Archives: MSRA

MSRA-0077

A 70-year-old man with a history of chronic heart failure due to ischaemic cardiomyopathy is being evaluated. He was discharged from the hospital two weeks ago after experiencing a heart attack. An echocardiogram conducted during his hospitalization revealed a left ventricular ejection fraction of 40%, but no valve issues were identified.

Despite his current regimen of furosemide, ramipril, carvedilol, aspirin, and simvastatin, he continues to experience shortness of breath with minimal exertion, such as walking 30 meters. On examination, his chest is clear, and there is only slight peripheral edema. What is the most appropriate next step in his management?

MSRA-0078

A 47-year-old man presents to the clinic with concerns about his risk of coronary heart disease after a friend recently had a heart attack. He has a history of anxiety but is not currently taking any medication. He is a smoker, consuming around 20 cigarettes a day. On examination, his cardiovascular system appears normal, with a BMI of 26 kg/m² and blood pressure of 126/82 mmHg.

As his healthcare provider, you strongly advise him to quit smoking. What would be the most appropriate next step?

MSRA-0079

A 56-year-old woman collapses during a hypertension clinic. She is not breathing and a carotid pulse cannot be felt. What is the appropriate ratio of chest compressions to ventilation?

MSRA-0080

A 70-year-old man presents with central chest pain that has been ongoing for 2 hours. The pain is radiating to his left arm. He has a medical history of hypertension and hypercholesterolemia.

Upon examination, the patient appears uncomfortable and sweaty. His vital signs are as follows:
– Heart rate: 90 bpm
– Respiratory rate: 20 breaths/min
– Peripheral oxygen saturation: 95% on room air
– Blood pressure: 136/78 mmHg
– Temperature: 37.0ºC

An ECG performed by the paramedics shows ST depression in leads II, III, and aVF, as well as T-wave inversion.

What is the immediate treatment that should be given?

MSRA-0081

A 57-year-old man of Indian descent presents for a hypertension follow-up. He presents a log of blood pressure readings he has taken at home, consistently showing values above 150/90 mmHg. He is currently taking amlodipine and atorvastatin, with optimal dosing for the past year. What would be the best course of action at this point?

MSRA-0082

A 63-year-old man presents to the emergency department with sudden-onset chest pain and nausea. He is not taking any regular medications. An ECG reveals ST depression and T wave inversion in leads V2-V4, and troponin levels are elevated. The patient receives a STAT 300mg aspirin, and there are no immediate plans for primary PCI. According to the GRACE score, the 6-month mortality risk is 8.0%. The patient is stable. What is the best course of treatment going forward?

MSRA-0083

A 28-year-old female presents to the hospital with palpitations. On ECG, a shortened PR interval and wide QRS complexes are observed, along with a slurred upstroke in lead II. What is the definitive treatment for this condition?

MSRA-0084

A 38-year-old male presents with left-sided dull chest pain that has been present for five days. He reports no associated shortness of breath, cough, collapse, or pleuritic nature of the chest pain. The patient had a recent sore throat and headache last week, which has since resolved. There is no family history of sudden cardiac death in a first-degree relative, and the patient has never smoked.

Upon examination, the patient’s blood pressure is 125/89 mmHg, heart rate is 95/min, temperature is 37.3ºC, and oxygen saturations are 97% on room air. Pulsus paradoxus is not present. Blood results reveal Hb of 154 g/L, platelets of 425 * 109/L, WBC of 11.5 * 109/L, Na+ of 137 mmol/L, K+ of 4.6 mmol/L, urea of 6.4 mmol/L, creatinine of 100 µmol/L, CRP of 40 mg/L, and Troponin T of 13 ng/L. The ECG shows ST-segment elevation in lead I, II, III, aVL, V5, and V6, and PR segment elevation in aVR.

What is the most likely diagnosis for this patient?

MSRA-0085

An 83-year-old man who resides in a nursing home arrives at the Emergency Department with symptoms of diarrhoea and vomiting. He has been experiencing 8 watery bowel movements per day for the past 3 days and seems disoriented and dehydrated. The patient has a medical history of atrial fibrillation, type II diabetes, and dementia. His heart rate is elevated at 110/min, and his electrocardiogram displays noticeable U waves. What is the probable reason for his ECG alterations?

MSRA-0086

A 62-year-old female presents to the Emergency Department complaining of central chest pain that has been radiating to her left arm for the past 30 minutes. Upon examination, an ECG reveals ST elevation in leads II, III, and aVF. Which coronary artery is the most probable culprit?