31. Revision Session

Question 1

Answer 1

D - increases diastolic filling. β-blocker used in HF.

Question 2

Answer 2

C - 0.04s

Question 3

Answer 3

What causes tented T waves? K⁺ thus answer = E, spironolactone.

Question 4

Answer 4

A. MI is A dx b/c there is STE BUT it isn’t the best dx for the WHOLE scenario. He has BP split - aortic dissection most likely dx.

Question 5

Answer 5

B - large T waves

Question 6

Answer 6

C - ECG

Question 7

Answer 7

Rupture of a papillary muscle - complication of a MI, gives pan systolic murmur

Question 8

Answer 8

A - acute anterior MI b/v V1-V4 is anterior.

Question 9

Answer 9

B - digoxin

Question 10

A 60yo woman is admitted with a hx of retrosternal chest pain. The ED doctor has performed an ECG on her and this is given below. What is the most likely dx?

a) Anterior MI
b) Inferior MI
c) Lateral MI
d) NSTEMI
e) Pericarditis

Answer 10

B - inferior MI b/c III and avF = STE (pattern recognition). Some leads show ST depression though = reciprocal changes due to ischaemia of surrounding tissues. If have ischaemia get depression.

Question 11

A 70yo woman is admitted as an emergency to a cardiac unit with a hx of chest pain of 1hr duration. She is also known to have bronchial asthma. She is already on aspirin and clopidogrel. Her haemodynamic status is unremarkable. The ECG on admission is given below. What should be the most appropriate intervention for her?

a) Moniter her for next 48hrs
b) IV furosemide
c) Commence on β-blocker
d) Percutaneous coronary intervention
e) Commence on an ACE-I

Answer 11

D. Dx = acute MI - STEMI in leads I, avL and V1-5! PCI is most appropriate.

Question 12

A 65yo man is admitted with a hx of chest pain of 4hrs duration. He is known to have a hx of HT and hyperlipidaemia. He has been on spironolactone for several years. He has a smoking history of 25 pack years. His ECG is given below. What is the most likely dx?

a) Pericarditis
b) Anterior MI
c) Inferior MI
d) Posterior MI
e) NSTEMI

Answer 12

E. See no STE, so it can’t be B, C and D. In pericarditis see STE too but a different type. Here is inverted T waves - usually goes with NSTEMI.

Question 13

A 60yo man is being treated for acute MI in a cardiac unit. On day 2, he complains of sudden onset of chest tightness and feels light headed. His pulse is feeble and his BP is 80/50mmHg. What should be the first line tx?

a) Synchronised cardioversion
b) IV sotolol
c) IV amiodarone
d) Carotid sinus massage
e) IV dobutamine

Answer 13

A. VT, broad complex. If hypotensive and unwell, then 1st line tx of choice is synchronised cardioversion.

NB: sotolol = β​-blocker, amiodarone = for arrhythmias and blocks Na, Ca and K channels, and antonist of α and β adrenergic receptors, dobutamine = stimulates B₁ receptors increasing contractility and CO. Carotid sinus massage = used to diagnose carotid sinus syncope and is sometimes useful for differentiating supraventricular tachycardia (SVT) from ventricular tachycardia​

Question 14

Answer 14

C - Hyper resonance on the R side of chest - sign of pneumothorax

Question 15

Answer 15

E - pulmonary embolism. (If pneumothorax, would find reduced expansion, hyper-resonant percussion, and quiet breath sounds on chest examination).

Question 16

Answer 16

D - spirometry b/c it will tell you if pt has COPD or not

Question 17

A 80yo man is brought to the ED in the early morning with a hx of SoB of an hour duration. He is known to have a hx of HT and has a smoking hx of 30 pack year. Once made a full assessment, the ED doctor has decided to treat this patient. The CXR is given below. Which one of the following should be the most appropriate tx?

a) IV dopamine infusion
b) IV benzyl penicillin and clarithromycin
c) IV co-amoxiclav
d) IV furosemide
e) IV normal saline infusion

Answer 17

D - IV furosemide b/c pt has pulmonary oedema, a bilateral batwing appearance

Question 18

A 34yo man is seen in the ED with a hx of cough, L sided chest pain, fever and discoloured sputum of 3 days duration. He has been well previously and has taken some ibuprofen for his chest pain. His CXR is given below. What is the most likely radiological dx?

a) Consolidation
b) Effusion
c) Collapse
d) Pneumothorax
e) Fibrosis

Answer 18

A - dx = pneumonia so will expect to see L lobe consolidation on CXR

Question 19

A 65yo man has increasing tiredness and difficulty staying awake at work. He has not noticed any change in his bowel habit or urine colour and has not lost any weight. He had a partial gastrectomy 10 yrs previously for a perforated gastric ulcer.

Ix:
Hb 55g.L (130-175)
MCV 125fl (80-96)
Reticulocytes 15 x 10⁹/L (25-100)
WCC 2.5 x 10⁹/L (3.0-10.0)
Platelets 120 x 10⁹/L (150-400)
Blood film: oval macrocytes ++, teardrop poikilocytes ++, red cell fragments +, neutrophil hypersegmentation ++
Lactate dehydrogenase 610 IU/L (70-250)

Which is the most likely mechanism for his anaemia?

a) Intravascular haemolysis
b) Reduced folic acid absorption in the small intestine
c) Reduced iron absorption in the small intestine
d) Reduced vitamin B₁₂ absorption in the terminal ileum
e) Small intestine bacterial overgrowth

Answer 19

D - macrocytic anaemia. B₁₂ commenst for gastrectomy so not B.

Partial gastrectomy: removal of a part of the stomach. It’s usually the lower half that’s removed. Folic acid absorption: actively absorbed from duodenum and jejunum. Iron absorption: duodenum mainly. B₁₂ absorption: readily absorbed in ileum BUT to be absorbed it must combine with IF, which is produced in the stomach.