A 50 year old lady presents to emergency department with sudden severe chest pain radiating
to both shoulder and accompanying SOB (shortness of breath). Examination: cold peripheries
and paraparesis. What is the single most appropriate diagnosis?
- a. MI
- b. Aortic dissection
- c. Pulmonary embolism
- d. Good pastures syndrome
- e. Motor neuron disease
0 voters
Ans. The key is B. Aortic dissection. [Cold peripheries due to reduced blood flow to distal parts of
dissection. Paraperesis or paraplegia due to spinal cord ischemia and infarction as a presenting
manifestation of aortic dissection has been found in 2 to 5 % of patients. Usual management for type A
dissection is surgery and for type B is conservative].
A 28 year old man presents with rapid pounding in the chest. He is completely conscious
throughout. The ECG was taken (SVT). What is the 1st med to be used to manage this condition?
- a. Amiodarone
- b. Adenosine
- c. Lidocaine
- d. Verapamil
- e. Metoprolol
0 voters
Ans. The key is B. Adenosine. [Management of SVT: i) vagal manoeuvres (carotid sinus message, valsalva
manoeuvre) transiently increase AV-block, and unmask the underlying atrial rhythm. If unsuccessful
then the first medicine used in SVT is adenosine, which causes transient AV block and works by i)
transiently slowing ventricles to show the underlying atrial rhythm ii) cardioverting a junctional
tachycardia to sinus rhythm. OHCM].