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WorksheetsChest Pain & MI
Total questions: 10
Worksheet time: 5mins
How many hours after a cardiac ischemia event would you expect to reliably find a positive troponin?
2
4
6
8
10
A patient presents with a history of HTN and epigastric and chest pain for 3 hours with negative biomarkers. EKG is normal. He responds to antacids and feels better. What is next appropriate response?
Rx for PPI
Admit for cardiac work-up
Emergent cardiac catheterization
Nitroglycerin
Repeat biomarkers
A 60 year old M presents to ER with acute onset of CP and SOB for 20 minutes. PMHx DM. EKG shows STEMI. PE shows new harsh apical systolic murmur that begins with S1 but ends before S2. No history of murmur. Which of the following is the most likely diagnosis?
Aortic insufficiency
Aortic stenosis
Mitral regurgitation
Pulmonary embolism
Ventral septal defect
What is the recommended door-to-EKG time in patients presenting with chest pain?
1 minute
10 minutes
15 minutes
20 minutes
30 minutes
A 54 year old M presents with acute substernal chest pain. EKG has 4 mm acute ST-segment elevation in lead III and 2 mm ST-segment elevation in lead II. Which of the following is the most likely vessel occluded?
Left anterior descending artery
Left circumflex artery
Left main coronary artery
Right coronary artery
Sinoatrial node artery
A 54 year old M presents with 6 hours of acute substernal chest pain. EKG shows 4 mm acute ST-segment elevation in leads V2-V5. What is the recommended reperfusion strategy?
Pain control then PCI when pain free
Primary PCI in < 90 minutes
Primary PCI in < 120 minutes
Thrombolysis in < 90 minutes
Thrombolysis in < 120 minutes
A 65 year old M with PMHx DM presents to the ED c/o substernal chest pain and diaphoresis for 45 minutes. Which is the most important next step in management?
Sublingual nitroglycerin
Oxygen
Place defibrillator pads
Aspirin to chew
Morphine
In the initial evaluation of a patient with chest pain, which is the most important diagnostic test?
Exercise stress test
CK-MB
Chest x-ray
Troponin
EKG
A 54 year old M is seen at a rural ED with 1 hour of nausea and substernal chest pain radiating to his jaw. EKG shows STEMI. PCI is not performed at this hospital and only performed at a hospital 2.5 hours away. Which of the following statements is most accurate?
Obtain repeat EKG to assess if patient truly has STEMI
Transfer patient for emergent PCI
Administer thrombolytics, then transfer to PCI center
Give aspirin, start heparin, obtain stress test
Give nitroglycerin, start heparin, admit to Cardiology
A 45 year old F arrives to the ED c/o chest pain. Troponin normal, EKG shows concave ST elevation with PR depression (see image). Associated "bad cold," and wants to sleep but CP is excruciating when laying down, feels better sitting up straight and leaning forward. What will be included in her treatment plan?
PCI
NSAIDs and colchicine
PPI, H2 blocker, antibiotics
IV Tylenol
Nitroglycerin
