41.A 68-year-old woman with recently diagnosed uterine cancer is
brought to the ED by her daughter. The patient complains of acute onset
right-sided chest pain that is sharp in character and worse with inspiration.
Her BP is 135/85 mm Hg, HR 107 beats per minute, RR 20 breaths per
minute, and oxygen saturation 97% on room air. Physical examination
reveals a swollen and tender right calf. ECG is sinus tachycardia. Which of
the following is the most appropriate next step in management?
a. Start heparin therapy prior to diagnostic study
b. Administer thrombolytics
c. Order a ventilation-perfusion scan
d. Order a CT angiogram
e. Order a D-dimer
42.A 57-year-old man complains of chest palpitations and lightheaded-
ness for the past hour. Five years ago he underwent a cardiac catheterization
with coronary artery stent placement. He smokes half a pack of cigarettes
daily, and drinks a glass of wine at dinner. His HR is 140 beats per minute,
BP is 115/70 mm Hg, and oxygen saturation is 99% on room air. An ECG
reveals a wide complex tachycardia at a rate of 140 that is regular in rhythm.
An ECG from 6 months ago shows a sinus rhythm at a rate of 80. Which of
the following is the most appropriate medication to treat this dysrhythmia?
a. Digoxin
b. Diltiazem
c. Amiodarone
d. Adenosine
e. Bretylium
43.A 55-year-old man with hypertension and a one-pack-per-day smok-
ing history presents to the ED complaining of three episodes of severe
heavy chest pain this morning that radiated to his left shoulder. In the past,
he experienced chest discomfort after walking 20 minutes that resolved
with rest. The episodes of chest pain this morning occurred while he was
reading the newspaper. His BP is 155/80 mm Hg, HR 76 beats per minute,
RR 15 breaths per minute. He does not have chest pain in the ED. An ECG
reveals sinus rhythm with a rate of 72. A troponin I is negative. Which of
the following best describes this patient’s diagnosis?
a. Variant angina
b. Stable angina
c. Unstable angina
d. Non–ST-elevation MI
e. ST-elevation MI
22 Emergency Medicine