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Update your Knowledge with MKSAP 17 Q&A

MKSAP has been trusted by internists since 1967 as the best resource for updating knowledge. MKSAP 17, available in Complete, Digital, and Print packages, consists of 11 comprehensive text chapters with related multiple-choice questions. You'll find 1,200 completely new questions to help you identify learning gaps, stay current, and gain the knowledge you need to provide the best possible patient care. MKSAP 17's original and high-quality questions evolve out of case studies and patient scenarios based on the latest evidence.

For more information on MKSAP 17, or to order your copy, visit mksap17.acponline.org.

MKSAP 17 Q & A

A 72-year-old man is evaluated in the emergency department for a witnessed syncopal episode. The patient was sitting in church when he noted acute onset lightheadedness accompanied by a rapid heartbeat. He abruptly lost consciousness and was unresponsive for 1 minute. There was no apparent seizure activity, bladder or bowel incontinence, or tongue biting. Upon regaining consciousness, he was groggy but alert with no retrograde amnesia, chest pain, shortness of breath, or weakness. He is a current smoker with a 50-pack-year history. Medical history is remarkable for type 2 diabetes mellitus, hypertension, and hyperlipidemia. Medications are metformin, lisinopril, and simvastatin.

On physical examination, temperature is 36.7 °C (98.0 °F), blood pressure is 138/86 mm Hg without orthostatic change, pulse rate is 56/min and regular, and respiration rate is 15/min. BMI is 33. Oxygen saturation is 93% with the patient breathing ambient air. Carotid upstrokes are normal and without bruits. The lungs are clear. Cardiac examination shows occasional premature beats but is otherwise normal.

Electrocardiogram reveals normal sinus rhythm with a left axis shift, QRS interval of 140 ms, and complete left bundle branch block pattern (unchanged from 1 year ago). Chest radiograph is normal.

Which of the following is the most appropriate next step in management?

A: 24-Hour ambulatory event monitor

B: Implantable loop recorder

C: Inpatient cardiac monitoring

D: Pacemaker insertion

Click here for the answer and critique.

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