Cardiology
2 Уровень
1
*!A man, 62 years old, felt nausea, epigastric pains. Twice he had vomiting with consumed food. Patient was delivered to infectious clinic, and his stomach was irrigated. At the end of this procedure, pains relocated behind the sternum and on the left of it, extrasystoles has appeared.
Which diagnosis is MOST probable?
*ACS without ST segment elevation
*Instable angina – ischemia on back wall
*ACS with ST segment elevation
*Acute myocardial infarction
*Subendocardial myocardial infarction
2
*!Man W., 46 years old, complains of severe burning behind his sternum, which is not relieving by nitroglycerine. He became ill one hour before after having a heavy physical load. Objectively: severe condition: pale coverlets, covered with cold sweat, I heart sound on the apex is subdued, arrhythmia. HR – 96 bpm, AP 100/70 mmHg. On ECG: frequent ventricular premature beats, QS I II aVL V2-V5 leads, SТ segment elevation.
What you must do at first?
*morphine
*metaprolol
*alteplasa
*clopidogrel
*heparini
3
*!A woman, 55 years old, suddenly increasing pressing retrosternal pain appeared, which in half an hour became intolerable. Patient is pale, covered with cold sweat. BR – 18 in 1 minute, HR – 100 in 1 minute. BP – 80/50 mmHg. Heart sounds are muffled, correct rhythm. In lungs, vesicular breathing. Blood was taken 4 hours after symptoms appearance.
Which indices, taken at the admission, will confirm your diagnosis?
*Creatinekinase MF
*ESR
*troponin T
*AST
*Myoglobine
4
*!Male, 45 years old, suddenly became ill after stress situation at work. Intense constricting retrosternal pain appeared, which lasted during the whole day. 8 hours later in the evening, patient called an emergency team. On ECG: pathologic Q wave in V1-3 leads, R wave disappearance, ST segment elevated by 6 mm.
Which diagnosis is MOST probable?
*ACS without ST segment elevation
*Instable angina – ischemia on back wall
*ACS with ST segment elevation
*Acute myocardial infarction
*Subendocardial myocardial infarction
5
*!Man, 77 years old, was delivered to hospital in severe condition with complaints against intense constricting retrosternal pains, lasted more than an hour. Suddenly patient sharply turned pale, was covered with cold sweat, collapsed. Pulse and BP cannot be determined, pupils are widened. On ECG (photo).
Which complication has MOST probably developed?
*paroxysmal tachycardia
*ventricular flutter
*atrial fibrillation
*premature ventricular beats
*atrial flutter
6
*!A woman, 64 years old, complains of severe burning behind the sternum, not relieving by nitroglycerin, pain appeared 2 hours before, after stress. Objectively: severe condition: pale coverlets, covered by cold sweat, I heart sound on the apex is subdued. HR – 96 bpm, BP – 110/70 mmHg. On ECG:
Which diagnosis is MOST probable?
*subendocardial anterior-septal-apical myocardial infarction
*transmural anterior-disseminated myocardial infarction
*transmural anterior-septal-apical myocardial infarction
*transmural posterior wall myocardial infarction
*acute coronal syndrome with ST elevation
7
*!Man А., 60 years old, suddenly became ill after a stress situation at work. Intense pressing retrosternal pain appeared, which lasted during the whole day. In the evening patient called the emergency team.
Which diagnosis is MOST probable?
*subendocardial anterior-septal-apical myocardial infarction
*transmural anterior-disseminated myocardial infarction
*transmural anterior-septal-apical myocardial infarction
*transmural posterior wall myocardial infarction
*acute coronal syndrome with ST elevation
8
*!A woman, 60 years old, woke up in the night due to constricting pain behind her sternum, which grew attack-like and wasn't relieved with nitroglycerin. Arrived emergency team took ECG. Patient was hospitalized. In examination findings: leukocytosis, increased of troponin.
Which diagnosis is MOST probable?
*subendocardial anterior-septal-apical myocardial infarction
*transmural anterior-disseminated myocardial infarction
*transmural anterior-septal-apical myocardial infarction
*transmural posterior wall myocardial infarction
*acute coronal syndrome with ST elevation
9
*!A man, 57 years old, was delivered to hospital in severe condition with complaints against intense pressing retrosternal pains, lasted more than 3 hours. It was not relieved with nitroglycerin, accompanied by cold sweat, weakness.
Which diagnosis is MOST probable?
*IHD, Transmural anterior-septal myocardial infarction
*IHD, Instable angina IIIВ according Braunwald
*IHD, Transmural posterior-diaphragmatic myocardial infarction
*IHD, Subendocardial anterior-septal myocardial infarction
*Subendocardial anterior-disseminated myocardial infarction
10
*!In a man, 46 years old, at the examination was found BP 160/90 mmHg. Complaints against headache. From life history: he smokes 1.5 packages of sigarettes daily, drinks 2 cans of beer once a week, his father has arterial hypertension. Height 176 cm, weight – 96 kg. Examination data: at 2-fold measurement BP 160/100 mmHg, HR 84 per 1 minute. Apical thrust will be determined in 5 intercostal space 1.0 cm outside of middle-clavicular line. Cholesterol 5.8 mmol/l, blood sugar 5.9 mmol/l.
Which diagnosis is MOST probable?
*Grade 2 arterial hypertension, low risk
*Grade 2 arterial hypertension, moderate risk
*Grade 2 arterial hypertension, high risk
*Grade 2 arterial hypertension, very high risk
*Symptomatic arterial hypertension
11
*!A man, 46 years old, was delivered by the emergency team in severe condition with complaints against general weakness. Objectively: pale moist coverlets, gray cyanosis, extremities coldness. Heart sounds are subdued, gallop rhythm, HR – 110 per min. BP 85/55 mmHg. Oliguria – less than 35 ml/h. ECG: sinus tachycardia, QSV1-V6, STV1-V6 segment as monophase curve over isoline.
Which of listed conditions is MOST probable?
*sepsis
*cardiogenic shock
*chronic heart failure
*pulmonary embolism
*acute renal failure
12
*!Male, 45 years old, was delivered to hospital two weeks ago with pressing retrosternal pains. On ECG: QS complex with ST elevation over isoline. Now following symptoms appeared in a patient: heart borders expansion more to the left, I tone weakening, precardial pulsation in III-IV intercostal space on the left, systolic murmur over the apex. On ECG – no dynamic:
Which complication has developed MOST probably?
*recurrent myocardial infarction
*interventricular septal rupture
*cardiac aneurysm
*papillary muscle abruption
*thromboendocarditis
13
*!In patient S., 60 years old, being in the resuscitation unit due to large-focal posterior-diaphragmatic myocardial infarction, short-time loss of consciousness with convulsive disorder, involuntary urination has developed. Heart sounds are subdued. HR 54 per 1 minute, BP – 130/70 mmHg.
Which complication MOST probably has developed?
*grade II sinoauricular block
*AV-block grade II Mobitz I
*AV-block grade II Mobitz II
*complete AV-block
*bundle-branch block
14
*! Man, 68 years old, admitted in cardiologic department because of large-focal posterior-diaphragmatic myocardial infarction two weeks ago. Now subfebrile temperature, dyspnea, pains in joints appeared. At the examination, pleural effusion was detected. In the auscultation, pericardial murmur is heard.
Which complication MOST probably has developed in this patient?
*chronic cardiac failure
*Dressler's syndrome
*pneumonia, complicated by pleurisy
*papillary muscle abruption
*bacterial endocarditis
15
*!woman, 50 years old, became ill suddenly, after stress situation at work. On ECG: pathological Q wave in V1-3 leads, R wave disappearance, ST segment elevation by 6 mm. On the 3rd day from disease commencement, suddenly rough systolic murmur in II, III, IV intercostal spaces along the left edge of the sternum appears, pain syndrome with quick development of congestive heart failure.
Which complication MOST probably has developed?
*recurrent myocardial infarction
*interventricular septal rupture
*cardiac aneurysm
*papillary muscle abruption
*thromboendocarditis
16
*!A woman, 33 years old, complaints against inspiratory dyspnoe at physical stress and in horizontal position, intermittences in heart function, palpitation. In anamnesis, frequent anginas in younger age. At auscultation: rhythm is incorrect, 1 tone is muffled and systolic-diastolic murmur on the apex, HR – 110 per min, pulse 92 bpm, irregular BP – 120/80 mmHg. On ECG:
Which arrythmia MOST probably complicated the course of disease?
*atrial fibrillation
*frequent supraventricular extrasystole
*atrial paroxysmal tachycardia
*atrial flutter
*ventricular premature beats
17
*!A man, 33 years old, suffered myocarditis of viral etiology. After 7 months, complaints against dizziness, dyspnoe at insignificant stress appeared, edemas on legs. Heart sounds are subdued, rhythm is correct, HR – 46 per minute, liver is 5 cm below the costal margin edge, edemas on lower limbs. On EchoCG, EDS – 7.6 cm, ESS – 4.5 cm, ejection fraction 44%. On ECG:
Occurrence of which rhythm or conductivity disturbance is MOST PROBABLE?
*grade I sinoauricular block
*grade II sinoauricular block
*AV-block grade II Mobitz I
*AV-block grade II Mobitz II
*complete AV-block
18
*!Patient N., 77 years old, was delivered to hospital in poor condition with complaints against intense constricting retrosternal pains, lasted more than an hour. Suddenly, patient sharply became pale, was covered with cold sweat, lost consciousness. Pulse and BP will be not determined, pupils are widened. On ECG (photo).
Which action from listed below should be performed firstly:
*to perform fibrinolytic therapy
*to apply drug analgesics intravenously
*to perform direct defibrillation
*to perform epidural anesthesia
*to apply antiaggregant drugs intravenously
19
*! Male, 57 years old, for 3 years suffers from exertional angina, takes atenolol 50 mg/day. After physical stress, angina attacks became more often, lengthy crisis with evident pain syndrome has developed. It was not relieved with nitroglycerin, was accompanied by cold sweat, weakness. BP 100/70 mmHg, HR – 115 per minute. On ECG: QS I II aVL V2-V5 leads, SТ segment elevation in the form of cat's back.
Which drug is MOST effective in this pathology in the first 6 hours:
*heparin
*morphine
*alteplaza
*streptokinasa
*nytroglicerin
20
*!A patient, 63 years old, for one year has intense pains in cardiac area at physical stress, 2 weeks ago pains started to occur at small stress. Today, pain attack has developed at rest, and lasted 1.5 hour. It was not relieved by nitroglycerin (he took nitroglycerin 1 tab 3 times), was accompanied by cold sweat, weakness. 1% morphine 0.8 ml in saline i/v applied.
What you must do at next step?
*acetylsalicylic acid
*metaprolol
*alteplasa
*streptokinase
*nytroglicerin
21
*!A man, 72 years old, complaints against pressing cardiac pains, appearing at physical stress. He had myocardial infarction 7 months ago. Objectively: left border is 1 cm to the left of left middle-clavicular line. In lungs, vesicular respiration, no rales. RR – 16 per minute. Heart sounds are muffled, rhythm is correct. HR – 84 per minute. BP – 160/90 mmHg. Serum cholesterol – 6.8 mmol/l, LPL 3.44 mmol/l, TG 1.46 mmol/l, serum creatinine – 75 µm/l. Blood sugar – 5.4 mmol/l. Which drug can be MOST reasonably prescribed for lipid metabolism correction?
*clofibrate
*atorvastatin
*vitamin complex
*nicotinic acid
*cholestyramine
22
*!A man, 62 year old, had myocardial infarction in the last year, complaining of angina attacks, occurring when raising to the 3rd floor and accompanying with asthma, heart function intermittences, relieving by isoket spray. Based on bicycle ergometry findings, exercise tolerance correspond to functional class II. In blood analysis: serum cholesterol – 7.8 mmol/l, HDL 0.5 mmol/l, LDL 4.6 mmol/l. Blood sugar – 5.9 mmol/l.
Prescription of which drug is MOST reasonable?
*simvastatin
*phenofibrate
*bisoprolol
*metformin
*clofibrate
23
*!Patient W., 46 years old, complains of severe burning behind his sternum, not relieved by nitroglycerin. He became ill one hour before, after heavy physical stress. Objectively: poor condition, pale coverlets, covered with cold sweat. Heart sound 1 on the apex is subdued, arrhythmia. HR – 96 bpm, BP – 100/70 mmHg. On ECG: ST elevation in V2-V5.
What most effective to restore coronary blood flow?
*heparin
*clopidogrel
*coronarography
*streptokinase
*isoket
24
*!A patient, 57 years old, for 3 years suffers from exertional angina, takes atenolol 50 mg/day. On the background of increased physical stress, angina attacks became more often, in the evening, lengthy attack with evident pain syndrome has developed. He was not relieved by nitroglycerin, was accompanied by cold sweat, weakness. BP 100/70 mmHg, HR – 95 per minute. Increased troponin is noted.
Name typical ECG signs, which should be present in this patient:
*ST elevation 1 mm, negative T wave
*SТ elevation 5 mm, confluent with T wave
*QRS in form of QS, ST on isoline
*ST segment depression, coronary T
*ST segment depression, large positive T
25
*! Male, 50 years old, suddenly became ill after a stress situation at work. On ECG: pathological Q wave in V1-3 leads, R wave disappearance, ST segment elevation by 6 mm. On the 3rd day after treatment beginning, suddenly rough systolic murmur appears in II, III, IV intercostal spaces along the left edge of sternum, pain syndrome with quick development of congestive heart failure.
Which diagnostics methods will be MOST informative for diagnosis confirmation:
*echocardiography
*transesophageal stimulating test
*transesophageal heart sonography
*CT of chest
*ECG
26
*!Patient С., 45 years old. Two weeks later after transmural myocardial infarction following symptoms have appeared: borders of heart extension more to the left, I sound weakening, precardiac pulsation in III-IV intercostal spaces on the left, systolic murmur over the apex, "squeak noise".
On the ECG MOST probably will be detected:
*QRS in form of QS with ST elevation over isoline without further dynamics
*QRS in form of QS with ST on isoline, T negative
*Complete blockage of left bundle-branch
*Complete AV-blockage
*Atrial fibrillation
27
*!A woman, 25 years old, has complaints against palpitation attacks, occurring suddenly, lasting for 30 minutes to 1 hour. Palpitations relieve by themselves. In anamnesis, frequent viral infections. Objectively: regular heart rhythm, HR 160 per minute, BP 110/70 mmHg.
Which rhythm disturbance MOST PROBABLY has developed in patient?
*paroxysmal ventricular tachycardia
*paroxysmal supraventricular tachycardia
*atrial flutter
*frequent supraventricular extrasystole
*evident sinus tachycardia
28
*!Man W., 46 years old, complains of severe burning behind sternum, palpitation. He became ill one hour ago after heavy physical stress. Objectively: poor condition: pale coverlets, covered with cold sweat. Heart sound I on the apex is muffled. HR – 150 bpm, BP – 100/70 mmHg. On ECG:
What preparation must be used firstly?
*atropine
*digoxin
*amiodarone
*metaprolol
*verapamil