Acute coronary syndrome - 2012

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Acute coronary syndrome - 2012
A 68-year-old man Mr. Zaruba is coming to the general practitioner. He is a frequent attender as he has got high blood pressure, diabetes and recently high blood cholesterol has been measurred, too. That´s why he has decided to quit smoking and he has been successful for six months already. He had a smoked pork knee for dinner yesterday and this morning he vomited, had heartburn and complained about uncomfortable chest pressure. On his way to the GP, the ambulance is located on the second floor, he felt short of breath. The correct following step is:

to give antibiotics for a suspected gastroenteritis.

Wrong answer

Gastroenteritis accomanied by vomiting, without diarrhoea or elevated temperature is probably caused by a diet mistake or has a viral origin. Giving antibiotics is not indicated in this case and it can worse patient´s outcome. Vomiting and nausea can be the first symptoms of acute myocardial infarction (AMI) of inferior wall. It is necessary to think about it. The warning typical pain in the chest can be hidden due to polyneuropathy and diminished pain perception.


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to give the patient instructions about a diet mistake and make him an appointment for tomorrow.

Wrong answer

Vomiting and nausea can be the first symptoms of acute myocardial infarction (AMI). It is necessary to think about it. The warning typical pain in the chest can be hidden due to polyneuropathy. The patient with AMI is threatened by a sudden cardiac death and every delay in diagnostics or therapy can have fatal consequences.


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to write a request form for a gastric fibroscopy.

Wrong answer

Gastric fibroscopy is not indicated due to the lenght of vomiting and no blood present in vomitus. You are causing the patient futher stress and wasting the tax payers money.


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to perform physical examination, measure the blood pressure and pulse.

Correct answer

Whatever happens, the thorough examination and carefully taken history are the cornestone of diagnostics.


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