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1. A 65-year-old man with a history of hypertension, diabetes, and chronic kidney
disease presents to the emergency department with chest pain, dyspnea, and
diaphoresis. His blood pressure is 200/120 mmHg, heart rate is 110 beats per minute,
and oxygen saturation is 90% on room air. An electrocardiogram shows ST-segment
elevation in leads V1-V4. What is the most likely diagnosis and what are the immediate
interventions that should be performed? (5 points)
Answer: The most likely diagnosis is acute anterior myocardial infarction (MI), which is a
type of ischemic heart disease caused by occlusion of the left anterior descending
coronary artery. The immediate interventions include administering oxygen, aspirin,
nitroglycerin, morphine, and beta-blockers; initiating revascularization therapy with either
percutaneous coronary intervention (PCI) or thrombolytic drugs; and monitoring for
arrhythmias, heart failure, and cardiogenic shock. The rationale for these interventions is
to restore blood flow to the ischemic myocardium, reduce oxygen demand and pain,
prevent further thrombus formation, and prevent or treat complications.
2. A 45-year-old woman with a history of systemic lupus erythematosus (SLE) and
rheumatoid arthritis (RA) is admitted to the hospital with fever, malaise, joint pain, and
rash. She has been taking prednisone and methotrexate for her autoimmune conditions.
Her laboratory tests show leukopenia, thrombocytopenia, anemia, elevated erythrocyte
sedimentation rate (ESR), and positive antinuclear antibody (ANA) and rheumatoid factor
(RF). What are the pathophysiological mechanisms underlying her clinical manifestationsÂ
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