Symptom-limited treadmill exercise testing is often done before discharge after a

STEML Which of the following parameters at exercise testing most strongly indicates
a good prognosis with medical treatment?
Above average exercise capacity. ‫الجواب‬
A 72-year-old male is admitted to the Emergency Room following a collapse at
church.
ECG reveals dissociation between the P and QRS complexes with a rate of 40 /
minute. Which one of the following clinical findings may also be found?

Loud Sl
Narrow pulse pressure

Giant v waveforms in the JVP

Variable intensity of Sl

Soft S2
Which of the following signs is not associated with the development of Eisenmenger's
syndrome in a patient with a ventricular septal defect?

Worsening of systolic murmur

Raised JVP

Loud second heart sound

Cyanosis

Large 'a' waves in jugular venous waveform

A 51-year-old male represents with chest pain, eighteen days after he was diagnosed
with a non-ST elevation myocardial infarction. It is severe, central chest pain with
radiations to the left shoulder and worse with deep inspiration. The pain woke him
from sleep at 03:00 and has improved slightly after getting up out of bed. Findings on
examination include reduced air entry to both bases coupled with fine basal
crepitations. Observations show.

An initial ECG shows diffuse saddle-shaped ST elevation. An echocardiogram shows a

small rim of fluid outside the pericardium. What is the most likely diagnosis?

Second myocardial infarction

Pulmonary embolism

Dressier's syndrome

Costochondritis
 Unstable angina
What does troponin T bind to?

Tropomyosin

Actin in thin myofilaments

Protein kinase C inhibitors

Calcium ions

T-tubule membrane wall

A 67-year-old female is prescribed simvastatin for hyperlipidaemia. Which one of the
following is most likely to interact with her medication?

Orange juice

Apple juice

Grapefruit juice

Cranberry juice

Carrot juice
A 23-year-old woman presents to the Emergency Department with a friend from
work. Around 30 minutes ago she developed a 'fluttering' in her chest. She reports
feeling 'a bit faint' but denies any chest pain or shortness of breath. An ECG shows a
regular tachycardia of 166 bpm with a QRS duration of 0.11s. Blood pressure is
102/68 mmHg and oxygen saturations are 99% on room air. What is the most
appropriate management?

Intravenous magnesium sulphate

Direct current cardioversion

Intravenous adenosine 3mg

Intravenous adenosine 6mg

Carotid sinus massage

A 66-year-old male with a 75 pack year history of smoking is admitted with a 2 hour
history of central crushing chest pain radiating to his jaw. ECG revealed ST
depression in Il, Ill, aVF. 6 hour troponin I was 450ng/L. Grace score revealed 6
month mortality risk of 9%. The patient was started on Tirofiban whilst waiting for
angiography.

What is the mechanism of action of Tirofiban?

ADP receptor antagonist

Factor Xa inhibitor

Gpllb/llla inhibitor

Cox inhibitor

Direct thrombin inhibitor

Which part of the jugular venous waveform may be exaggerated in tricuspid
regurgitation?

x descen

wave

descent

a wave

c wave
You review a 24-year-old woman who has recently been diagnosed as having long
QT syndrome type I (LQTSI). You are discussing the need to avoid certain drugs
and other aggravating factors. Which one of the following should be avoided if
possible?

Methotrexate

Sertraline

Grapefruit juice

Carbamazepine

Doxycycline