Question of the Week #490

490. An 18-year-old male presents to the Emergency Department for evaluation of chest pressure for an hour. The pain is radiating to his jaw. On examination, he is diaphoretic, and he complains of nausea. Past medical history is unremarkable. Urine reveals positive benzolegonine. Below is his ECG. What is the most likely cause of the patient’s symptoms?


A. Early repolarization

B. Ischemia

C. Cocaine induced myocardial infarction

D. Atrial fibrillation

E. Wolf-Parkinson-White Syndrome

Question of the Week # 225

225 ) A 40 year-old man presents to office for routine follow-up visit. His past medical history is significant for hypertension for which he is on Hydrochlorthiazide. He denies any chest pain, palpitatations, shortness of breath or syncope. He is a journalist by occupation. A routine EKG  is obtained and is shown below:

Which of the following is the most appropriate managment of this patient?

A) Beta-blocker

B) Catheter ablation

C) Diltiazem

D) Observation

E) Electrophysiological studies


Question of the Week # 224

224 ) A 38 year old man presents to the emergency room with complaints of palpitations that started 5 hours ago and are persistent. He denies having similar episodes in the past. He has no fever or shortness of breath or chest pain. His past medical history is unremarkable and he is not on any medications. On examination, blood pressure is 110/60 mmHg, heart rate  130/min, RR 20/min  and temperature 98.6 F.   Cardiovascular examination reveals irregularly, irregular heart rate at 140beats/min.  An Electrocardiogram now is shown below :

An EKG that was done during a pre-employment health check-up upon patient’s own request two months ago is shown below:

The most appropriate next step in managing this patient:

A) Defibrillation

B) Intravenous metoprolol

C) Intravenous Diltiazem

D) Intravenous Procainamide

E) Synchronized Cardioversion

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