus carinatum). What is the probable underlying cause of this patient’s chest pain?

mrcem2-0159

You are overseeing the care of a 68-year-old man who has presented to the ER after experiencing a sudden onset of dizziness and difficulty breathing. Upon examination, the patient’s heart rate is found to be 44 beats per minute, indicating bradycardia. Which of the following factors increases the risk of developing asystole?

mrcem2-0160

A 25-year-old woman comes in with a complaint of palpitations that occur during her regular jogging routine. Her mother passed away at a young age from an unknown cause. During the examination, her pulse feels irregular and there is a presence of a double apical impulse. A systolic murmur can be heard at the left sternal edge that spreads throughout the praecordium.

What is the SINGLE most probable diagnosis?

mrcem2-0161

A 25-year-old is brought into the emergency department after being discovered unresponsive in a neighbor’s backyard. It is suspected that the patient had consumed alcohol at a nearby bar and opted to walk home in the snowy conditions. The patient’s temperature is documented as 27.8ºC. The nurse connects leads to conduct a 12-lead ECG. Which of the subsequent ECG alterations is most closely linked to hypothermia?

mrcem2-0162

A 25-year-old is brought into the emergency department after being discovered unresponsive in a neighbor’s backyard. It is suspected that the patient had consumed alcohol at a nearby club and opted to walk home in the snowy conditions. The patient’s temperature is documented as 27.8ºC. The nurse connects leads to conduct a 12-lead ECG. Which of the subsequent ECG alterations is most closely linked to hypothermia?

mrcem2-0163

A 37 year old female presents to the emergency department complaining of shortness of breath and chest pain in the center of her chest. Upon further questioning, the patient reveals that she experienced muscle pain, gastrointestinal issues, a mild fever, and fatigue for approximately three days about a week ago. She informs you that she is typically in good health and regularly runs 5-10km two to three times per week. The patient has no significant medical history, does not take any medications on a regular basis, has never smoked, and does not consume alcohol. Given the patient’s symptoms, you suspect the possibility of myocarditis. Which of the following sets of blood test results would be expected in a patient with myocarditis?