All ECG Part 1 ( DES exam)

7/Bas/E/62/ Un jeune patient de 25 ans, se présente aux urgences pour nausées, vomissements et douleurs abdominales évoluant depuis 24 heures. Votre examen clinique initial relève une PA à 150/80, une tachycardie à 100/min une T ˚ 38,5 et une oligurie. Le reste de l’examen est normal en dehors d’un pli cutané. Vous réalisez de principe un ECG. Quelle est la meilleure explication physiopathologique à ce tracé ?

8/Bas/US/548/ A 69-year-old woman complains of easy fatigue and one episode of presyncope. On examination of the jugular venous pressure (JVP), there are irregular large a waves. The ECG has fixed PP and RR intervals but varying PR intervals. Which of the following conditions is this most likely caused
by?

9/Bas/US/ 555) A 70-year-old Caucasian man comes to the emergency department because of the sudden onset of nausea, vomiting, diaphoresis, and chest pain. His other medical problems include hypertension, diabetes mellitus-type 2, and aortic stenosis. He has smoked one-and-a-half packs of cigarettes daily for 30 years and drinks 4 ounces of alcohol daily. His temperature is 37.2°C (99°F), blood pressure is 100/60 mmHg, pulse is 60/min, and respirations are 18/min. The patient's pulse oximetry showed 98% at room air. Examination shows normal first and second he sounds. Lungs are clear to
auscultation. His EKG is shown below. Which of the following is the most likely mechanism of this patient's condition?

11/Dia/E/ 67) Un patient de 55 ans aux antécédents de diabète, HTA et tabagisme consulte pour une douleur médio-thoracique suspecte d’infarctus du myocarde à l’interrogatoire. PA 130/70 mmHg symétrique, FC 90/min, FR 24/min. Auscultation cardio-pulmonaire normale. L’ECG 12 dérivations est enregistré ci-joint. Quel est le diagnostic le plus probable à évoquer en
urgence?

12/Dia/E/ 107) Vous prenez en charge une femme de 35 ans présentant une douleur rétrosternale évoluant depuis 24 heures. Elle n'a pas d'antécédent particulier en dehors d'un tabagisme occasionnel. Votre examen clinique est normal, ses constantes sont les suivantes : PA 120/60 mmHg, pouls 85 /min, T˚ 38,1˚C.Vous disposez rapidement d'un tracé ECG. Quel diagnostic est le plus probable?

13/Dia/US/ 262) A 22-year-old woman complains of palpitations and has a regular heartbeat at a rate of 170/min, with a blood pressure of 110/70
mmHg. The rate abruptly changes to 75/min after applying carotid sinus pressure. Which of the following is the most likely diagnosis?

14/Dia/US/ 298) A 23-year-old woman who is an elementary school teacher is brought to the ED after syncopizing in her classroom while teaching. Prior to passing out, she describes feeling light-headed and dizzy and next remembers being in the ambulance. There was no evidence of seizure activity. She has no medical problems and does not take any medications. Her father died of a “heart problem” at 32 years of age. She does not smoke or use drugs. BP is 120/70 mmHg, pulse rate is 71 beats per minute, RR is 14 breaths per minute, and oxygen saturation is 100% on room air. Her physical examination and laboratory results are all normal. A rhythm strip is seen below. Which of
the following is the most likely diagnosis?

15/Dia/US/ 961) A 54-year-old woman presents to the ED because of a change in behavior at home. For the past 3 years, she has end-stage renal
disease requiring dialysis. Her daughter states that the patient has been increasingly tired and occasionally confused for the past 3 days and has not been eating her usual diet. On examination, the patient is alert and oriented to person only. The remainder of her examination is normal. An initial 12-lead ECG is performed as seen on the following page. Which of the following electrolyte abnormalities best explains these findings?

16/Dia/US/ 997) A 56-year-old diabetic female comes to the clinic with complaints of dizziness which has been going on for 3 weeks. She denies any
dyspnea or diaphoresis. She says her blood glucose is well controlled and denies any allergy. Her BP is 155/90 mmHg. Her chest-x ray is unremarkable and her blood work is normal. The ECG is recorded below. What is the most likely diagnosis?

17/Dia/US/ 1106) A 63-year-old female presents to your clinic complaining of palpitations. For the past 3 weeks, she has noticed pounding of her heart that comes and goes. Her symptoms are more frequent at night. Her only medicine is insulin for diabetes mellitus. On physical examination, she is alert and oriented, and in no distress. Her EKG is shown below. Which of the following best accounts for this patient's symptoms?

18/Dia/US/ 1142) A 65-year-old male cigarette smoker reports onset of claudication of his right lower extremity approximately 3 weeks previously.
He can walk 3 blocks before the onset of claudication. Physical examination reveals palpable pulses in the entire left lower extremity, but no pulses are palpable below the right groin level. Non-invasive flow studies are obtained and are pictured here. What is the level of the occlusive process in this patient?

19/Dia/US/ 1308) A 78-year-old man with advanced renal disease has the ECG shown in Fig. (lead II). What is the diagnosis?

20/Dia/US/ 1311) A 78-year-old woman presents to a nursing home physician complaining of palpitations over the past several months. Her episodes
are not associated with any chest pain, dizziness, or loss of consciousness. The patient reports that she spent several weeks in the hospital as a child with rheumatic fever. ECG is shown in the image. Which of the following is the most likely diagnosis?

21/Dia/US/ 1602) Three months after an anterior MI, a 73-year-old man has a follow-up ECG. He is clinically feeling well with no further angina symptoms. His ECG shows Q waves in the anterior leads with persistant ST-segment elevation. The current ECG is most compatible with which of the following diagnosis?

22/Dia/US/ 1623) You are performing medical screening of new military recruits when an 18-year-old male reports several episodes of palpitation
and syncope over the past several years. Physical examination is unremarkable. An ECG is obtained with excerpts shown below. What is
the most likely diagnosis?

23/Dia/US/ 1624) You are seeing a 2-year-old boy for the first time. His father denies any past medical or surgical history, but does note that the child’s day care recently sent a note home asking about several episodes, usually after the child does not get what he wants, when he “breathes funny” and sits in a corner with his knees under his chin for a few minutes. The day-care staffers think this “self-imposed time-out” is a good thing, but they worry about the breathing. One teacher even though he once looked blue, but decided that it was probably because of the finger paints he had been using. On examination, you identify a right ventricular impulse, a systolic thrill along the left sternal border, and a harsh systolic murmur (loudest at the left sternal border but radiating through the lung fields). His chest radio- graph and ECG are shown. Which of the following congenital cardiac lesions would you expect to find in this child?

24/Para/E/ 20) Vous recevez en consultation un homme de 63 ans pour réalisation d'un bilan préopératoire. Il n'a pas d'antécédent particulier en dehors d'une notion de ''mort subite'' dans la famille sans autre précision. Son examen clinique est normal en dehors d'une pression artérielle élevée à 150/100 mm Hg, pouls 60/min. Il ne prend pas de traitement médicamenteux. Vous lui réalisez un électrocardiogramme que vous interprétez. Quelle l’étiologie la plus probable?

26/Para/US/ 331) A 42-year -old male with a past medical history of bladder cancer and recurrent hematuria presents to the emergency room after "passing out" when he got out of bed this morning. The patient says that he was standing up to urinate shortly after waking when he began feeling dizzy. Fortunately he was able to return to his bed before losing consciousness for 7-10 minutes. His EKG at the time of admission is shown below. Which of the following most likely accounts for the observed EKG changes?

27/Para/US/ 381) A 46-year-old man comes to the ER because of weakness and chest tightness. He has had these symptoms for the past one hour. He denies any past medical history. He does not smoke or drink alcohol. His father had a myocardial infarction at 68 years of age and his mother has myasthenia gravis. His EKG is shown on the slide below. The patient should be evaluated for which of the following?

28/Para/US/ 520) A 61-year-old woman was on her way to the grocery store when she started feeling chest pressure in the center of her chest. She became diaphoretic and felt short of breath. On arrival to the ED by EMS, her BP is 130/70 mmHg, HR is 76 beats per minute, and oxygen saturation is 98% on room air. The nurse gives her an aspirin and an ECG is performed as seen below. Which of the following best describes the location of this patient’s myocardial infarction (MI)?

29/Para/US/ 603) A 70-year-old man has dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. He has generalized cardiomegaly and pulmonary and systemic venous hypertension. The ECG is shown in Fig.What is the cardiac rhythm?

30/Para/US/ 637) A 77-year-old woman comes to the emergency department because of feeling “light-headed and dizzy.” Except for the irregular pulse, her physical examination is normal. What is the rhythm in the lead tracing shown in Fig.?

31/Para/US/ 689) An 18-year-old male complains of fever and transient pain in both knees and elbows. The right knee was red and swollen for 1 day during the week prior to presentation. On physical examination, the patient has a low-grade fever. He has a III/VI, high pitched, apical systolic murmur with radiation to the axilla, as well as a soft, mid-diastolic murmur heard at the base. A tender nodule is palpated over an extensor tendon of the hand. There are pink erythematous lesions over the abdomen, some with central clearing. The following laboratory values are obtained: Hct: 42, WBC: 12,000/μL with 80% polymorphonuclear leukocytes, 20% lymphocytes, ESR: 60 mm/h. The patient’s ECG is shown below. Which of the following tests is most critical to diagnosis?

32/Para/US/ 736) The ECG shown in Fig. Was obtained during the initial stages of an acute MI. The patient had just received thrombolytic therapy. What is the rhythm?

33/Para/US/ 748) You are called by a surgical colleague to evaluate a 54-year-old woman with ECG abnormalities one day after a subtotal thyroidectomy for a toxic multinodular goiter. Her only medication is fentanyl for postoperative pain control. The patient denies any history of syncope, and has no family history of sudden cardiac death. Physical examination is unremarkable except for a clean postoperative incision at the
base of the neck. Her ECG is reproduced below. What is the best next step in evaluation and management of this patient?

34/Manag/E/ 90) Vous recevez en consultation un homme de 53 ans qui présente depuis 3 jours une asthénie importante. Il a pour principaux antécédents un diabète de type II sous metformine et une hypertension artérielle sous celiprolol 200 mg. Son examen clinique est normal en dehors d'une prise de PA à 150/95 mm Hg. Un ECG est réalisé que vous interprétez. Quelle prescription thérapeutique est la plus appropriée ?

35/Manag/US/ 370) A 27-year-old man who is otherwise healthy presents to the ED with a laceration on his thumb that he sustained while cutting a bagel. You irrigate and repair the wound and are about to discharge the patient when he asks you if he can receive an ECG. It is not busy in the ED so you perform the ECG, as seen below. Which of the following is the most appropriate next step in management?