Q914. A 62-year-old man presents to the emergency department with severe central chest pressure radiating to his left arm. The pain began 30 minutes ago and is associated with diaphoresis and nausea. His blood pressure is 128/78 mmHg, pulse is 96/min, and oxygen saturation is 97% on room air.

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للتواصل والاستفسار @Ducktor47

Q923. A 70-year-old man has disabling exertional angina despite optimised medical treatment. Coronary angiography demonstrates 80% stenosis of the left main coronary artery, 60% stenosis of the proximal left anterior descending artery and 70% stenosis of a major obtuse marginal branch. His left ventricular ejection fraction is 45%. He is considered suitable for cardiac surgery, and the coronary anatomy is amenable to complete surgical revascularisation.

دفعة 48 اللي يدور في قناة Cases و MCQs
و High yelid points
و Keywords

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@Ducktor47

Q1109. A 22-year-old man presents with severe chest pain and tachycardia following cocaine exposure. ECG shows sinus tachycardia without persistent ST elevation. His initial troponin is normal, but the symptoms began only 30 minutes ago. Which statement is most appropriate?

A. A negative initial troponin definitively excludes acute myocardial infarction.

B. Routine fibrinolysis is indicated solely because cocaine was used.

C. Immediate discharge is appropriate whenever the first ECG is nondiagnostic.

D. A normal initial ECG proves there is no myocardial ischaemia.

E. Acute coronary syndrome remains possible and requires appropriate monitored evaluation and serial testing.

انتو مو مال نصايح 🤣🤣🤣

✅✅✅✅
وهذي الصورة تخليك تفهم كويس

“Beta-thalassemia watching you prescribe iron because all you saw was microcytic anemia and you ignored the normal ferritin.”

A 68-year-old woman with type 2 diabetes mellitus and hypertension presents with intermittent central chest heaviness at rest over the preceding four hours, with the longest episode lasting 30 minutes. She is now pain-free. Her pulse is 84 beats/min, blood pressure is 146/86 mmHg, and oxygen saturation is 96% on room air. There are no clinical signs of heart failure. ECG demonstrates 2 mm horizontal ST-segment depression in leads V4–V6 and T-wave inversion in leads I and aVL. High-sensitivity troponin T is 86 ng/L on arrival and rises to 310 ng/L three hours later (upper reference limit 14 ng/L). Her creatinine is 82 µmol/L, and she has received aspirin 300 mg.

A 61-year-old man presents to a hospital without PCI facilities 13 hours after the onset of severe chest pain. ECG demonstrates persistent ST-segment elevation in leads V2–V6, and he continues to experience chest discomfort despite initial medical treatment. He is haemodynamically stable and has no contraindication to antithrombotic therapy. A PCI-capable centre can accept him for urgent transfer.
Which reperfusion strategy is most appropriate?

A. Administer fibrinolysis routinely because the patient remains within the first 24 hours.

B. Withhold reperfusion because the first 12 hours have already elapsed.

C. Arrange urgent transfer for primary PCI because persistent ischaemia warrants invasive reperfusion assessment.

D. Continue medical treatment alone and arrange an outpatient exercise test after discharge.

E. Repeat troponin testing for six hours before deciding whether coronary angiography is needed.

Q1138. A 58-year-old man is recovering after successful fibrinolysis for an anterior STEMI. His chest pain has resolved, serial ECGs show no evidence of recurrent ischaemia, and he has no clinical signs of heart failure. He is being prepared for discharge, and his left ventricular function has not yet been assessed.
Which investigation is recommended before discharge to guide treatment and estimate his risk of subsequent complications?

A. Routine symptom-limited exercise testing for every patient one week after infarction.

B. Coronary calcium scoring to estimate the extent of calcified coronary plaque.

C. Transthoracic echocardiography to assess ejection fraction, wall motion and mechanical complications.

D. Twenty-four-hour ambulatory ECG monitoring as a substitute for ventricular function assessment.

E. Repeat troponin testing until the concentration returns completely to normal.

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