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2) A 78 year old man presents to the emergency department with sudden onset chest pain of 2 hours duration with associated nausea. On examination he is cold and sweaty. His pulse rate is 65 beats per minute and his blood pressure is 125/80 mmHg. A resting electrocardiogram shows ST segment elevation across the anterior chest leads (V1-V5).

What is the most likely diagnosis?

A)

Acute exacerbation of asthma

B)

Diabetic ketoacidosis

C)

Hypothyroidism

D)

Myocardial infarction

E)

Uncontrolled hypertension

The correct answer here is “D.” Again, this would appear to be a good question for the same reasons indicated in the first question, a) there is a clear history followed by salient examination findings, b) there are no abbreviations contained within the text and units are included for all measured parameters, c) there is a positively worded question and d) there are 5 distinct answers listed in alphabetical order and all of similar length. Again this is a very easy question and the Angoff score will be very high and therefore the question will not adequately discriminate. The use of other cardiac diagnoses as distractors would improve the question further.

3) A 65 year old man presents to the A/E with sudden onset chest pain of 2 hours duration. O/E pulse 65 and BP 110/75. An ECG shows a STEMI.

Which of the following is NOT appropriate?

A)

Aspirin and heparin

B)

Aspirin, heparin, hydrocortisone and antibiotics

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