Masterclass Cardiology

1
Masterclass Cardiology

• Semesters 8-9
• Prof Yean Lim
• Semester 9 2010

2
Paper 2

• 39 A 32 year old man presents with a 6 hour
  history of chest pain. The pain is better when
  he leans forward and worse coughing and sneezing.
  He has had a sore throat for 2 days. An ECG
  performed on his arrival shows saddle type ST
  elevation in the anterior, lateral and inferior
  leads. The most appropriate treatment is
•    
•   a) Intravenous streptokinase
•   b) Topical nitroglycerin
•   c) Oral paracetamol
•   d) Subcutaneous fractionated heparin

3
Paper 2 contd

• 42 A 49 year old man presents to the RMH
  Emergency Department with a 2 hour history of
  severe of central crushing chest pain radiating
  to the jaw and left arm. He rates the pain at
  8/10. Examination reveals a mild tachycardia and
  profuse sweating. An ECG reveals 3mm of ST
  elevation in leads V1, V2, V3 and V4. After
  commencing O2, aspirin and inserting an IV
  cannula the most appropriate treatment is
•   Commence IV nitroglycerin
•   Commence IV streptokinase
•   Commence IV heparin
•   Commence a beta blocker
•   Commence a ACE inhibitor

4
Paper 3

• 34 Mrs Cardia walks into the Emergency Department
  with chest discomfort. She is 30 years old.
•    
•   What is your first action?
•   a) Take her pulse and sit her down.
•   b) Take her history.
•   c) Take an ECG.
•   d) Do a rapid assessment of her airway,
  breathing and circulation.

5
Paper 3 contd

• 35 Mrs Cardia now reports these clinical
  features chest tightness, palpitations,
  diaphoresis, mild dyspnoea and is slightly
  lightheaded.
•  
•   Your immediate clinical priority now is to
•   a) take a history
•   b) Defibrillate
•   c) Lie her on a trolley, apply oxygen and
  continuous cardiac monitoring
•   d) Give her a sub-lingual glyceryl trinitrate
  tablet.

6
Paper 3 contd

• 36 You decide the appropriate mode of oxygen
  delivery based upon
•  
• a) how the patient looks
•   b) Mrs Cardias respiratory rate
•   c) It should always be delivered by closed face
  mask at 10 litres/minute for chest tightness.
•   d) Rapid respiratory assessment, including
  pulse oximetry monitoring.

7
Paper 3 contd

• 37 4) You take an ECG. Mrs Cardia is diaphoretic
  and the electrode dots do not adhere to the skin.
  Initial troubleshooting will be?
•   a) shaving the chest
•   b) wiping the skin dry with a towel.
•   c) Wiping the skin with an alcohol swab
•   d) Using surgical tape to stick the electrodes
  to the skin

8
Paper 3 contd

•  38 Her ECG is below (atrial fibrillation, rate
  approx 130). Please select the most correct
  diagnosis.
•    
•   a) atrial fibrillation
•   b) rapid atrial fibrillation
•   c) sinus tachycardia
•   d) idioventricular rhythm

9
Paper 3 contd

• 39 Which of these cardiac rhythms are most
  likely to cause the sensation of palpitations?
•  
• a) sinus rhythm
•   b) ventricular fibrillation
•   c) sinus tachycardia
•   d) junctional bradycardia

10
Paper 3 contd

• 40 On questioning, Mrs Cardia denies taking any
  prescription or non-presciption drugs. She has
  an unremarkable past history and has never felt
  like this before. She reports flu-like symptoms
  in the past two weeks. Her current blood pressure
  is 85/60 mmHg, her respiratory rate is 28 / min.
  Chest auscultation demonstrates bibasal fine
  crackles and a systolic murmur over the mitral
  valve region.
•    
•   The most correct immediate management of Mrs
  Cardia is
•   a) Sedation, Cardioversion and admission to CCU
•   b) Intravenous fluids, digoxin and admission to
  CCU
•   c) Anti-arrythmic medication and admission to a
  medical ward.
•   d) Continuous cardiac monitoring, CXR, IV
  cannula and blood tests.

11
Paper 3 contd

• The immediate aim of management at this time is
  to
•   a) optimize hydration, revert arrhythmia
•   b) control arrhythmia rate, normalize blood
  pressure and urine output
•   c) control arrhythmia rate, optimize
  respiratory and cardiac function
•   d) refer immediately to surgeons with a view
  to urgent valve replacement

12
Paper 4

• 19 An 82 year old Great Grandmother has extensive
  complications related to her 32 year history of
  type 2 diabetes including ischaemic heart
  disease, peripheral vascular disease and
  retinopathy. She presents with a 0.5 x 0.5 cm
  ulcer of her heel with extensive cellulitis
  tracking up her leg. A popliteal pulse is
  palpable on the affected limb but there are no
  other distal pulses felt. Because of her
  exstensive co morbidities the patient is assessed
  as being unsuitable for vascular bypass. The best
  test to determine if the wound is likely to heal
  with conservative therapy is
•   a) Doppler ultrasound
•   b) Toe pressures
•   c) Angiography
•   d) CT Angiogram
•   e) Plain Xray