Answer and Explanation 5

5.  The correct answer is C.  Alcohol use is not identified as a risk factor in CAD.  In fact, it has been show when used in moderation to be helpful.  Diabetes, hyperlipidemia, and tobacco abuse are all recognized as major risk factors for CAD.

Question 5

 5.  Which of the following is not recognized as a recognized risk factor for coronary artery disease (CAD)?

A.  Diabetes Mellitus

B.  Hyperlipidemia

C.  Alcohol Use

D.  Tobacco Abuse

Answer and Explanation 4

4.  Choice C is the correct answer.  This EKG shows A-Fib with RVR.  It has an irregularly irregular pattern.  Cardioversion should not be considered immediately because the patients blood pressure is normal.  Adenosine is helpful for SVT and really does not show efficacy in A Fib with RVR.  Therefore the correct answer is C.

Question 4

4.  Which of the following actions is most appropriate treatment given the EKG below and knowing your patients blood pressure is 170/96 ?

A.  Adenosine 12 mg IV

B.  Adenosine 6 mg IV

C. Cardizem 15 mg IV bolus, followed by a drip

 

D.  Stat Cardioversion at 150 joules

Answer and Explanation 3

3.  Choice D is correct.  By definition of the Wells criteria the patient with cancer does not put the patient in a low risk population so a D-Dimer would not be helpful.  A VQ scan would not be the best test because the ventilation portion may be obscured by the pneumonia and lung cancer and will likely yield inconclusive results.  Selective pulmonary angiography could give you the diagnosis but is quite invasive and the procedure could have some complications.  Therefore the correct answer is D.

Question 3

 3.  Which of the of following is the best test to screen a 53 year old patient with lung cancer and pneumonia that has pleuritic chest pain and shortness of breath for a pulmonary embolus?

A.   D-Dimer

B.  VQ Scan

C.  Selective pulmonary angiography

D.  CTA of Chest with IV contrast

Answer and Explanation 2

2.  Choice A is correct.  In cases of new onset Left Bundle Branch Block in patients with chest pain you have to treat this as a ST elevation MI.  Cardiology should be consulted immediately and the patient should be evaluated for cardiac catheterization.  ST Depression is just indicative of ischemia no matter if it is in all leads or just the anterior lateral leads.  Another possibility with ST depression in all leads is an evolving pericarditis.  Flipping of the axis in lead AVR could mean lead reversal.

Question 2

 1.  Which of the following is consistent with a ST elevation myocardial infarction?

 A.  New onset Left Bundle Branch Block

 B.   ST depression in all leads

 C.  ST Depression in the anterior lateral leads

 D.   Flipping of the axis in lead AVR.

Answer and Explanation 1

1.  Answer C.  This patient is demonstrating signs of shock and presentation and a history that is suspicious for thoracic aortic dissection (TAD).  Choice A has some good ideas of getting an EKG and giving oxygen.  Nitroglycerin should not be given to a hypotensive patient.  Aspirin should probably not be given especially if it is proven that the patient is actively bleeding.  Choice B is also incorrect for the same reasons plus morphine should not be given to the hypotensive patient.  Choice D may seem like a good choice if the patient was  a straight forward chest pain.  Choice C is correct because this needs to be treated as a seconds to minutes emergency.  A CT Scan with IV contrast will be needed to confirm a case of thoracic aortic dissection.  In the case of a patient with CT scan anaphylaxis or a high creatinine you can try getting one without contrast but it will not tell your where the bleeding is coming from.  The best test if it is available is a transesophageal ECHO (TEE).  Having great IV access as well as having blood ready is essential in management of this patient.

Question 1

 1.  Patient is a 52 year old male who comes in to the Emergency Room with a sudden onset on sharp chest pain radiating to the back and he is diaphoretic.  His pain just started 30 minutes prior to arrival.  His vital signs are as follows BP-73/43 P-130, R-20 Temp-97.3  He had just had outpatient labs done at your hospital yesterday that showed a BUN of 12 and a Creatinine of 0.7.  Which of the following is the most appropriate action?

A.   Get an EKG, give 4 baby Aspirin, apply oxygen and give a nitroglycerin trial.

B.   Get an EKG, give 4 baby Aspirin apply oxygen, given a nitroglycerin trial and morphine.

C.   Get an EKG, order a stat CT scan with IV contrast, Type and Cross the patient for   4 units, get a second IV line, and notify the cardiologist or vascular surgeon of your results.

D.  Get an EKG, give 4 baby Aspirin, apply oxygen, repeat his labs including enzymes, get an a chest x ray and admit.