Discuss your answer. Part 1 A 57 year-old male lorry driver, presented to his local emergency department with a 20-minut
Posted: Tue Mar 15, 2022 2:54 pm
Discuss your answer.
Part 1
A 57 year-old male lorry driver, presented to his local
emergency department with a 20-minute episode of diaphoresis and
chest pain. The chest pain was central, radiating to the left arm
and crushing in nature. The pain settled promptly following 300 mg
aspirin orally and 800 mcg glyceryl trinitrate (GTN) spray
sublingually administered by paramedics in the community. He smoked
20 cigarettes daily (38 pack years) but was not aware of any other
cardiovascular risk factors. On examination he appeared comfortable
and was able to complete sentences fully. There were no heart
murmurs present on cardiac auscultation. Blood pressure was 180/105
mmHg, heart rate was 83 bpm and regular, oxygen saturation was
97%.
What is the most likely diagnosis?
A
Acute coronary syndrome
B
Aortic dissection
C
Esophageal rupture
D
Peptic ulceration
E
Pneumothorax
Part 2
An ECG was requested and is shown in figure 1.
How would you manage the patient? (The patient has already
received 300 mg aspirin).
A
Atenolol 25 mg, Atorvastatin 80 mg, Clopidogrel 75 mg, GTN 500
mcg
B
Atenolol 25 mg, Clopidogrel 75 mg, GTN 500 mcg, Simvastatin 20
mg
C
Atorvastatin 80 mg, Clopidogrel 300 mcg, GTN 500 mcg, Ramipril
2.5 mg
D
Atorvastatin 80 mg, Clopidogrel 75 mg, Diltiazem 60 mg,
Oxygen
E
Clopidogrel 300 mg, Morphine 5 mg, Ramipril 2.5 mg, Simvastatin
20 mg
Part 3
30 minutes later the patient's chest pain returned with greater
intensity whilst waiting in the emergency department. Now, he
described the pain as though “an elephant is sitting on his chest”.
The nurse has already done an ECG by the time you were called to
see him. This is shown in figure 2.
Figure 1:
ECG on admission.
Figure 2:
ECG 30 minutes after admission.
What would be the optimal management for this patient?
A
Administer intravenous morphine
B
Increase GTN dose
C
Observe as no new significant changes
D
Proceed to coronary angiography
E
Thrombolyse with alteplase
Part 5
One week later, he receives a letter informing him that he is
required to attend cardiac rehabilitation. The patient is confused
as to what cardiac rehabilitation entails, although he does
remember a nurse discussing this with him briefly before he was
discharged. He phones the hospital in order to get some more
information.
Which of the following can be addressed during cardiac
rehabilitation?
A
Diet
B
Exercise
C
Pharmacotherapy
D
Smoking cessation
E
All of the above
Part 1
A 57 year-old male lorry driver, presented to his local
emergency department with a 20-minute episode of diaphoresis and
chest pain. The chest pain was central, radiating to the left arm
and crushing in nature. The pain settled promptly following 300 mg
aspirin orally and 800 mcg glyceryl trinitrate (GTN) spray
sublingually administered by paramedics in the community. He smoked
20 cigarettes daily (38 pack years) but was not aware of any other
cardiovascular risk factors. On examination he appeared comfortable
and was able to complete sentences fully. There were no heart
murmurs present on cardiac auscultation. Blood pressure was 180/105
mmHg, heart rate was 83 bpm and regular, oxygen saturation was
97%.
What is the most likely diagnosis?
A
Acute coronary syndrome
B
Aortic dissection
C
Esophageal rupture
D
Peptic ulceration
E
Pneumothorax
Part 2
An ECG was requested and is shown in figure 1.
How would you manage the patient? (The patient has already
received 300 mg aspirin).
A
Atenolol 25 mg, Atorvastatin 80 mg, Clopidogrel 75 mg, GTN 500
mcg
B
Atenolol 25 mg, Clopidogrel 75 mg, GTN 500 mcg, Simvastatin 20
mg
C
Atorvastatin 80 mg, Clopidogrel 300 mcg, GTN 500 mcg, Ramipril
2.5 mg
D
Atorvastatin 80 mg, Clopidogrel 75 mg, Diltiazem 60 mg,
Oxygen
E
Clopidogrel 300 mg, Morphine 5 mg, Ramipril 2.5 mg, Simvastatin
20 mg
Part 3
30 minutes later the patient's chest pain returned with greater
intensity whilst waiting in the emergency department. Now, he
described the pain as though “an elephant is sitting on his chest”.
The nurse has already done an ECG by the time you were called to
see him. This is shown in figure 2.
Figure 1:
ECG on admission.
Figure 2:
ECG 30 minutes after admission.
What would be the optimal management for this patient?
A
Administer intravenous morphine
B
Increase GTN dose
C
Observe as no new significant changes
D
Proceed to coronary angiography
E
Thrombolyse with alteplase
Part 5
One week later, he receives a letter informing him that he is
required to attend cardiac rehabilitation. The patient is confused
as to what cardiac rehabilitation entails, although he does
remember a nurse discussing this with him briefly before he was
discharged. He phones the hospital in order to get some more
information.
Which of the following can be addressed during cardiac
rehabilitation?
A
Diet
B
Exercise
C
Pharmacotherapy
D
Smoking cessation
E
All of the above