Download Myocardial infarction

Myocardial infarction - 2
1. A 48-year-old man is admitted to the coronary care unit with an acute inferior myocardial infarction.
Two hours after admission, his blood pressure is 86/52 mmHg; his heart rate is 40 beats per minute with
sinus rhythm. Which of the following would be the most appropriate initial therapy?
(A) Immediate insertion of a temporary transvenous pacemaker
(B) Intravenous administration of atropine sulfate, 0.6 mg
(C) Administration of normal saline, 300 mL over 15 min
(D) Intravenous administration of dobutamine, 0.35 mg/min
(E) Intravenous administration of isoproterenol, 5.0 mcg/min
2. A 70-year-old retired banker with no past medical history presents to the emergency department 4 h
after the onset of severe substernal crushing chest pain with radiation to the left arm and neck.
Electrocardiography reveals significant ST-segment elevation in leads I, L, V5, and V6. The patient has
no clear-cut medical contraindications to anticoagulation. Which of the following would be the optimal
management strategy at this time?
(A) Intravenous tissue plasminogen activator alone
(B) Intravenous tissue plasminogen activator and aspirin
(C) Intravenous tissue plasminogen activator and heparin
(D) Intravenous tissue plasminogen activator, heparin, and aspirin
(E) Thrombolytic therapy is contraindicated because of the patient's age
3. A previously healthy 58-year-old man is admitted to the hospital because of an acute inferior
myocardial infarction. Within several hours, he becomes oliguric and hypotensive (blood pressure is
90/60 mmHg). Insertion of a pulmonary artery (Swan-Ganz) catheter reveals the following pressures:
pulmonary capillary wedge, 4 mmHg; pulmonary artery, 22/4 mmHg; and mean right atrial, 11 mmHg.
This man would best be treated with
(A) fluids
(B) digoxin
(C) norepinephrine
(D) dopamine
(E) intraaortic balloon counterpulsation
4. Clear contraindications to the use of thrombolytic agents in the setting of an acute anterior myocardial
infarction include all the following EXCEPT
(A) left carotid artery occlusion with hemiparesis 1 month ago
(B) transurethral resection of the prostate 1 week ago
(C) diastolic blood pressure of 110 mmHg during chest pain
(D) patient age greater than 70
(E) epigastric pain and melena 1 week ago treated with histamine receptor antagonists
5. All the following are known clinical markers for acute myocardial infarction EXCEPT
(A) CK-MB2
(B) CK-MB1
(C) cardiac-specific troponin I
(D) cardiac-specific troponin T
(E) cardiac-specific tropomyosin I
6. A 48-year-old patient presents to the hospital with syncope, dyspnea of sudden onset and hypotension.
His ECG is shown below. What is the most likely diagnosis?
A. Acute anterior MI
B. Acute inferior MI
C. Acute pericarditis
D. Acute pulmonary
embolism
E. Non-cardiogenic
syncope
7. What is your interpretation of the ECG below?
Hint:
measure PR
interval
8. A 28-year-old man presents to the hospital with chest pain that began at a party. On further
questioning, he was using cocaine at a party. His ECG is shown below. The most likely cause of his chest
pain is
A. Acute inferior MI
B. Acute anterior MI
C. Acute pericarditis
D. Acute pulmonary
embolism
E. Right ventricular
MI
9. A 38-year-old man without cardiac risk factors presents with chest pain that has been continuous for 2
days. His vital signs are as follows: temperature, 37.4°C; heart rate, 86 bpm; blood pressure, 140/78 mm
Hg; and respiratory rate, 21 per minute. His ECG is shown below. He had symptoms of a common cold 3
weeks ago:
A. Acute anterior MI
B. Acute inferior MI
C. Acute pericarditis
D. Acute pulmonary embolism
E. Prinzmetal’s angina
10. A 55-year-old male presents with severe substernal chest pain for the last hour. It began at
rest and is associated with dyspnea and nausea. The electrocardiogram shows bradycardia with a
Mobitz type II second-degree block. Chest plain film is normal. Which of the following is likely
to be found in addition on the electrocardiogram?
A.
B.
C.
D.
E.
ST elevation in V1-V3
Wellen’s T waves
ST elevation in II, III, aVF
ST depression in I and aVL
No other abnormality