Online Clinical Case Study (February 2018)

Clinical Cardiology Series

The content of the February Cardiology Series is provided by:
Dr. WONG Chi Yuen
MBBS (HK), MRCP (UK), FHKCP, FHKAM (Medicine), Specialist in Cardiology
Dr. CHUI Shing Fung
MBChB (CUHK), MRCP (UK), FHKCP, FHKAM (Medicine), Specialist in Cardiology

Treadmill Exercise Test for assessment of chest pain

A 69-year-old man with diabetes mellitus, hypertension and hyperlipidaemia complained of exertional chest pain after 10 minutes of exercise which was relieved with rest. Physical examination was unremarkable with no heart murmur detected. A treadmill exercise test (TMT) was arranged.

Answer Sheet

Complete Cardiology case 0.5 CME POINT will be awarded for at least 2 correct answers in total

Clinical Cardiology Series臨床心臟科個案研究

Resting ECG is shown in Figure 1.

Figure 1

Figure 2

Figure 3

1. Patients with following resting ECG abnormalities should NOT undergo TMT for ischaemia assessment, EXCEPT
A. Left bundle branch block
B. Wolf-Parkinson-White syndrome
C. Pacemaker rhythm
D. Right bundle branch block
E. Resting ST depression > 1 mm

This gentleman was put on Bruce Protocol of TMT. Patient was asymptomatic throughout the test. The test was terminated prematurely by the cardiologist for certain reasons. Maximum HR achieved was 121 BPM. Total exercise time was 5 min 19 sec with 7.0 METS achieved. The haemodynamic record (Figure 2) and the ECG at peak exercise (Figure 3) were shown.

2. What is the Target Heart Rate (THR) for this gentleman?
A. 121
B. 136
C. 151
D. 170
E. 220

3. What were the potential reasons for premature termination of TMT in this gentleman?
 1. Abnormal blood pressure response
 2. Abnormal heart rate response
 3. Significant ST segment changes
 4. THR achieved

A. 1 and 2 only
B. 1 and 3 only
C. 1, 2 and 3 only
D. 4 only
E. All of the above

4. How would you interpret the TMT result?
A. Positive test, high probability of coronary artery disease
B. Positive test, low probability of coronary artery disease
C. Inconclusive test, due to incomplete test
D. Inconclusive test, due to uninterpretable ECG at peak stress
E. Negative test

Dermatology Series 皮膚科病例研究

Dermatology Series for February 2018 is provided by:
Dr. KWAN Chi Keung, Dr. TANG Yuk Ming, William, Dr. CHAN Hau Ngai, Kingsley, Dr. LEUNG Wai Yiu and Dr. CHANG Mee, Mimi
Specialists in Dermatology & Venereology

Itchy pubis

A 56 year-old man who is a street-sleeper complained itch over the pubic region for 1 week. The itch occurred after a commercial sex 2 to 3 weeks ago. He claimed that condom was used. There was no urethral discharge, dysuria or frequent urine. Physical examination review no abnormal growth, ulcer or erosion over genital area. However, multiple, small shiny, whitish spot were found and attached firmly on the shaft of pubic hair. Otherwise, no other abnormality was detected.

Answer Sheet

Complete Dermatology case, 0.5 CME POINT will be awarded for at least 2 correct answers in total

Dermatology Series 皮膚科病例研究

1. What is your diagnosis?
a) Scabies
b) Insect bites
c) Xerotic skin with skin peeling
d) Pubic Pediculosis
e) Dermatophyte infection

2. The small, shiny, whitish spot on the shaft of pubic hair is the
peeling of skin after excoriation because of itch. (True or False)

3. Fungal culture is needed to confirm the diagnosis. (True or False)

4. What other investigation(s) is/are needed in managing this man?
a) HIV test
b) Syphilis test
c) Neisseria gonorrhoeae PCR
d) Chlamydia trachomatis PCR
e) All of the above

5. What is the treatment for this man?
a) 1% permethrine lotion
b) 0.5% malathion lotion
c) 1% Lindane lotion
d) 25% benzyl benzoate emulsion (BBE)
e) All of the above

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