QUES- TIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES
(VERIFIED ANSWERS), SAEM Practice 2020
1. "Which coronary vessel is usually "A. left anterior descending (LAD)
the cause of the myocardial in-
farction in a patient with ST eleva- The answer is A. This EKG pattern is consistent
with that of
tion in V1, V2, and V3? describes a tearing sen-
A. left anterior descending sation. Vital signs are HR
(LAD) 110, BP
B. left circumflex artery
C. posterior descending
branch of the right
coronary artery
D. right coronary artery
(RCA)
E. right ventricular branch
of the right coronary
artery"
2. "A 51-year-old male with
long-standing hypertension
pre- sents with abrupt onset
of se- vere chest pain
radiating to the back. He
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QUES- TIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES
(VERIFIED ANSWERS), SAEM Practice 2020
anterior wall myocardial infarction (MI). The LAD elevation in leads V4 and V5 of a right-side leads
supplies the anterior wall of the myocardium. The EKG suggests infarction of the right ventricle. A
left circumflex artery, the LAD, or a branch of the posterior MI (ST depression in V1-V3) results from
RCA supplies the lateral wall of the left ventricle. occlusion of the RCA, its posterior descending
Proximal occlusion of the LAD will give ST elevation branch, or a dominant left circumflex."
in leads V1-6, aVL and I (an anterolateral MI).
Occlusion of a branch of the RCA will result in an "C. CT of the chest with IV contrast
inferolateral MI (ST elevation in leads II, III, aVF
"CT of the chest is the test most often used to
and I, aVL, V5 and V6). The RCA supplies the
confirm the diagnosis of aortic dissection. CT is
inferior wall and SA node. Occlusion in leads II,
readily available in most Emergency Departments,
III and aVF causes an inferior MI. The right
and has a sensitivity of 83-98% and specificity of
ventricle is usually supplied by the RCA or, less
87-100% for aortic dissection
commonly, a dominant left circumflex. ST
175/105, RR 20, T 37.4. EKG shows (highest accuracy with helical scans). Other
benefits as-
LVH. CBC, electrolytes, sociated with the use of CT include the ability to
BUN/Cre- atinine are all identify intramural thrombus, pericardial ettusion,
normal. CXR is and potentially
as shown below. What diagnostic reveal another etiology for the patient's pain. The
major
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QUES- TIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES
(VERIFIED ANSWERS), SAEM Practice 2020
test would be most
appropriate for making a 4. "A 64 year old female
definitive diagnosis at this presents to the emergency
time? department with chief
[image shows CXR w/ wide complaints of occipital
medi- astinum]
A. MRI of the thoracic spine
B. Aortogram
C. CT of the chest with IV
con- trast
D.Esophagram using
Gastrograf- fin"
3. "A 60 year old male
presented to the emergency
department with chest pain.
He subsequently be- came
unresponsive. The moni- tor
shows the rhythm below.
The rhythm is:
[image monomorphic wide
QRS tachycardia with no p
waves]
A. sinus tachycardia
B. ventricular tachycardia
C. atrial fibrillation with
rapid ventricular
response
D. atrial flutter"
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QUES- TIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES
(VERIFIED ANSWERS), SAEM Practice 2020
disadvantage of CT is the need for iodinated The answer is A. Elevated blood pressure in the setting
contrast, which requires normal renal function."" of optic disk edema is a hallmark of malignant
hypertension
"B. ventricular tachycardia
The answer is B. Ventricular tachycardia is wide and
com- plex. It is distinguished from supraventricular
tachycar- dia by width and morphology of the QRS
complexes. (Though there are numerous
exceptions, supraventric- ular tachycardias usually
exhibit narrow QRS complexes with morphology
similar to that when the patient is in sinus
rhythm.)"
"A. hypertensive crisis
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