Medical Finals Quiz - March 2007

(Closing date: 1st April 2007)

With Dr Chris Lockhart, SpR in cardiology, Belfast

PasTest Book

PasTest Logo

Please take part in our monthly quiz. This quiz is open to all.

This month for the quiz winner, there is a very useful book on "Data Interpretation for Medical Students"  (which gives comprehensive practice in data interpretation, which is a common feature of undergraduate annual and final exams. Includes ECGs, blood tests and radiographs, along with a wide range of common patterns and case scenarios.) This book is very kindly provided by PasTest.

The winner will be picked at random from all entries (ie. does not matter if your answers are correct or not).

In order to contact the winner of the book, please enter your name and email address at the bottom of this page.

The closing date is 1st April 2007.

Learn as you test yourself. Detailed answers with teaching points will be given after you complete this page.

Question 1

A 75 year old gentleman is admitted via ambulance to A & E. He gives a 4 hour history of vague upper abdominal discomfort. There is no radiation. He also complains of feeling dizzy.

Relevant past medical history includes: an abdominal aortic aneurysm repair/stenting performed 3 months previously via percutaneous technique. He tells you he was admitted 2 weeks ago for 2 days of observation as follow up ultrasound scan had revealed a small leak at the site of repair. He has never been treated for ischaemic heart disease.

On examination he is fully conscious and alert. Heart rate is 70bpm regular and BP is 110/68. Heart sounds one and two are present and normal in character. There are no additional heart sounds or murmurs. Auscultation of the chest is clear. His left femoral pulse is very difficult to palpate.

You perform an ECG:

ECG 1
ECG image from: ecglibrary.com

What is the diagnosis?

(a) Acute Anteroseptal Myocardial Infarction
(b) Complete heart block
(c) Acute pericarditis
(d) Infero-posterior myocardial infarction
(e) Acute Inferior myocardial infarction

Question 2

What is your initial management of the above patient?
(a) Aspirin 300mg, clopidrogrel 300mg, reteplase, enoxaparin 60mg, metoprolol 5mg IV
(b) Aspirin 75mg, clopidrogrel 75mg, reteplase, enoxaparin 60mg, metoprolol 5mg IV
(c) Aspirin 300mg, clopidrogrel 300mg, enoxaparin 60mg, metoprolol 5mg IV, transfer for primary angioplasty and stenting
(d) Aspirin 300mg, clopidrogrel 300mg, reteplase, enoxaparin 100mg, metoprolol 5mg IV
(e) Aspirin 300mg, reteplase, enoxaparin 60mg, metoprolol 25mg PO

Question 3

Which coronary artery do you think is affected in the above patient?
(a) The left anterior descending artery (LAD)
(b) The circumflex artery (Cx)
(c) The right coronary artery (RCA)
(d) Left main stem
(e) The LAD and RCA together

Question 4

During transfer to the ward he suddenly loses consciousness. You immediately note the ECG defibrillator/monitor rhythm has changed. (see below)

ECG 2
ECG image from: images.emedicinehealth.com

What is your immediate treatment?

(a) Further bolus of reteplase
(b) Commence immediate CPR at a rate of 15:2
(c) Commence immediate CPR at a rate of 30:2
(d) Administer 200 J DC biphasic shock
(e) Administer 360 J DC biphasic shock

Question 5

Your treatment is successful and he regains consciousness. He is treated in the cardiology department, makes a successful recovery and is discharged. He returns 6 months later complaining of syncope. His ECG has changed again. (see below)

ECG 3
ECG image from: sprojects.mmi.mcgill.ca

What is the diagnosis?

(a) Complete heart block
(b) Left bundle branch block
(c) Old infero-posterior infarct, and trifasciular block
(d) Acute posterior infarct
(e) 2nd degree heart block

Question 6

What month are your clinical finals exam? January
February
March
April
May
June
July
August
September
October
November
December
Don't know date of final exams yet
No exams
Are your clinical finals exams in an OSCE format? YES     NO     Not Sure     No exams    
Does data interpretation feature in your final exam? YES     NO     Not Sure     No exams    
Does radiology feature in your final exam? YES     NO     Not Sure     No exams
Do you have any local courses for finals? YES     NO     Not Sure
Have you/will you attend a course before finals? YES     NO     Not Sure
I would like to register to receive regular updates from www.medicalfinals.co.uk: Yes     No thanks
COMMENTS:
(Please add any more comments
you may have about the site)

If you wish to enter the draw for a free copy of the very useful book on "Data Interpretation for Medical Students"  very kindly provided by PasTest, or would like to be emailed about updates to the medicalfinals website, then please enter your name and contact email address below:

Your Name:
Your Email address:
Confirm email address:
University/Hospital:
Year of Study/Work:
(eg. Year 1 student, Year 2 student,.. or PRHO, SHO,....)
Location/Country:
How did you find this website:
(eg. Google, Friend, Poster, Link from other site, etc.)

Please check your answers, and then click the "Post My Answers" button below. A message will then be displayed asking for any missing input, or confirming your answers. A link will be given to the detailed answers and teaching points. Thankyou.
 
(There may be a short, typically 10 seconds, delay before anything happens).

www.MedicalFinals.co.uk