Cardio Vascular PDF

This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Welcome To First AID AMC Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com # 17 year old male was runnin...

This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Welcome To First AID AMC Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com # 17 year old male was running a race and suddenly collapses on the floor. Luckily someone was there and performed CPR as patient did not have a palpable pulse and resuscitated him. Upon arrival to the ED it is revealed that his father died at age 28. He is now alert, asymptomatic, ECG was non eventful and he is anxious to go home. What would you do next? A. Send him home and arrange an outpatient consult with a cardiologist B. Send him home. C. Admit and refer for cardiologist team consult D. Outpatient Echo E. Stress Echo Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com # a young athlete presents with history of sudden syncope and dyspnea. Ecg shows Left ventricular hypertrophy. patient's father had sudden death at very young age. initial treatment? a. verapamil b. septal myomectomy c. defibrillator d. LMWH e. adenosine Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com a young girl 15 yr collapsed at excercise,her father had HOCM, after ecg and echo u find no abnormality, next step a) holter monitoring b) stress echo c) Repeat Echo now c) repeat echo after 3 year Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com A 9 year old male was running playing football and suddenly collapses on the floor. Upon arrival to the ED it is revealed that his father died at age 28. He is now alert, asymptomatic. What would you do next? a) holter monitoring b) stress echo c) repeat echo after 3 year d) ECG E) ECHO Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com a 16 yrs old male who presents with ejection murmur in second left intercostal space , which of the following is likely to be the diagnosis? A- ASD with aortic stenosis B- ASD with mitral stenosis C- ASD with pulmonary HTN D-ASD with aortic regurgitation Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com https://step2.medbullets.com/cardiovascular/120006/atrial-septal- defect-asd Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com vsd Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com #A young guy while playing cricket suddenly had syncopal attack without any convulsive features. Soon he spontaneously recovered and started fielding and continue playing rest of the game. What was the cause? a)Vasovagal syncope b)cardiac syncope c)Epilepsy d)Neurogenic Syncope e)Postural hypotension Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com ANS: if there is post ictal state then SEIZURE otherwise SYNCOPE. If there is prodromal signs then more with Vasovagal if no prodromal sign and recover immediately(seconds) more with cariogenic (there could be murmur), no murmur arrhythmic syncope. But there is some rare once too cardiogenic: the patient drops down suddenly and regains consciousness in seconds. Neurogenic: goes suddenly and come backs in minutes (vasovagal , seizure) Metabolic: the patient goes gradually and come backs gradually. https://www.aafp.org/afp/2005/1015/p1492.html Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com A 45-year-old male presented to the emergency department with left sided chest pain radiating to the left arm and jaw. There is no ECG changes and troponin is negative 4 hours since the onset of chest pain. He has been on sildenafil for erectile dysfunction, metformin for type 2 diabetes mellitus, and ramipril for hypertension. What would be the most appropriate next treatment? a. Nitrates b. Heparin c. Morphine d. Beta blocker e. Paracetamol Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com A-72-year-old male presented with severe chest pain radiating to his back. On cardiac examination you notice diastolic murmur. Chest X-ray shows wide mediastinum. ECG given. What is the most appropriate management? a. Give alteplase b. Give aspirin and intravenous morphine c. Give morphine, B-blocker and arrange for trans-oesophageal echocardiogram d. Refer the patient to cardiology clinic e. Consider urgent MRI of the cervical and thoracic spine Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com https://step2.medbullets.com/cardiovascular/120030/aortic-dissection Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com # Elderly man with multiple falls during the day especially in the morning after waking up. ECG found LVH and multiple ventricular ectopics. Orthostatic hypotension was also noted. How will investigate further? A. Repeated measure of BP in supine and prone positions B. 24 hour ECG holter C. Serum electrolytes D. Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com A young pt has been getting multiple lightheadness, dizziness. his clinical features are normal, CXR, ECG normal, Holter monitor reveals ventricular ectopics. What you will do next? A reassure B ETT C Dobutamine indeced echo D plain echo Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com patient on amlodipine, amiodarone, frusemide, aspirin ,had intermittent falls, reason? Ecg given looked like hyperkalaemia. A- amlodipine and frusemide B- amlodipine and amiodarone C- aspirine and amlodipine. D- aspirin and furosemide Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com scenario about multiple drug including : ramipril , amlodipine , hydrochlorothiazide, celecoxib, asking about which combination making muscle weakness without tenderness ? A. ramipril and HCT B. amiloride and ramipril C. celecoxib and HCT Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com ECG of an adult presented with chest pain, cardiac enzymes and 1st ECG normal, BP was 120/70 , After 8 hrs of observation his BP goes down 89/50 And ECG is showing SVT with HR 150 ,What would you do ? A Adenosine B Flecainide C Atropine D Synchronized cardioversion E defibrillation Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Pt on Digoxin, Bisoprolol, thiazide. Longterm hx of HTN and CHF & AF. stopped taking meds for 3 weeks while on vacations. Now presents with edema upto his knees & a raised JVP of 4 cm but with clear chest sounds. BP 145/90, pulse irregular. What would u do as initial management of this pt? 1- commence furosemide mane 2- commence spironolactone 3- commence metoprolol 4- commence digoxin, bisoprolol 5-recommence all medication Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Given ECG showing “M” spike QRS complex in all leads and given long lead II. Also on long lead II, all QRS are “M” spike and irregularly irregular. HR calculate is 150. Scenario gives patient with hypertension and BP-150/90. Patient is taking only atorvastatin. Not given chest pain clinical features. A Metoprolol. B Apixaban C warfarin D Verapamil Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com A middle aged man known hypertensive started feeling dizziness & he feels his heart is racing.it occurred after running.there was also travel history few days ago.he is on Irbesartan-Hydrochlorothiazide, & well controlled. No mention of diabetes.BP was around 138/78 with no postural change.asked what is most appropriate next investigation? 1-CTPA 2-D-diamer 3-TSH 4-TROPONIN Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com 60 yrs. old male, 10 yrs history of hypertension, feeling dizzy and light headache from this morning when he was doing exercise. smoke 20 cigarettes per day, drinks 2-3 glass of wine most of the night. BP 138/80 sitting 120/75 on lying. Currently on irbesartan-thiazide 150/12.5 Mg and ASA 100 mg. symptoms lasted for abut 2 hrs. ECG was given (SVT) HR around 150/min. Cause of his presentation? A) dehydration B) ischemic heart disease C) hypertension D) alcoholic cardiomyopathy Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com https://www.mja.com.au/journal/2009/190/5/supraventricular-tachycardia Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com ECG with bradycardia and prolong QT, patient came with chest pain for 15 min and relieve by rest. Troponin normal. Pulse – normal and regular. BP normal. What to do next? 1.repeat troponin 2. echo 3. coronary angiography 4. repeat ECG Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com A women on multiple drugs one of them was digoxin , she presented with central abdominal pain and tenderness, her pulse was irregular. Apart from ct what is most appropriate next investigation? A. Abdomen USG B. Serum Lipase C. Serum lactate D. Digoxin level Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com https://emedicine.medscape.com/article/189146-workup#c7 Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com A 23 years old man comes for follow up. His bilateral arm BP 140- 160 / 100-110 range on several occasion. Occasional headaches, rest of physical exams and urinalysis is normal. Heart rate 75/min with mild left ventricular hypertrophy. BB , hydrochlorothiazide , captopril was used and BP now is 150/100. Next appropriate step? A duplex ultrasound of renal arteries B. Echo c. repeat ECG D. Prescribe triamterene. E do ophthalmoscopy Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com RAS should be considered as a cause of high blood pressure in people who ▪ are older than age 50 when they develop high blood pressure or have a marked increase in blood pressure ▪ have no family history of high blood pressure ▪ cannot be successfully treated with at least three or more different types of blood pressure medications https://www.niddk.nih.gov/health-information/kidney-disease/renal-artery- stenosis Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com old man taking digoxin and hydrochlorothiazide presents with palpitation and ECG was given. What is the cause of his problem? A Digoxin toxicity B Hypokalemia C Hyperkalemia Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com pt on many medication metoprolol, digoxin, frusemide, ecg given. Pt complains nausea, vomiting and abdominal pain, digoxin level was given and it was normal. what to do? A. cease digoxin B. cease metoprolol C. temporary pacemaker D. angiography E. cease metoprolol and commerce verapamil Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com ECG of WPW HR 280, systolic pressure 105. Mx? A. Verapamil B. Adenosine C. Amiodarone D. Digoxin E. DC Cardioversion Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com A 65 years old Pt presented with light headedness and palpitation, Examination was clinically normal, he’s on perindopril, Eltroxin, verapamil, antidiabetic medications. ECG (1st degree heart block). What’s the next appropriate treatment? A. Increase Eltroxin B. Stop verapamil C. Stop perindopril D. Add digoxin Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com child with URTI treated for infective endocarditis. blood cultures taken. treated with penicillin but murmur still persists. what to do? a. give antibiotic for 4 weeks with blood culture weekly b. echo c. Repeat blood culture d. Switch to meropenem Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com pregnant woman at 36weeks of gestation presents with dyspnea and orthopnea. X-ray shows bi-basal effusion and cardiomegaly. Exam: crept. Next appropriate investigation? a. ECG b. Echo c. d-dimer d. CTPA Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Pacemaker syndrome with difficulty in breathing with faint heart sounds, spo2 96%, bp-90/60mmhg, jvp-6 with no ECG given. investigation of choice ? A. Chest x-ray. B. CTPA. C. ECG D. ECHOCARDIOGRAM Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com A hypertensive and a diabetic pt presented with histories of numbness, nausea and sweating. He developed dizziness while urinating. Pulse is irregular and ECG shows atrial fibrillation. Diagnosis? a. Myocardial infarction b. Micturition syncope c. Vasovagal syncope Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com old woman, brought after fall, confused, on warfarin , bruises on both thighs and buttocks, troponin 0.08. ck 1000(N=60-220), what dx? a. recent MI less than 12hrs b. MI in 4 hrs c. rhabdomyolysis Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com https://step2.medbullets.com/r enal/121879/rhabdomyolysis Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Patient on medications for HTN (perindopril+indapamide).She feels dizzy when get out of the bed. happening for a while.. she also had some falls. BP 160/100, Has AF. Next Ix? A echo B x-ray C holter monitoring D 24 hour BP monitoring E repeat for postural BP measuring Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com 70+ year old man on Ramipril 5mg for hypertension. On Examination Bp- 150/90, pulse – normal. Cholesterol 6.5 (normal range given around 2). Rest investigation within normal limit. Which one will reduce his risk of stroke? A. Low dose Aspirin B. Clopid C. Increase Ramipril D. Atova Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com 57 year Man complains of anorexia and weakness. known case of CCF on digoxin 0.25 , frusemide/hydrochlorothiazide. lab value cbc-normal. Na - 131, K- 3.1. Ecg (not given). atrial rate 180.ventricular rate 110. ▪ Increase frusemide ▪ hydrochlorothiazide ▪ Stop Digoxin and add K ▪ Defibrillation ▪ Cardioversion Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Aboriginal lady has mitral stenosis and dyspnea. On chest auscultation bilateral basal crepts. No fever cough sputum. Chest x-ray given with bilateral peri hilar opacities coin like. Asked diagnosis. A. pulmonary hypertension, B. TB C. Lymphoma D. Left ventricular failure E. Sarcoidosis Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Lady 75 years old has HTN, DM, well controlled on drugs. She has an episode of chest pain during walking for 15 mins which is relieved after rest. Her current medications include ramipril , metformin, metoprolol. Now the b.p is 130/85, Heart rate is 54bpm. Which of the following investigations will you consider next? a. Serum Troponin b. Thalium scan c. Holter monitoring d. CT angiogram Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com patient with AF... pain in legs.. right leg is pallor absent pulses... Most appropriate Ix? A ct angiogram B uss veins C Arterial Doppler uss leg D d dimer Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com An ECG od AF, old age man come for dyspnoea and H/O of Hypertension and DM but no H/O of Stroke.HR is 80/min irregular and hypertension is treated with losartan and DM for metformin, next appropriate Rx? A.warfarin B.metoprolol C.digoxin D.verapamil E.Atropine Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com 65years old man on hypertensive treatment & history of MI 3yrs ago ,now all examination is normal except of soft blowing precordial murmur on the left border of sternum.. what to do ? ◈ a.cease metaprolol ◈ b.cease metaprolol & commence verapamil ◈ c. add warfarin Ans: C Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com 60 yrs old lady with ecg showing anterior septal wall mi already oxygen , morphine , aspirin given what is the next , patient presents with in 2 hrs ? a. alteplase ◈ b.reteplase ◈ c. angiogram Ans: C Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Scenario of man with multiple drugs now has developed urinary retention and also pedal edema He was in af too I think ◈ A. Urinalysis ◈ B. USG bladder ◈ C. Digoxin level ◈ D. Echo Ans: D Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Post MI after 4 years cane to your clinic for follow up visit, the patient is doing well. Still on diet and regular exercise with complete normal lab work provided. He is on ace and aspirin only ◈ a. reinforce diet and exercise ◈ b. stop aspirin ◈ c. add statin ◈ d. complete in regular follow up ◈ e. till him he don't need any more follow up Ans: C Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com ecg of inferior wall mi patient presented after 2 hrs of chest pain.whats the best mx? Not initial but best Tx....?? ◈ a.tpa ◈ b.angiography and angioplasty ◈ c.iv heparind.gtn patch ◈ d,. Aspirin Ans: a Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Pt with attack of MI, u started heparin and 12 hrs later abdominal swelling developed, u suspect hematoma, what to do ◈ A. Stop heparin ◈ B. Reassure ◈ C. Stop heparin and give aspirin ◈ D. Give FFP ◈ E. Give platelet Ans: B Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com ecg of biventricular cardiac failure,with features of lbbb and tall T waves(so many features)….patient was on digoxin,enalapril,carvedolil,what next? ◈ 1increase dose of digoxin, ◈ 2increase carvedolil, ◈ 3increase enalapril, ◈ 4start furosemide, ◈ 5stop all drugs and reassess in 12 hours. Ans: 5 Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com 70 yrs ant wall mi on ekg one hr since pain next ◈ a.oxygen ◈ b.aspirin ◈ c.ntg ◈ 4.morphine ◈ 5.angioplasty Ans: B Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com A 50 year old women had a mitral valve replacement surgery after rheumatic infection. After 24 hours she starts developing a swelling in the femoral region which is increasing in size every hour, the swelling is pulsatile on palpation. What would be your immediate next step? ◈ A. Perform USG ◈ B. Perform CT angio ◈ C. Put pressure on the swelling ◈ D. MRI Ans: A Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com A 45-year-old male presented to the emergency department with left sided chest pain radiating to the left arm and jaw. There is no ECG changes and troponin is negative 4 hours since the onset of chest pain. He has been on sildenafil for erectile dysfunction, metformin for type 2 diabetes mellitus, and ramipril for hypertension. What would be the most appropriate treatment? ◈ a. Nitrates ◈ b. Heparin ◈ c. Morphin ◈ d. Beta blocker ◈ e. Paracetamol Ans: C Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Patient was just shifted from icu after pacemaker insertion. Patient Suddenly complains of chest pain and difficult breathing. Pulse 88 bpm ,oxygen 98% heart sounds very faint on auscultation. what next ? ◈ a) chest xray ◈ b) ctpa ◈ c) ct ◈ d) troponin ◈ e) Echocardiogram Ans: E Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com patient presented with diplopia for 1 day. On examination there was diplopia on the right eye when looking towards the right side. his glucose is normal. ECG has occasional verntricular ectopics. Whats the most appropriate management. ◈ A. Warfarin ◈ B. Peridropnil ◈ c. Metformin ◈ d. Observation Ans: D Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com cardio pt on many medications , indapamide, verapamil, perindopril , aspirin….. present wth light headedness and mobitz type 2 ecg given wt to do next ◈ 1.valsalva manover ◈ 2.cease verapamil ◈ 3.temporary pace maker ◈ 4.ceaseindapamide Ans: 3 Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com An ECG came with Atrial fibrillation. It was very prominent. The patient came with complains of palpitation. Heart rate was I think in 70s. He was hypertensive. Asking for treatment? a) Digoxin b) Beta blockers c) Adenosine d) Amiodarone Ans: B Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Patient with CHF taking B-blocker , furosemide , perindopril , K supplement , Metformin for DM , started Amiodarone due to arrythmic problems , now complain of lightheadedness and palpitation & feeling like syncope. Potassium level was given about 6.5 and other lab values were within normal range ◈ A.Metformin & amiodarone ◈ B.Metformin & K supplement ◈ C.Frusemide & Perindopril ◈ D.Frusemide & Metformin ◈ E. Amiodarone +Perindopril Ans: E Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Pt become Hypertensive after dialysis. Which drug will you choose A. Losartan B. Amlodipine… C. Frusemide D. CarvideloL Ans: D Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com a 50 year old man present with hypertension with asthma and reflux nephropathy.lab inv were given.there was high urea,high creatinine and proteiuria 900 mg/day.what is the choice of anti HTN? 1.amlodipine 2.losartan 3.perindropil 4.indapamide 5.BB Ans: 1 Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com A 62-year-old Caucasian female is being evaluated after she had an episode of syncope. She complains of having progressive exertional dyspnea over the last two months with an occasional dry cough. Cardiac auscultation findings over the apex is holosystolic murmur. Which of the following best explains the physical findings in this patient? A. Ascending aortic aneurysm B. Constrictive pericarditis C. Mitral regurgitation D. Tricuspid valve stenosis ◈ Ans: C Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com PT with Complete Heart block, but I was at a SUBURBAN hospital, asking the most appropriate Mx?? A- refer by ambulance. B- Refer Cardiologist. C- Insert pacemaker Ans: C Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com ◈ a young athlete presents with history of sudden syncope and dyspnea. ecg shows Left ventricular hypertrophy. patient's father had sudden death at very young age. initial treatment? a. verapamil b. septal myomectomy c. defibrillator d. LMWH e. adenosine Ans:A Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com A-72-year-old male presented with severe chest pain radiating to his back. On cardiac examination you notice diastolic murmur. Chest X-ray shows wide mediastinum. ECG shows acute inferior myocardial infarction. What is the most appropriate management ◈ a. Give alteplase ◈ b. Give aspirin and intravenous morphine ◈ c. Give morphine, B-blocker and arrange for trans-oesophageal echocardiogram (aortic dissection) answer ◈ d. Refer the patient to cardiology clinic ◈ e. Consider urgent MRI of the cervical and thoracic spine Ans: C Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com A 62-year-old Caucasian female is being evaluated after she had an episode of syncope. She complains of having progressive exertional dyspnea over the last two months with an occasional dry cough. Cardiac auscultation findings over the apex is holosystolic murmur. Which of the following best explains the physical findings in this patient? A. Ascending aortic aneurysm B. Constrictive pericarditis C. Mitral regurgitation D. Tricuspid valve stenosis Ans: C Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com ECG bradycardia with hyperacute T wave only one strip….Middle age pt c/o light headache and syncopal attack 3 episode in one month, bp 100/60 0r 90/60 ??he is on multiple drugs.which drug combination will be the cause of his problem? Actually confusing scenario not that simple…. A.Amiodarone +Aspirin B.frusimide+Aspirin C.Amlodipin+Amiodaron D.Aspirin+ Nitrtriglycerite Ans: C Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com ◈ a 50 year old man present with hypertension with asthma and reflux nephropathy.lab inv were given.there was high urea,high creatinine and proteiuria 900 mg/day.what is the choice of anti HTN? 1.amlodipine 2.losartan 3.perindropil 4.indapamide 5.BB ◈ ◈ Ans: 1 Flexcil - The Smart Study Toolkit & PDF, Annotate, Note  This Document has been modified with Flexcil app (iOS) https://www.flexcil.com ◈ 23yr old woman come to clinic for pre employment check up.she got type 1 DM since age of 13.. u perform a full physical xamination.her temp was 37.1,bp 146/89, pulse 54/min,rr 12/min.her skin is warm and dry.cvs xam normal. she returns to d clinic several times and her bp remains high.. what is appropriate for her initial treatment ATENOLOL AMLODIPINE ENALAPRIL FRUSEMIDE HYDROCHLOROTHIAZIDE ◈ Ans: ENALAPRIL Flexcil - The Smart Study Toolkit & PDF, Annotate, Note This Document has been modified with Flexcil app (iOS) https://www.flexcil.com Flexcil - The Smart Study Toolkit & PDF, Annotate, Note