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,A 55-year-old man presents to Polycythaemia rubra vera
the ED with central crushing
chest pain. He has no co- Myeloproliferative condition where too
morbidities and is not many RBCs are made (JAK2 mutation)
currently taking any Symptoms:
medication. On systems - itching, burning pain in hands and feet
enquiry, he mentions that he - red/blue discolouration
has very itchy skin and that he - Post-bath pruritis/aquagenic pruritis
occasionally gets painful, - Splenomegaly -- early satiety, LUQ pain
discoloured fingers and toes. - gout
Blood tests are as follows: - headache blurred vision
- thrombosis (central crushing chest pain)
Haemoglobin 18.0 g/dL (12.5 -
16.5 g/dL) He has a high haemoglobin level and is
White cell count 10.9 × 109/L approaching a raised WCC.
(4.0 - 11 × 109/L) Would have elevated HCT and RCM
Platelets 390 × 109/L (150 - 400
× 109/L)
Troponin T 0.32 ng/mL (<0.105
ng/mL)
He is commenced on
treatment for ACS and
referred to haematology with
a likely diagnosis of which of
the following?
myelodysplasia
chronic myeloid leukaemia
essential thrombocythaemia
,myelofibrosis
polycythaemia rubra vera
A 77-year-old man presents to Left anterior descending
the Emergency Department
complaining of chest pain that Elevation in V1-V4 = anterior-septal MI
started one hour ago. Most likely left anterior descending
artery
Electrocardiogram shows ST
elevation in leads V2, V3 and
V4. He undergoes
percutaneous coronary
intervention.
Coronary angiography is likely
to show a blockage in which
blood vessel?
great cardiac vein
left anterior descending artery
right coronary artery
left circumflex artery
left coronary artery
, An 85-year-old woman visits The ventricles filling rapidly in diastole
her general practitioner (GP)
as she has been short of _____________________________________
breath recently. On S1 = closure of mitral and tricuspid valves
examination, the GP notices a
third heart sound S2 = closure of aortic and pulmonary
valves
What does a third heart sound
represent? S3 = ventricular filling (ventricular gallop)
large volume of blood striking a
a) the atria contracting against compliant LV
a stiff ventricle cordae tendinae
b) the oscillation of blood in a (normal in children, if heard in adults
dilated ventricle associated with ventricular dilatation -
c) the ventricles filling rapidly systolic failure)
in diastole
d) the opening of the S4 = oscillation of ventricular wall, due to
pulmonary valve stiffened (non-complicant) ventricle e.g.
e) the closing of the aortic hypertropy, ischaemia, old age
valve ALWAYS ABNORMAL (atrial gallop)