Chest Pain QUIZ

Chest PAin mcq's

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A patient presents to A&E complaining of severe fatigue, shortness of breath and describes the phenonium of feeling like their heart pauses for a beat. Upon admission you find they are bradycardic and have the following ECG:

Pacemaker (The patient has complete heart block which is a medical emergency)

Aspirin and clopidogrel followed by PCI (primary percutaneous intervention)

Bisoprolol and digoxin

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A patient calls 999 complaining of a central crushing chest pain that radiates to the jaw. Upon arrival at hospital they appear pale and sweaty. An ECG is performed and the result is as followed:They are taken for immediate PCI, in which coronary artery do you expect the balloon to be inserted?

Left Coronary Artery

Right Coronary Artery

Circumflex Artery

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A 32 year old woman presents to her GP with swelling on their knuckles. They are concerned about arthritis as their mother has similar swelling. Upon examination, they are found to have Xanthelasma and corneal arcus.Test results show that they have a cholesterol level of 8.2 (RR 3.5- 6.5) and Rheumatoid Factor level of 5 (RR 0-20). What is an appropriate approach to treatment?

Simvastatin + advice about dietary lifestyle

Simvastatin alone

Hydroxychloroquine

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A 62 year old man receives a diagnosis of Hyperchylomicronaemia.Which of the following is correct about Chylomicrons?

Chylomicrons have the lowest density of the lipoproteins

Chylomicrons contribute to atherosclerosis

Chylomicrons are rich in Triacylglycerols

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A 67 year old woman presents to her GP complaining of muscle pain. She currently takes ramipril, atorvastatin, sertraline, Folic Acid supplements and rivaroxaban. Which medication is most likely to be causing the muscle pain?

Folic Acid supplements

Rivaroxaban

Atorvastatin

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Patient comes with sharp, stabbing chest pain, whcih radiates to the shoulder and jaw. The pain typically lasts a few minutes and is relieved by rest . What is the likely diagnosis?

PE

Stable Angina

Myocardial Infarction

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Maria (39, female) comes into the GP for her annual contraceptive pill check up.As part of this assessment her blood pressure is taken and comes back as 150/90mmHg. The GP discusses diet and lifestyle advice with her as she has a BMI of 31kg/m^2. What should be his next course of action?

Prescribe a calcium channel blocker or diuretic

Prescribe an ACE inhibitor or ATII as she is younger than 55

Prescribe a beta-blocker

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Emma (78, female) has been discharged from hospital following a period of acute dyspnoea, severe fatigue and swollen ankles. She has been diagnosed with congestive heart failure and prescribed Furosemide. What is the mechanism of action for Furosemide?

Inhibits Na-Cl symporter in the ascending limb of the loop of Henlé

Inhibits Na-K-Cl co-transporter in the ascending limb of the loop of Henlé

Inhibits Na-K-Cl co-transporter in the DCT

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Furosemide is a loop diuretic agent and they inhibit reabsorption of water from the ascending limb of the loop of Henlé in the renal tubule by inhibiting the luminal Na-K-Cl co-transporter, causing more sodium, chloride and potassium to stay in the tubule and therefore bring water with it and then be excreted as urine. Thiazides inhibit the Na-Cl sympoter in the DCT

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Which system/response in the body is activated to increase blood volume and consequently venous return to maintain cardiac output?

Wronganswer

Wrong answer

Correctanswer

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Mrs X has come into hospital with oedema, shortness of breath and an irregular heartbeat. She is diagnosed with heart failure. She is prescribing spironolactone by the doctor, which of this is a correct side effect for this drug?

Hypokalaemia due to the activation of the ROMK BK receptor.

Hyperkalaemia due to the inhibition of the ENAC transporter and consequently stopping Na, K, ATPase

Hypovolemia

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A 67 year old woman comes into A and E with crushing central chest pain that came on after she had eaten a spicy burrito. She says the pain is radiating down her left arm and up to her jaw and that it came on suddenly. Her ECG results are below:

Lateral anterior descending artery

Right coronary artery

Circumflex artery

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A 30-year-old comes into A and E having fallen off their motorbike. They are complaining of pain in the left side of their chest. The left side of their chest is tender when you palpate, and there appears to be bruising.

Manage in outpatients with oral analgesia and incentive spirometry

Admit them straight to ICU, this is an emergency

Admit them to hospital

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They have at least 5 broken ribs. If a patient has less than 3 broken ribs then the advice is to manage in outpatients. If a patient has 3 or more broken ribs then they should be admitted to hospital. An elderly patient with 6 or more broken ribs should be admitted to ICU. There is a significant correlation between 3 or greater broken ribs and having serious internal injuries. to hold stunning creativity, experiences and stories.

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A patient has a mitral regurgitation murmur. Where would you auscultate to hear this murmur?

2nd intercostal space, right sternal edge

4th intercostal space, left sternal edge

5th intercostal space, mid-clavicular line

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To auscultate for the mitral valve you would listen in the 5th intercostal space in the mid-clavicular line.

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What is implied with the following presentation? Muslce twitches, paralysis, atrial fibrillation, ECG changes: reduced T waves, ST depression, prolonged PR interval, (reduced cardiac excitability).

Hypernatremia

Hyperkalaemia

Hypokalaemia

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Which of the following is most specific for myocardial necrosis?

Lactate dehydrogenase

Myoglobin

Troponin

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Why can't troponin be used to diagnose an MI on it's own?

Doctors must always have at least 2 confirmed tests

It is still not specific enough to the heart

It is not specific to ischaemia

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Detection of a rise and/or fall in cardiac biomarker values (preferably troponin) with at least one value above the 99th percentile of the reference limit and at least one of the following: • Symptoms of ischaemia • New or presumed new significant ST changes or new LBBB • Development of pathological Q waves on the ECG • Imaging evidence of new loss of viable myocardium • Identification of intracoronary thrombus by angiography

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