Final control mercile fertim of tription in the work of the beet your suffered arocardial infarctum Vescolar rescation is the funes mm Hu The hour is red there are no sea DOUtachycanda caricial chanens in the nevications from Ventricular extrasystoles Otzidan was prescribed ut a dose of 160 mg/day, Sustak Forte 1 tablet 3 tumes a day, Panangin Ribocis 1. Anhythonia 2. Tachycardia 3. Hypotension, cheamess fisur Nausea, somiting, abdominal pain 5. The appearance of edens of the lower extratiities 2 Patiem R., aged 56, was admitted to the hospital with cromplaints of pressing retrontemal pon that occurs during the love feeling of interruptions in the to the with of infarction Vesicular respiration in the p 130/90 mm Hg. The liver is not end that the pedal sinus tachycardia, cicatricial changes in the myocardium, Heart sounds are muffled, systolves are fred Scart rate 102 per minute. H isolated ventricular extrasystoles. Choose an antianhythmic drug? 1. Hisoprolol 2. Amlodipine 3. Atropine four. Lidocaine 5. Ethacizine 3. Patient K., 26 years old, complains of shortness of breath at rest, palpitations, severe weakness, nausea. The above complaints appeared 20 minutes ago, called an ambulance Associated with fatigue. Auscultation of the heart heart sounds are clear. thythmic, severe tachycardia. HELL 130/80 mm 21st. Heart rate 170 per minute, in the lungs and other organs-b/o. On the ECG: Paroxyam of sinus tachycardia with a heart rate of 170 beats per minute. The vertical position of the EOS. What is your tactic? 1. Lidocaine 100 mg IV bolus 2. Atropine 0.1%-1 ml IM 3. Kordaron 300 mg per 200.0 physical solution IV, cap 4. Isoptin 2.5%-4 ml physical solution 10, iv, jet 5. Novocainamide 10%-5 ml IM 4 Patient 5, 39 years old, complains of severe weakness, heaviness in the heart, lack of air, shortness of breath. On the ECG simus rhythm with a heart rate of 49 per minute. What is your tactic? 1. Isoptun 2.5-4 ml + physical solution 10, iv, jer 2. Atropine 0.1-0.5 ml/m 3 Kordaron 300 mg per 200.0 physical solution IV, cap 4. Lidocaine 2%-5 ml IV bolus 5. Novocainamide 10%-5 ml IM 5. In the morning, a 72-year-old patient S. was brought to the emergency department of the emergency hospital with complaints of dull retrostemal compressive pain, lack of air, and shortness of breath. The pain has been bothering me since last night. On examination the skin is cold, cyanosis In the lungs, weakened vescular respiration. HP-100/70 mm Hg, beat rate - 100 beats per minute. KLA Leukocytes-12 10/1, ESR-15 min th Troponin test positive. On the ECG, the sinus thythm is interrupted by frequent ventricular extrasystoles in the form of bigenua Elevation of the ST segnent on the anterior lateral wall of the Izh. Your tactics 1. Promedol 1% I mi im. Heparin 5 thousand UD get IV + Aspirm I sab chew solution Lidocaine 2% -5 ml IV Isosorbide dinitrate 10.0 per physical 2. Promedol 1% 1 ml im. solution Bisoprolol 5 mg orally Heparm 5 thousand

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These are clinical pharmacology/cardiology exam questions. The text is OCR-corrupted but the clinical scenarios and answer choices are clear. Let me work through each question systematically using textbook knowledge confirmed by the library searches.

Question-by-Question Analysis


Question 1 — Patient on Otzidan (Bisoprolol) 160 mg/day, Sustak Forte (isosorbide dinitrate), Panangin, Ribocis after myocardial infarction — sinus tachycardia, ventricular extrasystoles

"Choose the side effects of the prescribed treatment" (implied by the answer options listed)
The medications mentioned:
  • Otzidan = Bisoprolol (beta-blocker)
  • Sustak Forte = Isosorbide dinitrate (long-acting nitrate)
  • Panangin = K⁺/Mg²⁺ supplement
  • Ribocis = Ribose/metabolic agent
Answer options: Arrhythmia | Tachycardia | Hypotension, dizziness, flushing | Nausea, vomiting, abdominal pain | Oedema of lower extremities
Correct answer: 3. Hypotension, dizziness, flushing (headache)
Reasoning: The dominant side-effect profile of isosorbide dinitrate (Sustak Forte) is vasodilation → hypotension, flushing, and headache/dizziness. Bisoprolol causes bradycardia (not tachycardia), and none of the regimen components typically cause lower limb oedema or prominent GI upset. Nitrate side effects (headache, flushing, hypotension) are the most clinically significant here.

Question 2 — 56-year-old, post-infarction scar, sinus tachycardia HR 102, isolated ventricular extrasystoles, BP 130/90

Choose an antiarrhythmic drug.
Options: Bisoprolol | Amlodipine | Atropine | Lidocaine | Ethacizine
Correct answer: 1. Bisoprolol
Reasoning: This patient has post-MI cicatricial changes + sinus tachycardia + isolated ventricular extrasystoles. Beta-blockers (bisoprolol) are the first-line antiarrhythmic in this context — they reduce sympathetic drive, lower heart rate, suppress ventricular ectopy, and are proven to reduce post-MI mortality. Lidocaine is for acute sustained ventricular tachycardia/fibrillation, not isolated VEBs. Ethacizine (class IC) is contraindicated post-MI due to proarrhythmic risk (CAST trial). Amlodipine is a calcium channel blocker with no antiarrhythmic role in ventricular ectopy. Atropine would worsen the tachycardia.

Question 3 — 26-year-old, acute onset palpitations/SOB, HR 170, ECG: paroxysmal sinus tachycardia HR 170, BP 130/80

What is your tactic?
Options: Lidocaine IV | Atropine IM | Amiodarone (Kordaron) 300 mg IV | Isoptin (Verapamil) IV | Novocainamide IM
Correct answer: 4. Isoptin (Verapamil) 2.5% — 4 ml + saline, IV slow
Reasoning: The ECG shows paroxysmal supraventricular tachycardia (the "sinus tachycardia" label at HR 170 in a young patient with acute onset is clinically PSVT/SVT, not true sinus tachycardia). Verapamil (Isoptin) IV is the classic first-line agent for paroxysmal SVT — it terminates re-entrant SVT through AV node blockade rapidly and effectively. Amiodarone is reserved for more refractory or haemodynamically unstable cases. Lidocaine targets ventricular arrhythmias, not SVT. Atropine accelerates the sinus node and would be counterproductive. Novocainamide can be used for SVT but is second-line in this context.

Question 4 — 39-year-old, severe weakness, heaviness, dyspnoea, ECG: sinus rhythm HR 49/min (bradycardia)

What is your tactic?
Options: Verapamil IV | Atropine 0.1% — 0.5 ml IM | Amiodarone IV | Lidocaine IV bolus | Novocainamide IM
Correct answer: 2. Atropine 0.1% — 0.5 ml IM
Reasoning: Symptomatic sinus bradycardia (HR 49, weakness, dyspnoea, heaviness) — atropine is the standard first-line treatment. It blocks vagal tone on the SA node, increasing heart rate. Verapamil would worsen bradycardia. Amiodarone, lidocaine, and novocainamide are all antiarrhythmics without a role in treating bradycardia (and amiodarone/lidocaine can worsen it).

Question 5 — 72-year-old, overnight retrosternal compressive pain + dyspnoea, BP 100/70, HR 100, cold cyanotic skin, Leukocytes 12×10⁹/L, ESR 15, Troponin positive, ECG: sinus rhythm with frequent bigeminal ventricular extrasystoles + ST elevation anterior-lateral wallAcute STEMI + ventricular bigeminy

Your tactics?
  • Option 1: Promedol 1% 1 ml IM + Heparin 5000 U IV + Aspirin 1 tab chewed + Lidocaine 2% 5 ml IV + Isosorbide dinitrate
  • Option 2: Promedol 1% 1 ml IM + solution + Bisoprolol 5 mg orally + Heparin 5000 U
Correct answer: 1 — Promedol (analgesia) + Heparin + Aspirin + Lidocaine IV + Nitrates
Reasoning: This is acute STEMI with haemodynamically significant ventricular bigeminy (a warning arrhythmia in the acute infarct setting). The immediate priority is:
  • Analgesia: Promedol (morphine equivalent) for pain/sympathetic activation
  • Antithrombotic: Heparin + Aspirin (cornerstone of acute STEMI management)
  • Nitrates: Isosorbide dinitrate for ischaemia/preload reduction
  • Lidocaine IV: For acute ventricular arrhythmia suppression in the context of STEMI — this is the appropriate antiarrhythmic in the acute phase with bigeminy
Bisoprolol orally (Option 2) can eventually be used in STEMI but is not the right choice when the patient has frequent bigeminal VEBs in the acute phase with hypotension (BP 100/70) — beta-blockers are relatively contraindicated in acute STEMI with haemodynamic compromise and active arrhythmia requiring immediate IV management.

Summary Table

#Clinical ScenarioCorrect Answer
1Post-MI on nitrate + beta-blocker — side effects3. Hypotension, dizziness, flushing (nitrate side effects)
2Post-MI, sinus tachycardia HR 102, isolated VEBs1. Bisoprolol
326 y/o, paroxysmal SVT HR 170, BP stable4. Verapamil (Isoptin) IV
439 y/o, symptomatic sinus bradycardia HR 492. Atropine 0.1% IM
572 y/o, acute STEMI + bigeminal VEBs, BP 100/701. Promedol + Heparin + Aspirin + Lidocaine IV + Nitrate

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