Repeated Medical PG Question- 20

#MEDICINE(INICET)

Q- A 65-year-old man with diabetes, on an oral hypoglycemic, presents to the ER with a sports- related right shoulder injury. His heart rate was noted to be irregular and the following ECG was obtained. The best immediate therapy is

         A. Atropine 

         B. Observation

         C. Pacemaker 

         D. Electrical cardioversion

Answer is B. Observation

▪️This ECG shows Mobitz type I second-degree AV block, also known as Wenckebach phenomenon, characterized by progressive PR interval prolongation prior to block of an atrial impulse. This rhythm generally does not require therapy. It may be seen in normal individuals; other causes include inferior MI and drug intoxications such as from digoxin, beta blockers, or calcium channel blockers. Even in the post-MI setting, it is usually stable, although it has the potential to progress to higher-degree AV block with consequent need for pacemaker.

▪️The Mobitz type I AV block is typically a benign condition and usually does not progress to advanced forms of an AV block

By contrast, the Mobitz type II AV Block is pathological and frequently progresses to an advanced AV block 1

▪️This block is located either at or below the level of the His bundle, thus justifying the broader QRS complex observed in a majority of patients.

Q- Compliance curve of the lung in the given image where marked arrow signify which of the following conditions? 

          A. Pulmonary fibrosis 

           B. Empysema 

           C. Atelectasis 

           D. None

Answer is B. Empysema 

 High compliance lungs:   

○ Curve shifting upward & left with steep slopes.  

○ Emphysema 

 Low complaint lungs:  

○ Curve shifting downward & right. 

○ Pulmonary congestion and interstitial pulmonary fibrosis.