Cardiovascular Medicine EMQs 3

Question 1

A 65 year old man with heart failure requires rate control to treat coexisting atrial fibrillation.

Answer 1

Digoxin

Question 2

A 65 year old woman being treated with large doses of loop diuretic requires add-on therapy for oedema refractory to treatment.

Answer 2

Metolazone (thiazide diuretic)

Question 3

A 69 year old woman with asthma being treated with a loop diuretic, ACE inhibitor and long-acting nitrate is prescribed a drug to reduce long-term mortality.

Answer 3

Spironolactone

Question 4

A 70 year old woman with history of chronic heart failure presents with severe pulmonary oedema.

Answer 4

100 per cent O2
IV diamorphine
IV furosemide
Sublinguinal GNT (glyceryl trinitrate)

Question 5

Treatment of mild symptoms of dyspnoea and ankle oedema in a 65 year old man with left ventricular dysfunction caused by ischaemic heart disease. He is already taking an ACE inhibitor

Answer 5

Oral furosemide - loop diuretic

Question 6

Treatment of a 65 year old man with AF of longer than 48 hours before DC cardioversion.

Answer 6

Digoxin + warfarin for 1 month

Question 7

Initial therapy in a 60 year old woman presenting severely compromised with acute persistent AF.

Answer 7

Direct Current Shock + heparin

Question 8

A 55 year old man admitted with an acute myocardial infarction develops a short run of symptomatic ventricular tachycardia despite bisoprolol 10 mg. He requires treatment for prophylaxis against recurrent VT.

Answer 8

Intravenous Amiodarone

Question 9

Drug to aid diagnosis in a 50 year old man presenting with an unidentifiable, regular, narrow-complex tachycardia.

Answer 9

Intravenous Adenosine

Question 10

Prophylaxis of ventricular tachycardia in a patient with varying QRS axis and prolonged Q-T interval.

Answer 10

Intravenous Magnesium + Ventricular pacing

Question 11

A 65 year old man presenting with chest pain becomes unresponsive. His ECG shows ventricular fibrillation.

Answer 11

DC Shock + Adrenaline

Question 12

A 40 year old woman collapses after a flight with breathlessness and right-sided pleuritic chest pain.
Managment:

Answer 12

100 per cent O2
Subcutaneous Lmw Heparin
Intravenous fluids

Question 13

A 45 year old man with chronic glomerulonephritis presents with a severe headache. On examination he has papillodema and bilateral retinal haemorrhages. His BP is 240/132 mmHg.
Treatment:

Answer 13

Labetalol

Question 14

A 55 year old man requires immediate pharmacological management for severe symptomatic sinus bradycardia.

Answer 14

Atropine.