doc649
Forum Junior
Topics: 18
Posts: 56
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21. A 32-year-old man is stabbed in the left chest
and presents to the ED in distress. His vital
signs are pulse 130/min, blood pressure 70/50
mm Hg, and respiratory rate 39/min. The stab
wound is found to be located in the left fifth
intercostal space in the midaxillary line. On
examination his trachea is deviated to the
right, jugular veins are distended bilaterally,
and he has absent breath sounds and hyperresonance
to percussion on the left side. Subcutaneous
emphysema is palpated on the left thoracic
wall. What is the next best step in
management?
(A) Chest tube thoracostomy
(B) Diagnostic peritoneal lavage
(C) Immediate decompression by needle thoracotomy
(D) Pericardiocentesis
(E) Surgical exploration
22. A 75-year-old man comes into the ED with a
10-minute history of crushing substernal chest
pain radiating to his left arm. This man is well
known to the ED staff due to his long history
of chest pain. An ECG is done and his cardiac
enzyme levels are drawn. His creatine kinase–
myocardial bound fraction percentage of
total creatine phosphokinase is 6% with a troponin
T level of 0.4 ng/mL. What is the correct
diagnosis of this patient?
(A) Acute myocardial infarction
(B) Hypochondriasis
(C) Prinzmetal’s angina
(D) Stable angina
(E) Unstable angina
23. A 91-year-old woman presents to the ED with
a chief complaint of shortness of breath over
the past 2 days. She has a history of hypertension
and coronary artery bypass surgery 25
years earlier. Her blood pressure is 178/92 mm
Hg and she has jugular venous distention, hepatomegaly,
and 3+ lower extremity edema.
ECG is remarkable for left ventricular hypertrophy,
no ST-segment elevations or depressions,
no Q waves, and no T-wave abnormalities.
Echocardiogram reveals an ejection
fraction of 60% and left atrial dilatation. There
is universal left ventricular thickening. No
valvular regurgitation or stenosis was noted.
Which of the following underlying conditions
is the most likely cause of this patient’s symptoms?
(A) Hypertensive heart disease
(B) Hypertrophic obstructive cardiomyopathy
(C) Ischemic heart disease
(D) Mitral valve prolapse
(E) Myocarditis
24. A 39-year-old white man with a past medical
history significant for essential hypertension
presents for a routine health maintenance visit.
He has no complaints and reports compliance
with his hydrochlorothiazide. His pulse is
70/min, blood pressure is 145/92 mm Hg, and
respiratory rate is 16/min. His body mass index
is 24 kg/m2. His physical examination is within
normal limits. For which condition is the patient
at increased risk?
(A) End-stage renal disease
(B) Hypercholesterolemia
(C) Hypertrophic cardiomyopathy
(D) Second-degree Mobitz I atrioventricular
block
(E) Type 2 diabetes mellitus
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| arlete
Intern in 2009!!!!!
Topics: 24
Posts: 1,782
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21 - C
22 - What are the normal lab values?
23- A
24 - C
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| doc649
Forum Junior
Topics: 18
Posts: 56
|
21.AAA for tension pneumothorax
22. not sure ??aa (CK-MB <5%=normal...donnow abt Troponin T)
23. ?AA
24. ?B dt Thiazide
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| doc649
Forum Junior
Topics: 18
Posts: 56
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21...CCCC sorry..typo mistake...pt needs immediate needle decompression.....
I don't have ans..and I don't know the normal lab value of Troponin T but CK-MB is <5% normal
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| hir
Forum Newbie
Topics: 0
Posts: 157
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21. c
22. ??
23. a
24.???a,b,c anything can happen,,,,,a,b( due to hypertension),c(due to thiazide side effect)...????
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| drshvetasm
Forum Elite
Topics: 19
Posts: 232
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21. C
22. weird and what happened to ECG results...i feel the question is incomplete!
23.A
24. A
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| Ivonne
Going for step 3/99
Topics: 50
Posts: 1,396
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C
Experimental Question
A
A. (Is C saying dyastolic dysfunction...not sure)
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| brutus25
Forum Junior
Topics: 13
Posts: 46
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21.A
A small primary spontaneous pneumothorax usually requires no treatment. It usually does not cause serious breathing problems, and the air is absorbed in several days
With a smaller pneumothorax, a needle and syringe can be used to suction the air out
When the pneumothorax is large and the patient is having difficulty breathing, a chest tube is inserted through the chest wall
22.A ???
Troponin T Serum 0-0.1 ng/mL
Creatine kinase-MB Serum < 3% of total <0.03 of total
With + markers it could be either NSTEMI ( usually < 30 min ) or STEMI ( >30 min ongoing chest pain )
23.A - Even if the history may be a red hering , all the other evidence
24.A - I`d still go with this one
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| guangyu
Forum Elite
Topics: 28
Posts: 281
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1. C
2. C
3. A
4. B pt use hydrochlorothiazine
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| Vietnamese
Forum Senior
Topics: 8
Posts: 150
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21- C
22 -B Hypochondriasis
23 -A
24 -C
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