A 42-year-old man presents to the Emergency Department (ED) with a history of fainting. He reports feeling lightheaded while jogging. His father recently passed away suddenly due to a heart condition. Upon examination, he has an irregular pulse, a forceful cardiac impulse, and a mid-systolic murmur.
What is the most probable diagnosis? Choose the ONE best option from the list below.
A 50-year-old woman presented to her GP with a 3-week history of fatigue, fever and muscle aches. A new murmur was detected in the mitral area.
Which of the following is the most suitable initial investigation?
A 60-year-old man with a history of high blood pressure and high cholesterol presents to the Emergency Department with occasional episodes of chest pain, lasting only for a few minutes. This occurs while at rest and is accompanied by palpitations. He is currently stable, with a blood pressure of 140/95 mmHg, oxygen saturation of 98% and a heart rate of 160 bpm. An electrocardiogram (ECG) is done which shows no P waves, with regular narrow QRS complexes interspersed along a saw-tooth baseline. Vagal manoeuvres have failed and three boluses of adenosine fail to control the arrhythmia.
Given the likely diagnosis, which of the following treatments is indicated?
Select the SINGLE best treatment option from the list below.
You are asked by the nursing staff to review an elderly patient in recovery overnight. As you arrive, the nurse looking after the patient informs you that she is just going to get a bag of fluid for him.
On examination, the patient is unresponsive with an obstructed airway (snoring). You notice on the monitor that his heart rate is 33 beats per minute (bpm) and blood pressure 89/60 mmHg. His saturation probe has fallen off.
What is the most appropriate immediate management option?
You have just received a 70-year-old man into the resuscitation room who had a witnessed collapse after complaining of chest pain. There was no pulse, and cardiopulmonary resuscitation (CPR) was performed at the scene. CPR is ongoing upon patient arrival in the Emergency Department. Pulse check demonstrates no palpable central pulse, and there is no respiratory effort. A 3-lead electrocardiogram (ECG) demonstrates no coordinated electrical activity or recognisable complexes, looking very much like a wandering flat line.
What is the most appropriate management of this patient?
A 30-year-old medical student noticed that he had a murmur when he tested his new stethoscope. On assessment in the Cardiology Clinic, he was found to have a harsh systolic murmur over his precordium, which did not change with inspiration. His electrocardiogram (ECG) showed features of biventricular hypertrophy.
Which of the following is the most likely diagnosis?
A 72-year-old man has recently been diagnosed with heart failure. He is currently taking ramipril for his high blood pressure. What is the most appropriate medication to help manage his heart failure?
A 45-year-old man presents to the Emergency Department with a 7-day history of fever and night sweats. His parameters include a blood pressure of 110/80 mmHg, oxygen saturation of 99%, heart rate of 115 bpm and a temperature of 38.5°C.
On examination, a murmur is elicited at the right upper sternal edge. Infective endocarditis is suspected and an echocardiogram is done which shows multiple vegetations on the aortic valve.
Which of the following is the best next step to confirm the diagnosis?
Select the SINGLE best management option from the list below.
Select ONE option only.
A 55-year-old man presents to the Emergency Department with a 2-day history of malaise, fever and night sweats. He also complains that he has recently developed increased sensitivity in his fingertips and states that every time he touches something his fingers hurt.
His past medical history includes diabetes and end-stage chronic kidney disease, for which he receives regular haemodialysis. His parameters include a blood pressure of 130/95 mmHg, oxygen saturation of 98%, heart rate 120 bpm and a temperature of 38.2°C.
Which of the following investigations would be needed to make a diagnosis?
Select the SINGLE best investigation from the list below.
Select ONE option only.
A 32-year-old woman presents with dizziness to her General Practitioner. She reports a similar episode six months ago, which was also accompanied by some discomfort in her chest lasting for a short period. Upon further questioning, she admits to feeling her heart beating rapidly in her chest. She is currently stable, with a blood pressure of 120/80 mmHg, oxygen saturation of 99%, and a heart rate of 110 bpm. What is the best investigation to guide further management?