MEQ Session (16/12/17): Mr LTK
1. Mr LTK is a 63 yo Chinese male, active smoker of 40 pack years, with background history of hypertension, hyperlipidaemia, presents with sudden onset of severe central chest pain since 10am in the morning, associated with dyspnea and diaphoresis. Please see his ECG on the next slide. Apart from calling the cardiology registrar on-call, which of the following is the MOST important to do? (Choose 2 of 7) *
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2. Mr. LTK underwent angiogram and was found to have an acute total occlusion of RCA. A drug eluting stent was deployed. His chest pain resolved after procedure and he was transferred to ICU for further monitoring. He was given a GTN patch before cath and PCI to relieve his chest pain. 4 hours later, you were called to see him as the on call MO, because his heart rate became 40 bpm, and blood pressure dropped to 75/50mmHg. Patient is conscious and asymptomatic. Besides performing a 12 lead ECG, what’s your next step of action? (Choose only one correct option) *
3. Fortunately, Mr LTK managed to respond to fluid challenge, had a temporary pacing wire inserted, and became haemodynamically stable. 2 days later, his heart block resolved and his blood pressure is 110/70mmHg without any support. He’s ready to be transferred out of ICU. However, the ICU nurse noted that patient had one episode of blood stained stool. Which of the following actions would you avoid doing now? (Choose one option only) *
4. Mr LTK was reviewed by colorectal surgeon and was found to have minor haemorrhoidal bleeding. Discussion with family and patient concluded that dual antiplatelets to be continued in view of minor non-life-threatening bleeding. Mr LTK was transferred to general ward and being prepared for discharge in 1-2 days. His cardiovascular risk factor screening showed fasting glucose of 5.6, fasting LDL is 3.8. He is started on atorvastatin 40mg ON. Patient asks about his LDL target in the long run.(Choose one option only) *
5. Mr LTK is ready to be discharged. His heart rate is 80, blood pressure 140/75. His echo showed a LVEF 40% with regional wall motion abnormality consistent with his recent infarct. His fasting LDL and glucose levels are shown in the last question. He was also counselled for smoking cessation. What other medications should be given to him upon discharge, other than DAPT with PPI, and atorvastatin? (Choose one option only) *
6. 2 years later, Mr LTK is attending his routine cardio clinic follow up and he revealed to you that recently he became more easily tired, and develops shortness of breath upon walking for 2 bus stops or climbing 2 flights of stairs only. Otherwise, he has no orthopnea or paroxysmal nocturnal dyspnea, no diaphoresis. He claims compliant to medications every day. He is still smoking but he’s only smoking 5 sticks a day now. His physical exam is normal. He expressed his concern and asked you what could be the reason and what to do with it. What would you do? (Choose one option only) *
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