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B.

Renal ultrasound scan

C.

ACTH

D.

CT of adrenal glands

E.

MRI of pituitary gland

Cardiology

A 34 year old man presents with a sudden onset of central chest pain.  His blood pressure is 90/60 and he feels slightly lightheaded.  An ECG is taken.

(probably VT, rate 180/min, shown)

What is the best management option at this point?

A.

DC cardioversion

B.

Lignocaine

C.

Amiodarone

D.

Streptokinase

E.

Digoxin

A doppler echocardiogram is recorded across the mitral valve.  (Mitral stenosis, shown)

What is the most likely condition?

A.

Aortic stenosis

B.

Aortic regurgitation

C.

Mitral regurgitation

D.

Mitral steosis

E.

Aortic stenosis plus aortic regurgitation

A 17 year old woman has had several episodes of sudden lightheadedness and trainsient loss of conscoiusness, each lastin around 2 minutes.  Her initial rhythm strip is shown (looks like Torsades des Pointes)  30 seconds later, her heart rhythm changes and a 12 lead ECG is taken (shown, sinus bradycardia, long QT interval, even after correcting for the bradycadia)  What is the best long-term tratment?

A.

Implantable cardioverter-defibrillator

B.

Permanent pacemaker

C.

Sotalol

D.

Amiodarone

E.

Reassurance

A patient presents with severe central chest pain. An ECG is obtained (ST segment elevation in inferior and lateral leads, heart rate 80/min, shown)  Streptokinase is administered and he is admitted to the coronary care unit.  Four hours later, he suddenly feels unwell.  BP now 75 mmHg by palpation. A second ECG is done (some resolution of ST elevation, heart rate 45/min, shown)  Which option best improves his long term prognosis?

A.

Permanent pacemaker

B.

Temporary pacing

C.

Acute angiography/angioplasty

D.

Intravenous fluid resuscitation

E.

Administration of tPA

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