MSFinals-0159
A 68-year-old woman is admitted to the Cardiology Ward with acute left ventricular failure. The patient is severely short of breath.
What would be the most appropriate initial step in managing her condition?
Archives: Medical Student Finals
MSFinals-0160
A 67-year-old woman arrives at the Emergency Department by ambulance with chest pain that began 45 minutes ago. An ECG is performed and shows ST elevation in leads V1-V6, with ST depression in leads III and aVF. The closest facility capable of providing primary PCI is a 2 hour transfer time by ambulance. What is the most appropriate course of action for this patient?
MSFinals-0161
A 29-year-old man with valvular heart disease is urgently admitted with fever, worsening shortness of breath and a letter from his GP confirming the presence of a new murmur. During examination, a harsh pansystolic murmur and early diastolic murmur are detected, along with a temperature of 38.3 °C and bilateral fine basal crepitations. Initial blood cultures have been collected.
What is the most pressing concern that needs to be addressed immediately?
MSFinals-0162
A 55-year-old woman with type II diabetes is urgently sent to the Emergency Department by her General Practitioner (GP). The patient had seen her GP that morning and reported an episode of chest pain that she had experienced the day before. The GP suspected the pain was due to gastro-oesophageal reflux but had performed an electrocardiogram (ECG) and sent a troponin level to be certain. The ECG was normal, but the troponin level came back that afternoon as raised. The GP advised the patient to go to Accident and Emergency, given the possibility of reduced sensitivity to the symptoms of a myocardial infarction (MI) in this diabetic patient.
Patient Normal range
High-sensitivity troponin T 20 ng/l <14 ng/l
What should be done based on this test result?
MSFinals-0163
A 72-year-old man is brought by ambulance to Accident and Emergency. He presents with central crushing chest pain and has ST-segment elevation present on an electrocardiogram (ECG). You are at a District General Hospital without access to percutaneous coronary intervention (PCI), and you will not be able to transfer the patient across for PCI in time.
Which of the following is an absolute contraindication to thrombolysis?
MSFinals-0164
A patient presents to the Emergency Department following a fracture dislocation of his ankle after a night out drinking vodka red-bulls. His blood pressure is low at 90/50 mmHg. He insists that it is never normally that low.
Which one of these is a possible cause for this reading?
MSFinals-0165
A 50-year-old man who is a known alcoholic is brought to the Emergency Department after being found unconscious. Over several hours, he regains consciousness. His blood alcohol level is high and a head computerised tomography (CT) scan is negative, so you diagnose acute intoxication. A routine chest X-ray demonstrated an enlarged globular heart. An echocardiogram revealed a left ventricular ejection fraction of 45%.
What is the most likely cause of his cardiac pathology, and what might gross examination of his heart reveal?
MSFinals-0166
A previously healthy 58-year-old man collapsed while playing with his grandchildren. Although he quickly regained consciousness and became fully alert, his family called an ambulance. The emergency medical team found no abnormalities on the electrocardiogram. Physical examination was unremarkable. However, the patient was admitted to the Coronary Care Unit of the local hospital. During the evening, the patient was noted to have a fast rhythm with a wide complex on his monitor, followed by hypotension and loss of consciousness.
After electrical cardioversion with 200 watt-seconds of direct current, which one of the following may possible therapy include?
MSFinals-0167
A 58-year-old Caucasian man with type II diabetes is seen for annual review. His blood pressure is 174/99 mmHg, and his 24-hour urine collection reveals moderately increased albuminuria (microalbuminuria). Blood results show Na+ 140 mmol/l, K+ 4.0 mmol/l, urea 4.2 mmol/l and creatinine 75 μmol/l.
Which of the following medications would be the most appropriate to use first line to treat the hypertension?
MSFinals-0168
A patient in their 60s was diagnosed with disease of a heart valve located between the left ventricle and the ascending aorta. Which of the following is most likely to describe the cusps that comprise this heart valve?