Final MCQ Test IACC

A 61-year-old man presents with 45 minutes of substernal chest pressure radiating to the left arm. He is diaphoretic and anxious. Vitals: BP 96/62 mmHg, HR 58 bpm, RR 18/min, SpO2 96% on room air. ECG shows 2 mm ST-segment elevation in leads II, III, and aVF with reciprocal depression in leads I and aVL.

• Administer sublingual nitroglycerin

• Initiate fibrinolytic therapy

• Administer IV fluids and assess for right ventricular infarct

• Start intravenous beta-blockers

• Obtain serial troponin levels

A 69-year-old woman with diabetes presents with atypical chest pain. Vitals: BP 138/86 mmHg, HR 102 bpm, ECG shows no ST-elevation. Troponin I is elevated at 3.2 ng/mL. Which of the following is the next best step in her management?

• Immediate coronary angiography

• Stress testing with echocardiography

• Administer aspirin and monitor

• Dual antiplatelet therapy and risk stratification

• Administer thrombolytic therapy

A 55-year-old man undergoes successful PCI with a drug-eluting stent for a STEMI. On post-procedure day 3, he develops hypotension, new pansystolic murmur, and pulmonary edema.

• Acute mitral regurgitation due to papillary muscle rupture

• Ventricular septal rupture

• Pericardial tamponade

• Cardiogenic shock from stunned myocardium

• Free wall rupture

A 73-year-old man presents 4 hours after the onset of chest pain. ECG shows new LBBB. Troponin is not yet elevated. Which of the following criteria most strongly supports a diagnosis of acute myocardial infarction?

• Sgarbossa concordant ST elevation ≥1 mm in any lead

• Discordant ST depression ≥1 mm in V1–V3

• ST depression in lead I and aVL

• ST elevation in V3–V4

• Absence of Q waves

A 65-year-old woman with a recent NSTEMI is on aspirin and ticagrelor. She develops upper GI bleeding. INR is 1.1. Which of the following is the best next step in her antiplatelet management?

• Discontinue both aspirin and ticagrelor

• Discontinue aspirin and continue ticagrelor

• Discontinue ticagrelor and continue aspirin

• Continue both aspirin and ticagrelor

• Switch to clopidogrel monotherapy

A 58-year-old man with a history of hypertension and dyslipidemia presents with acute chest pain for 30 minutes. Vitals: BP 120/80 mmHg, HR 88 bpm. ECG shows dynamic T-wave inversions in V2–V4. Troponin I is mildly elevated.

• Emergent PCI

• Conservative medical therapy only

• Invasive angiography within 24–72 hours

• Thrombolytic therapy

• Repeat troponin in 12 hours

A 62-year-old woman presents 3 days after a STEMI treated with PCI. She now has chest pain that worsens with inspiration and improves when sitting forward. ECG shows diffuse ST elevation and PR depression.

• High-dose aspirin only

• Colchicine and NSAIDs

• Systemic corticosteroids

• Repeat coronary angiography

• Anticoagulation with heparin

A 70-year-old man with chronic kidney disease and recent DES placement for STEMI presents with active GI bleeding. He is on aspirin and clopidogrel. INR is 1.0. Which of the following is the best strategy to manage his antiplatelet therapy?

• Stop both antiplatelets immediately

• Hold clopidogrel, continue aspirin

• Continue both antiplatelets

• Replace clopidogrel with ticagrelor

• Resume DAPT once bleeding is controlled

A 66-year-old male is undergoing fibrinolysis for a STEMI due to lack of PCI availability. One hour after tenecteplase administration, he develops slurred speech and right-sided weakness.

• Administer IV heparin

• Start aspirin immediately

• Perform urgent brain CT scan

• Continue fibrinolysis

• Administer Vit K and FFP

A 55-year-old woman presents with chest pain. ECG shows ST elevation in V1–V4. She is taken for urgent PCI. Angiography shows 100% LAD occlusion. After revascularization, she has persistent LV dysfunction with EF 25%. What is the most likely explanation for her persistent LV dysfunction?

• Myocardial stunning

• Reperfusion injury

• Chronic ischemic cardiomyopathy

• Hibernating myocardium

• Papillary muscle rupture