08-20-2014, 11:02 AM
1.A 76-year-old man is brought to the Emergency Department by relatives who state that he had collapsed suddenly but regained consciousness within minutes. There was no seizure activity. His electrocardiogram showed a sinus rhythm (76/minute), a right bundle branch block and left anterior fascicular block (left axis deviation). Which one of the following most likely accounts for this man’s loss of consciousness?
a.Ventricular tachycardia.
b.Type I second degree artrioventricular block (Wenckebach).
c.Paroxysmal supraventricular tachycardia.
d.Intermittent heart block.
e.Atrial flutter with 2 :1 artrioventricular block.
2.58-year-old man presents to the Emergency Department with sudden onset of left-sided chest pain associated with shortness of breath, palpitations and dizziness. His past history is relevant for a recent diagnosis of a lung carcinoma. Which one of the following tests is most likely to confirm his diagnosis?
1. Electrocardiogram.
2. Chest radiograph.
3. Ventilation-perfusion (V/Q) of the lung.
4. Echocardiogram.
5. Holter monitoring.
3.58-year-old man presents to the Emergency Department with sudden onset of left-sided chest pain associated with shortness of breath, palpitations and dizziness. His past history is relevant for a recent diagnosis of a lung carcinoma. Which one of the following tests is most likely to confirm his diagnosis?
1. Electrocardiogram.
2. Chest radiograph.
3. Ventilation-perfusion (V/Q) of the lung.
4. Echocardiogram.
5. Holter monitoring.
4.A 32-year-old unemployed man who abuses alcohol and who underwent a mastoidectomy as a youngster presents with headaches, nausea, vomiting, drowsiness and confusion. He does not have a fever but his right eardrum is not visualized and there appears to be some discharge there. There is slight neck stiffness as well. Which one of the following investigations is the most appropriate at this time?
1. Lumbar puncture.
2. Electroencephalogram.
3. Skull x ray.
4. Blood culture.
5. Intermittent heart block.
5..An 84-year-old woman presents with a history of confusion and constipation. Laboratory investigations reveal a serum calcium of 2.9 mmol/L, a creatinine of 146 mmol/L and a hemoglobin of 108 g/L. These findings are most suggestive of a diagnosis of:
1. Hyperparathyroidism.
2. Multiple myeloma.
3. Chronic renal failure.
4. Vitamin D intoxication.
5. Renal cell carcinoma.
6.A 65-year-old man who had been making an apparently satisfactory recovery from a myocardial infarction six days previously suddenly develops pulmonary edema. There is a regular tachycardia of 120/minute, a parasternal heave, and a pansystolic murmur over the precordium and a S3 gallop. Blood pressure is 100/60 mmHg. Which one of the following is the most likely diagnosis?
1. Post-infarct pericarditis.
2. Another myocardial infarction.
3. Ruptured papillary muscle.
4. Cardiac tamponade.
5. Ventricular aneurysm.
7.A 24-year-old female presents to a walk-in clinic with fever, flank pain, frequency and dysuria. The urinalysis (urine microscopy) shows 1+ proteinuria, 25 white blood cells per high power field and a few granular casts. Which one of the following is the next best step in the management of this patient?
1. Midstream urine culture.
2. Intravenous pyelography.
3. Intravenous antibiotics.
4. Creatinine clearance.
5. Oral analgesia.
8.A 78-year-old man presents to the Emergency Department with sudden onset of left-sided chest pain radiating to his back. He has a past history of stable angina and peripheral vascular disease. His blood pressure is 80/50 mmHg with a heart rate of 120/minute. Which one of the following tests is most likely to confirm his diagnosis?
1. Electrocardiogram.
2. Chest radiograph.
3. Echocardiogram.
4. Ventilation-perfusion (V/Q) of the lung.
5. Computerized tomography (CT) of the chest.
9.You are examining a young man who dislocated his shoulder 1 month ago and now complains about muscle weakness and loss of sensation. He is likely to have difficulty with which one of the following actions?
1. Extending his arms behind his back.
2. Scratching his shoulder blades from below.
3. Pressing his hand down on the table.
4. Raising his arm above his head.