Answer and Explanation 10

10.  The correct answer is A.  This patient is likely having premature atrial contractions or premature ventricular contractions.  She is healthy.  The diagnosis can be made by a holter monitor.  A repeat EKG in 1 week would not be helpful.  A cardiac catheterization or stress test would likely not be helpful given her symptoms are consistent with an heart arrhythmia rather than any coronary artery disease.

Question 10

10.  Patient is a a 29 year old female that presents with fluttering in her chest that lasts for a couple of seconds.  She has no chest pain or shortness of breath.  These symptoms have been going on for 3 weeks.  Her EKG is normal.  Her vital signs are normal.  Her CBC, Electrolytes, Glucose, and TSH are normal as her Troponin.  She is healthy and does not smoke.  Which of the following is the best workup to initiate.

A. Holter Monitor

B.  Repeat EKG in 1 week

C. Arrange for the patient to have a cardiac catheterization

D. Arrange for the patient to have a stress test.

Answer and Explanation 9

9,  The correct answer is D.  While gastroesophageal reflux disease (GERD) can give you similar symptoms of chest pain when laying flat alleviated leaning forward it will not give you EKG changes.  Pneumomediastinum typically does not give you EKG changes unless it is severe enough to induce tamponade.  Pulmonary Emboli can give EKG changes but does not give EKG changes in all leads .  Diffuse ST elevation in all leads is consistent with pericarditis.

Question 9

 9.   Patient is a 23 year old male who presents with non radiating chest pain that is exacerbated with laying flat and alleviated with leaning forward.  His EKG reveals diffuse ST elevation in all leads.  Which of the following is the likely diagnosis?

A.   GERD

B. Pneumomediastinum

C.  Pulmonary Embolus

D.  Pericarditis

Answer and Explanation 8

8.  The correct answer is D.  Aortic regurgitation is a diastolic murmur.  Mitral and Tricuspid regurgitation are systolic murmurs as is aortic stenosis.

Question 8

 8.  Which of the following is a diastolic murmur?

A.  Mitral Regurgitation
 
B.  Aortic Stenosis

C.  Tricuspid Regurgitation

D.  Aortic Regurgitation

Answer and Explanation 7

 7.  The correct answer is A.  This patient is describing symptoms of stable angina.  The patient is in a low risk group.  From an outpatient management perspective it would be appropriate to manage him as an outpatient as described arranging for a stress test.  The patient has a normal EKG and does not have any active chest pain so a cardiac cath is not indicated at this point.  The patient does exhibit any symptoms suspicious for a pulmonary embolus so a VQ scan would not be helpful at this point.  While risk factor modification is important in the management of patients with or wanting to prevent CAD, a lipid panel could be ordered but this patient really needs an outpatient stress test.