Q1159. A 56-year-old man who smokes 20 cigarettes daily presents with crushing central chest pain radiating to his left arm, accompanied by sweating and nausea. His pulse is 92 beats/min, blood pressure is 134/82 mmHg, and oxygen saturation is 97% on room air. ECG shows 4 mm ST-segment elevation in V1–V4 with reciprocal ST depression in II, III and aVF. The catheterisation laboratory is ready to receive him within 30 minutes.
Which is the most appropriate reperfusion strategy?
Anonymous Quiz
83%
A. Proceed with primary PCI without waiting for the troponin result.
4%
B. Administer fibrinolysis followed by discharge if the pain resolves.
0%
C. Give intravenous heparin alone and reserve angiography for recurrent pain.
0%
D. Arrange emergency CABG before defining the coronary anatomy.
13%
E. Continue observation until serial ECGs establish the final infarct size.
❤3
Forwarded from iNternal-MeDicine MCQs and Cases
Q1179. A 59-year-old man with established coronary artery disease has hypertension, type 2 diabetes, obesity and dyslipidaemia. He continues to smoke 20 cigarettes daily despite receiving preventive medication. He asks which single behavioural intervention should be prioritised alongside his pharmacological treatment because it directly addresses a major modifiable cardiovascular risk factor.
Which is the most appropriate recommendation?
A. Achieve complete smoking cessation with structured behavioural and pharmacological support when appropriate.
B. Reduce dietary carbohydrate intake while continuing the same smoking pattern.
C. Delay exercise and weight-management measures until LDL cholesterol normalises.
D. Restrict fluid intake to reduce the risk of coronary atherosclerosis.
E. Replace preventive medication with dietary supplements and periodic ECG monitoring.
Which is the most appropriate recommendation?
A. Achieve complete smoking cessation with structured behavioural and pharmacological support when appropriate.
B. Reduce dietary carbohydrate intake while continuing the same smoking pattern.
C. Delay exercise and weight-management measures until LDL cholesterol normalises.
D. Restrict fluid intake to reduce the risk of coronary atherosclerosis.
E. Replace preventive medication with dietary supplements and periodic ECG monitoring.
Forwarded from iNternal-MeDicine MCQs and Cases
Clinical Case Scenario
A 19-year-old male with a known history of Type 1 Diabetes Mellitus (T1DM) is brought to the emergency department by his family. He has a 2-day history of nausea, vomiting, diffuse abdominal pain, and frequent urination. On examination, he is lethargic, dehydrated, and breathing deeply and rapidly (Kussmaul breathing) with a fruity odor on his breath.
• Blood Glucose: 450 mg/dL
• Serum Bicarbonate (HCO₃⁻): 12 mEq/L (Low)
• Arterial Blood Gas (ABG): pH 7.28
• Serum Ketones: Strongly positive
A 19-year-old male with a known history of Type 1 Diabetes Mellitus (T1DM) is brought to the emergency department by his family. He has a 2-day history of nausea, vomiting, diffuse abdominal pain, and frequent urination. On examination, he is lethargic, dehydrated, and breathing deeply and rapidly (Kussmaul breathing) with a fruity odor on his breath.
• Blood Glucose: 450 mg/dL
• Serum Bicarbonate (HCO₃⁻): 12 mEq/L (Low)
• Arterial Blood Gas (ABG): pH 7.28
• Serum Ketones: Strongly positive