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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2669_Библиотеки_им_академика_М_И_Перельмана
.pdf
BONUS MCQ 6
A 63 F with no prior medical history presents to the ER with a 2 hour history of
palpitations. She measured her HR at the gym 4 hours previously at 74 bpm.
She is found to be in rapid atrial fibrillation with a heart rate of 170 bpm. She
has no other medical history and her CHADS65 score is 0. Her labs are
unremarkable. A TEE guided cardioversion is completed in the ER and she is
started on a beta-blocker. Which of the following is the best next step:
1) Start anticoagulation with a DOAC for at least 4 weeks.
2) Start anticoagulation with warfarin for at least 4 weeks.
3) Start ASA alone for at least 4 weeks
4) Given a CHADS65 score of 0, the patient does not need anticoagulation
and can be discharged without further anticoagulation/antiplatelet
therapy
https://t.me/medicina_free
BONUS MCQ 7
A 64 year old female with a history of palpitations is found to have a diastolic
murmur at the apex on routine exam. She has had increasing exertional
dyspnea but no chest discomfort or heart failure symptoms. Echocardiogram
shows mitral stenosis with an estimated valve area of 1.3 cm2 and moderate
mitral regurgitation. Her EF is 67%. What do you recommend as the next step?
A) Start medical therapy and repeat echo in 6 months
B) Refer to interventional cardiology for percutaneous mitral balloon
valvuloplasty
C) Refer to cardiac rehab for exercise training program
D) Refer to cardiovascular surgery for potential valve repair/replacement
https://t.me/medicina_free
BONUS MCQ 8
Patient presents with palpitations and chest tightness (ECG
shown). Blood pressure is 90/60. What is your next step in
management?
A) DC cardioversion
B) Adenosine 6 mg IV push
C) Amiodarone 150 mg IV
D) Metoprolol 5 mg IV
E) Procainamide 100mg IV
211
https://t.me/medicina_free
BONUS MCQ 9
A 22 year old woman presents with syncope. She has no past
medical history. Exam shows a blood pressure of 100/50. Heart
rate is 86 bpm. There is a fixed split S2 and left parasternal heave.
ECG shows incomplete RBBB. What is your working diagnosis?
A) VSD
B) ASD
C) PE
D) Severe aortic stenosis
https://t.me/medicina_free
BONUS MCQ 10
A 70 M with hx of hypertension, dyslipidemia, and a L parietal stroke
complicated by hemorrhagic transformation 8 years ago presents to
the hospital with a 4 hour history of sudden onset chest discomfort.
He is 4 hours away from the closest PCI centre. His ECG shows inferior
ST elevation with ST depression in the anterior leads. Which of the
following is the next best management step?
A) Perform thrombolysis patient and transfer urgently to PCI centre
B) Transfer urgently to PCI centre for primary PCI
C) Perform thrombolysis and reassess ECG/symptoms
D) Complete CT head prior to consideration of medical therapy
https://t.me/medicina_free
BONUS MCQ 11 – updated 2024
You’re asked to evaluate a 65 year o ld ma le at a community hospital w ith hypertension who
presents to the ER with 10/10 substernal chest pain which started suddenly. He states his
pain radiates to the middle of his back. On exam his BP is (R) 230/122 and (L) 190/105, HR
105. You note that he has a mild right sided facial droop. As you are talking with him, you
note that he is becoming more short of breath and his O2 saturation has dropped to 88% on
room air. You quickly auscultate his chest and note bilateral rales. His heart auscultation is
challenging but you hear a 3/6 diastolic murmur. ECG shows 3mm Inferior ST Elevations.
Which of the following is not indicated right now?
A) IV Labetalol
B) IV Nitroglycerin
C) Emergent Surgery
D) Referral for Primary PCI
(old question: what valvular pathology does he have? Answer = AR
Here the answer is D – pt has type A dissection clinically)
https://t.me/medicina_free
BONUS MCQ 12
You are asked to evaluate a 45 year old male with no known medical history
who was incidentally found to have murmur. He works as a dog walker and
walks at least 5km/day without any symptoms. He takes no medications, and
has no allergies. His sister unfortunately passed away when she was 40 years
old unexpectedly. O/E: BP 120/80, HR 75. Auscultation of the heart reveals a
3/6 systolic murmur at the base of the heart. ECG shows sinus rhythm with
LVH by voltage. You are debating b/w AS and HOCM as a cause of his murmur.
What maneuvers can you do to differentiate?
A) Squat – HOCM murmur will get louder
B) Valsalva – HOCM murmur will get quieter
C) Leg raise – HOCM murmur will get quieter
D) Hand grip – HOCM murmur will get louder
https://t.me/medicina_free
BONUS MCQ 13 – updated 2024
A 66-year-old woman undergoes mechanical mitral valve
replacement for severe symptomatic mitral regurgitation. Her
other risk factors include HTN. A preoperative coronary angiogram
showed no atherosclerosis. What long-term anticoagulation
should she be on?
A. Apixaban 5mg BID
B. Warfarin with goal INR 2-3
C. Warfarin with goal INR 2.5-3.5 and aspirin
D. Warfarin with goal INR 2.5-3.5
216
https://t.me/medicina_free
BONUS MCQ 14
A college basketball player presents for routine physical
examination. Blood pressure 120/50, HR 60bpm. Precordial
exam reveals a systolic crescendo–decrescendo murmur at the
LLSB radiating to the base. S2 is paradoxically split. Which of
the following is not a cause of paradoxically split S2?
a) HOCM
b) LBBB
c) WPW
d) ASD
e) Aortic Stenosis
https://t.me/medicina_free
BONUS MCQ 15
A 70 M with hx of elective PCI 2 months ago with a Drug Eluting Stent to his RCA has
severe symptoms from significant R knee osteoarthritis and is being considered for
elective surgery. Anesthesia prefers spinal anesthetic rather than GA. He has atrial fib.
He is on ASA, Clopidogrel, Rivaroxaban 2.5 mg BID, Metoprolol, Perindopril, and
Atorvastatin. He has no cardiac symptoms and feels well. What would you
recommend with respect to antiplatelet agents and surgery?
A) Recommend patient to have surgery after 3 months of DAPT. Hold Clopidogrel 7
days pre-op and continue ASA, but stop ASA postop and resume clopidogrel only.
Hold Rivaroxaban 48h preop, resume at reduced dose 15mg daily postop.
B) Recommend patient to have surgery now. Continue ASA, hold Clopidogrel 7 d
preop. Hold Rivaroxaban 48h preop, start 20 mg daily POD#1.
C) Recommend patient to have surgery after 12 months of DAPT
D) Recommend patient to have surgery after 3 months of DAPT. Hold Clopidogrel 5
days pre-op and continue ASA, but stop ASA postop and resume clopidogrel only.
Hold Rivaroxaban 48h preop, resume at reduced dose 10mg daily postop.
https://t.me/medicina_free
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