ECG: wide QRS tachycardia (498/1700)

An ECG of an elderly lady who collapsed in the ED shows rapid ventricular rate of 220bpm,
QRS=140ms. What is the most probable dx?
a. Atrial fibrillation
b. VT
c. SVT
d. Mobitz type1 2nd degree heart block
e. Sinus tachycardia

ECG (439/1700)

A 72yo man is found to be not breathing in the CCU with the following rhythm. What is the most
likely dx?

a. SVT
b. VT
c. VF
d. Atrial fib
e. Atrial flutter

ECG (363/1700)

A 66yo man has the following ECG. What is the most appropriate next step in management?

a. Metoprolol
b. Digoxin
c. Carotid sinus massage
d. Adenosine
e. Amiodarone

Pansystolic murmur at sternal edge (1333/1700)

A new born bay is borught with pansystolic murmur at sternal border but the baby is not
cyanosed. What is the dx?

a. VSD
b. ASD
c. TOF
d. PDA

Fever, Dyspnea, Syncope, Emboli (630/1700)

A 43yo lady is admitted with pyrexia, arthropathy, breathlessness and syncope. She was recently
dx with pulmonary emboli. There is an early diastolic sound and a mid-diastolic rumble. Her JVP
is elevated with prominent a-waves. What is the most likely cause?
a. Mitral regurgitation
b. Ventricular ectopics
c. Pulmonary regurgitation
d. Atrial myxoma
e. Complete heart block

ST elevation MI, next step? (561/1700)

A 48yo presents with severe chest pain since the last 40mins. In the ED he is given oxygen, GTN,
morphine. ECG=ST elevation. Bloods=increased troponin levels. What is the next step of
management?
a. Beta blockers
b. Percutaneous angiography
c. Anticoagulant & heparin
d. Clopidogrel
e. Aspirin

Sudden chest pain in a diabetic (520/1700)

A 50yo man with DM suddenly develops persistent crushing central chest pain radiating to the
neck. What is the single most appropriate dx?
a. Angina
b. Costochondritis (tietz’s disease)
c. Dissecting aneurysm
d. MI
e. Pulmonary embolism

Chest pain - Normal ECG (510/1700)

A 45yo manual worker presented with a 2h hx of chest pain radiating to his left arm. His ECG is
normal. What is the single most appropriate inv?
a. Cardiac enzymes
b. CXR
c. CT
d. ECG
e. V/Q scan

Irregular rhythm (505/1700)

A man was brought to the ED from a shopping mall after collapsing there. He is conscious and
answering questions now. His ECG shows irregular rhythm. Your choice of inv:
a. CT
b. MRI
c. 24h ECG
d. Echo

Diabetic with HTN, now Chest pain (504/1700)

A 58yo T1DM on anti-HTN therapy for 13yrs developed central chest pain for 45 mins while
driving a/w cold sweating and dyspnea. What is the single most appropriate dx?
a. MI
b. Pericarditis
c. Pulmonary embolism
d. Costochondritis
e. Pneumothorax

Cartoid massage was done, Next step? (454/1700)

A 65yo male presents with dyspnea and palpitations. Exam: pulse=170bpm, BP=120/80mmHg.
Carotid massage has been done as first instance. What is the next step of the management?
a. Adenosine
b. Amlodipine
c. DC cardioversion
d. Lidocaine
e. Beta blocker

Supraventricular Tachycardia (424/1700)

A 28yo man presents with rapid pounding in the chest. He is completely conscious throughout.
The ECG was taken (SVT). What is the 1st med to be used to manage this condition?
a. Amiodarone
b. Adenosine
c. Lidocaine
d. Verapamil
e. Metoprolol

Sudden chest pain, SOB, cold peripheries (418/1700)

A 50yo lady presents to ED with sudden severe chest pain radiating to both shoulder and
accompanying SOB. Exam: cold peripheries and paraparesis. What is the single most appropriate
dx?

a. MI
b. Aortic dissection
c. Pulmonary embolism
d. Good pastures syndrome
e. Motor neuron disease

Chest pain relieved by sitting forwards (412/1700)

A 45yo man who is diabetic and HTN but poorly compliant has chronic SOB, develops severe
SOB and chest pain. Pain is sharp, increased by breathing and relieved by sitting forward. What
is the single most appropriate dx?

a. MI
b. Pericarditis
c. Lung cancer
d. Good pastures syndrome
e. Progressive massive fibrosis

Palpitations, Irregular tachycardic pulse (409/1700)

A 29yo lady came to the ED with complaints of palpitations that have been there for the past 4
days and also feeling warmer than usual. Exam: HR=154bpm, irregular rhythm. What is the tx for
her condition?

a. Amiodarone
b. Beta blockers
c. Adenosine
d. Verapamil
e. Flecainide

ST elevation MI (406/1700)

A woman had an MI. She was breathless and is put on oxygen mask and GTN, her chest pain has
improved. Her HR=40bpm. ECG shows ST elevation in leads I, II, III. What is your next step?

a. LMWH
b. Streptokinase
c. Angiography
d. Continue current management
e. None

Normal ECG, Episodes of Dyspnea and Palpitations (402/1700)

A 61yo man has been referred to the OPD with frequent episodes of breathlessness and chest
pain a/w palpitations. He has a regular pulse rate=60bpm. ECG=sinus rhythm. What is the most
appropriate inv to be done?
a. Cardiac enzymes
b. CXR
c. ECG
d. Echo
e. 24h ECG

Saw tooth ECG waves (381/1700)

ECG of an 80yo pt of ICH shows saw-tooth like waves, QRS complex of 80ms duration,
ventricular rate=150/min and regular R-R interval. What is the most porbable dx?
a. Atrial fib
b. Atrial flutter
c. SVT
d. Mobitz type1 second degree heart block
e. Sinus tachycardia

Infant, cool peripheries, tachycardia (356/1700)

A 1m boy has been brought to the ED, conscious but with cool peripheries and has HR=222bpm.
He has been irritable and feeding poorly for 24h. CXR=borderline enlarged heart with clear lung
fields. ECG=regular narrow complex tachycardia, with difficulty identifying p wave. What is the
single most appropriate immediate tx?

a. Administer fluid bolus
b. Administer oxygen
c. Oral beta-blockers
d. Synchronized DC cardio-version
e. Unilateral carotid sinus massage

Increased ejection fraction, decreased septal wall thickness (353/1700)

A 47yo man with hx of IHD complains of chest pain with SOB on exertion over the past few days.
ECG normal, Echo= increased EF and decreased septal wall thickness. What is the most likely dx?

a. Dilated CM
b. Constrictive pericarditis
c. Amyloidosis
d. Subacute endocarditis