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Fellowship course Week 1 - CVSWRITTEN EXAMINATIONSHORT ANSWER QUESTIONS EXAMINATION TIME: 66 MinutesQuestion 1 (16 marks) 6 minutes A 54-year-old man presents with 1 hour of central chest pain.12852403746500An ECG is taken on arrival, with 3 additional right-sided pericordial leads:-397510203644500Question 1 (continued)State three (3) abnormalities shown on this ECG. (3 marks)_____________________________________________________________________________________________________________________________________________________________________________________________________________________State three (3) significant implications of these findings. (3 marks)_____________________________________________________________________________________________________________________________________________________________________________________________________________________Question 1 (continued)List four (4) medications that you would commence in the emergency department. Provide doses for each medication. (4 marks)___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Prior to being given any of these medications, his blood pressure is noted to be 70/30 mmHg with the same rate and rhythm as shown in the ECG. Assuming that the blood pressure does not improve, list three (3) specific treatments for his blood pressure. List one (1) justification for each choice. (6 marks)Specific treatment(3 marks)Justification(3 marks)1.2.3.Question 2 (12 marks) 6 minutesA 64-year-old man presents to your Emergency Department with chest pain.Serial ECGS are taken- ECG 1 is taken on arrival with pain, ECG 2 is a pain free ECG.State five (5) points of significance of the abnormal findings in these ECGs. (5 marks)___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 2 (continued)State the seven (7) diagnostic features of this condition. (7 marks)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 2 (continued)Question 3 (11 marks) 6 minutes A 75-year-old man presents following a collapse.An ECG is taken.State five (5) abnormalities shown in this ECG. (5 marks)___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 3 (continued)List six (6) possible causes for this ECG problem. (6 marks)__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 3 (continued)-1579861129343900Question 4 (12 marks) 6 minutesA 76-year-old woman presents to your emergency department with one hour of severe chest pain.An ECG is taken- refer to the props booklet- page 1.State four (4) abnormal findings in this ECG. (4 marks)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What is the significance of these ECG changes for this patient? Sate four (4) points in your answer. (4 marks)_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 4 (continued)The cardiology registrar does not agree with your assessment of this ECG and its’ significance.State four (4) pieces of information from a bedside ECHO that would support your case. (4 marks)_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 4 (continued)-1879675227991200Question 5 (15 marks) 6 minutesA patient presents with atrial fibrillation.List six (6) patient factors that would lead you to choose a rhythm control strategy. (6 marks)__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 5 (continued)You select electrical cardioversion as the treatment of choice. List your initial defibrillator settings.(3 marks)_________________________________________________________________________________________________________________________________________________________________________________________________________________________________List six (6) key pieces of information that you would provide to the patient prior to electrical cardioversion. (6 marks)__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 6 (12 marks) 6 minutesA 65-year-old woman presents with chest pain. You decide that she requires further investigation to investigate the possibility of acute coronary syndrome.List two (2) important pros and one important (1) con for the investigative options below for this patient. (12 marks)Imaging optionPros(4 marks)Con(2 marks)Exercise stress testNuclear medicine stress test Continued over…Question 6 (continued)Imaging optionPros(4 marks)Con(2 marks)Stress ECHO CT Coronary Angiography Question 7 (16 marks) 9 minutesComplete the table, listing six (6) ECG features that assist in distinguishing between supraventricular tachycardia with aberrancy and ventricular tachycardia. (6 marks)ECG featureSVTVT1.(1 mark)2.(1 mark)3.(1 mark)4.(1 mark)5.(1 mark)6.(1 mark)Question 7 (Continued)List four (4) indications for the insertion of an Automated Implantable defibrillator. (4 marks)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________List six (6) indications for Percutaneous Coronary Intervention in a patient with chest pain and a ventricular paced rhythm. (6 marks)__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 8 (12 marks) 6 minutesA 62-year-old woman with a history of atrial fibrillation and hypertension presents with acute shortness of breath. Her observations are: BP 65/34 mmHgHR 140 /minTemp 36°C SaO2 not recordableA bedside ultrasound of the heart is taken- a static image is shown.List three (3) abnormal findings in this ultrasound in the setting of this scenario. (3 marks)_____________________________________________________________________________________________________________________________________________________________________________________________________________________List five (5) possible causes for this problem for this patient. (5 marks)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 8 (continued)List four (4) key steps in the management of this condition in this patient in the next 10 minutes. (4 marks)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 9 (18 marks) 9 minutesA 72-year-old woman presents with tearing chest pain suggestive of dissection of her thoracic Aorta. State three (3) pros for the utility of chest Xray in this presentation. (3 marks)_____________________________________________________________________________________________________________________________________________________________________________________________________________________State three (3) cons for the utility of chest Xray in this presentation. (3 marks)_____________________________________________________________________________________________________________________________________________________________________________________________________________________Question 9 (continued)List six (6) Chest Xray findings that support the diagnosis of thoracic Aortic dissection. (6 marks)__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 9 (continued)State six (6) key issues in the management of a patient with proven thoracic Aortic dissection. (6 marks)___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _______________________________________________________________________Question 10 (12 marks) 6 minutesA 65-year-old male presents is successfully resuscitated after experiencing an out of hospital ventricular fibrillation arrest.What is your temperature aim for his ongoing care? (1 mark)__________________________________________________________________________Provide justification for this choice. State five (5) points in your answer. (5 marks)___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 10 (continued)The ambulance ACLS protocol in your region does not include vasopressin. What is the the current role of vasopressin in: Out of hospital arrest. State three (3) points. (3 marks)_____________________________________________________________________________________________________________________________________________________________________________________________________________________In- hospital arrests. State three (3) points. (3 marks)_____________________________________________________________________________________________________________________________________________________________________________________________________________________ ................
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