STEMI Flashcards
(168 cards)
1
Q
Which histologic feature is commonly associated with coronary plaques prone to disruption in STEMI?
A. Thick fibrous cap with a low lipid core
B. Thin fibrous cap with a rich lipid core
C. Absence of a fibrous cap with extensive calcification
D. Intact endothelium with minimal inflammatory cells
A
B
1
Q
Which of the following most accurately describes the typical mechanism of STEMI?
A. Gradual occlusion of a high-grade coronary artery stenosis due to collateral network failure
B. Abrupt decrease in coronary blood flow after a thrombotic occlusion of an atherosclerotic coronary artery
C. Coronary artery spasm in the absence of atherosclerosis
D. Acute embolization from an intracardiac thrombus causing coronary obstruction
A
B
2
Q
The activation of which receptor on platelets promotes cross-linking and aggregation in STEMI?
A. Thromboxane A2 receptor
B. Glycoprotein IIb/IIIa receptor
C. ADP receptor
D. Serotonin receptor
A
B
3
Q
Which of the following factors contributes to the disruption of atherosclerotic plaques, favoring thrombogenesis in STEMI?
A. Collagen vascular disease
B. Cigarette smoking
C. High levels of physical activity
D. Advanced age without comorbid conditions
A
B
4
Q
What is the role of thrombin in the pathophysiology of STEMI following acute plaque rupture?
A. Thrombin inhibits platelet activation, reducing thrombus formation.
B. Thrombin converts fibrinogen to fibrin, stabilizing the developing thrombus.
C. Thrombin activates Factor X only, limiting the extent of the thrombus.
D. Thrombin prevents tissue factor exposure, reducing coagulation.
A
B
5
Q
Which of the following statements is true regarding the onset of STEMI?
A. STEMI usually occurs during periods of deep sleep.
B. STEMI is commonly triggered by factors like vigorous exercise, emotional stress, or a recent medical illness.
C. STEMI is primarily seen in the evening hours.
D. The majority of STEMI cases have no identifiable precipitating factors.
A
B
6
Q
Which characteristic best describes the typical pain experienced by patients with STEMI?
A. Sharp and localized to a single area
B. Mild discomfort relieved by rest
C. Deep, visceral pain that is heavy, squeezing, or crushing in nature
D. Limited to the lower abdomen and always radiates to the legs
A
C
7
Q
Radiation of STEMI pain to which of the following areas would suggest an alternative diagnosis, such as acute pericarditis?
A. Right arm
B. Left jaw
C. Trapezius muscle
D. Lower back
A
C
8
Q
Which of the following groups is more likely to experience a painless presentation of STEMI?
A. Young patients without comorbidities
B. Patients with diabetes mellitus and elderly patients
C. Middle-aged adults with hypertension
D. Patients with a prior history of pericarditis
A
B
9
Q
n elderly patients, which of the following symptoms may be an atypical presentation of STEMI?
A. Crushing chest pain radiating to the left arm
B. Sudden-onset breathlessness progressing to pulmonary edema
C. Mild chest discomfort that improves with rest
D. Chest pain that radiates to the lower abdomen
A
B
10
Q
The combination of ____ persisting for >30 min and ____ strongly suggests STEMI.
A
substernal chest pain
diaphoresis
11
Q
Patients with ____ infarction may have manifestations of sympathetic nervous system hyperactivity (tachycardia and/or hypertension), and those with ____infarction may show evidence of parasympathetic hyperactivity (bradycardia and/or hypotension).
A
anterior
inferior
12
Q
Signs of Ventricular Dysfunction:
>__ and __ heart sounds
>Decreased intensity of the __ heart sound.
>Paradoxical splitting of the __ heart sound.
A
> 4th and 3rd
> 1st
> 2nd
13
Q
Temperature may elevate up to 38°C during the ___ week after STEMI.
A
first
14
Q
Systolic Blood Pressure:
Variable but often declines by ~10–15 mmHg from the preinfarction state in patients with ___infarction.
A
transmural
15
Q
Patients with an anterior STEMI are more likely to exhibit which of the following findings within the first hour of presentation?
A. Bradycardia and hypotension
B. Tachycardia and hypertension
C. Bradycardia and hypertension
D. Tachycardia and hypotension
A
B
16
Q
Which physical finding may suggest ventricular dysfunction in a patient with STEMI?
A. Increased intensity of the first heart sound
B. Paradoxical splitting of the second heart sound
C. Systolic pressure rise of 10–15 mmHg
D. Absence of third and fourth heart sounds
A
B
17
Q
The presence of a pericardial friction rub in a patient with STEMI is most likely associated with which type of infarction?
A. Subendocardial STEMI
B. Transmural STEMI
C. Non-STEMI
D. Inferior wall STEMI without transmural involvement
A
B
18
Q
In a patient with STEMI, a decrease in the carotid pulse volume is most indicative of which underlying issue?
A. Elevated systemic vascular resistance
B. Reduced stroke volume
C. Increased preload
D. Pulmonary congestion
A
B
19
Q
Which of the following stages corresponds to the initial cellular response in the infarct zone of a STEMI?
A. Acute phase
B. Healing phase
C. Healed phase
D. Chronic phase
A
A
20
Q
In the healing phase of STEMI (7–28 days), which cellular component is primarily involved in recruiting fibroblasts to the infarct zone?
A. Polymorphonuclear leukocytes
B. Reparative monocytes
C. Proinflammatory monocytes
D. Lymphocytes
A
C
21
Q
During the healed phase of STEMI (≥29 days), what is the primary role of reparative monocytes in the infarcted myocardium?
A. Recruitment of polymorphonuclear leukocytes
B. Clearance of dead cells
C. Angiogenesis and interstitial collagen production
D. Activation of fibroblasts
A
C
22
Q
T or F
Contemporary studies using magnetic resonance imaging (MRI) suggest that the development of a Q wave on the ECG is more dependent on the volume of infarcted tissue rather than the transmurality of infarction.
A
T
23
Q
Which of the following is the primary electrocardiographic manifestation of total occlusion of an epicardial coronary artery in STEMI?
A. T-wave inversion
B. ST-segment elevation
C. Loss of R waves
D. Prolonged PR interval
A
B
24
Contemporary studies using MRI have shown that the development of Q waves on the ECG is more related to which of the following?
A. Transmurality of the infarction
B. Volume of infarcted tissue
C. Duration of the ischemic episode
D. Presence of collateral circulation
B
25
The criteria for AMI require a rise and/or fall in cardiac biomarker values with at least one value ____ of the upper reference limit for normal individuals.
above the 99th percentile
26
Which of the following best explains how serum cardiac biomarkers become detectable in the peripheral blood following STEMI?
A. Increased cardiac output following STEMI
B. Increased demand for oxygen in peripheral tissues
C. Overflow into venous circulation after cardiac lymphatic clearance is exceeded
D. Immediate diffusion of proteins through the coronary arteries
C
27
According to the criteria for acute myocardial infarction (AMI), which of the following is required for a diagnostic rise and/or fall in cardiac biomarker values?
A. At least one value above the 95th percentile of normal individuals
B. At least one value above the 99th percentile of the upper reference limit for normal individuals
C. A steady increase in values over a 24-hour period
D. Values fluctuating but remaining below the reference limit
B
28
What characteristic of cardiac-specific troponins T (cTnT) and I (cTnI) allows for highly specific assays to detect myocardial injury?
A. Smaller molecular weight compared to other proteins
B. Structural similarity to skeletal muscle proteins
C. Unique amino acid sequences that differ from skeletal muscle forms
D. Slow rate of release into circulation after myocardial injury
C
29
Why are cardiac troponins (cTnT and cTnI) considered particularly valuable in cases where there is suspicion of a small MI or skeletal muscle injury?
A. They rise more slowly than CK-MB and CK, allowing better long-term monitoring.
B. They are detectable at very low concentrations and are highly specific to cardiac tissue.
C. They are less costly to measure compared to CK-MB.
D. They decrease faster, allowing quicker return to baseline values.
B
30
In practical terms, high-sensitivity troponin assays are of less immediate value in which group of patients?
A. Patients with unstable angina (UA)
B. Patients with NSTEMI
C. Patients with STEMI requiring urgent reperfusion
D. Patients with skeletal muscle injury
C
31
Which statement is true regarding the timeline of elevation for cardiac-specific troponins (cTnT and cTnI) following STEMI?
A. They return to normal within 24 hours.
B. They remain elevated for only 2–3 days.
C. They remain elevated for 7–10 days after STEMI.
D. They are undetectable after 5 days.
C
32
Which laboratory marker is known to rise within 4–8 hours after STEMI and generally returns to normal within 48–72 hours?
A. cTnT
B. CK-MB
C. cTnI
D. Total CK
D
33
An elevated CK-MB to CK activity ratio (≥2.5) suggests which of the following?
A. Cardiac source of CK-MB elevation
B. Skeletal muscle injury only
C. Early renal failure
D. Only recent myocardial reperfusion
A
34
Why might hospitals prefer to use cardiac troponins (cTnT or cTnI) rather than CK-MB for diagnosing STEMI?
A. Cardiac troponins are less specific for cardiac tissue.
B. Cardiac troponins are more cost-effective and have greater sensitivity.
C. CK-MB levels remain elevated longer than cardiac troponins.
D. CK-MB levels are unaffected by extracardiac conditions
B
35
Which of the following biomarkers is likely to peak earlier when there is rapid reperfusion of an occluded coronary artery?
A. Erythrocyte sedimentation rate (ESR)
B. CK-MB
C. Polymorphonuclear leukocytes
D. Cardiac-specific troponins due to washout from the infarct zone
D
36
Which of the following best describes the initial mechanism for the release of serum cardiac biomarkers following myocardial infarction?
A. Direct diffusion through coronary arteries
B. Breakdown of the sarcolemmal membrane of cardiomyocytes
C. Immediate release from the lymphatic system
D. Passive release through capillary filtration
B
37
Which biomarkers are typically the first to appear in the blood following the onset of myocardial infarction?
A. Cardiac troponins T and I
B. Myoglobin and CK isoforms
C. Lactate dehydrogenase
D. Erythrocyte sedimentation rate
B
38
Following a large myocardial infarction, troponin levels may exceed the upper reference limit by:
A. 2–3 times
B. 10–15 times
C. 20–50 times
D. 5–7 times
C
39
Which of the following markers is generally less specific for myocardial injury due to its presence in skeletal muscle?
A. Myoglobin
B. CK-MB
C. Troponin I
D. Troponin T
Answer: A
A
40
For patients with a confirmed MI, which biomarker typically remains elevated for several days and provides a prolonged diagnostic window?
A. Myoglobin
B. Total CK
C. Troponin T
D. CK-MB
C
41
The nonspecific reaction to myocardial injury is associated with polymorphonuclear leukocytosis, which appears within a few hours after the onset of pain and persists for ___days;
3–7
42
T/F
Acute STEMI cannot be distinguished from an old myocardial scar or from acute severe ischemia by echocardiography,
T
43
Which of the following imaging modalities is almost universally associated with detecting wall motion abnormalities in STEMI?
A. Radionuclide ventriculography
B. Echocardiography
C. Cardiac MRI with late enhancement
D. Myocardial perfusion imaging
B
44
Which of the following imaging modalities is almost universally associated with detecting wall motion abnormalities in STEMI?
A. Radionuclide ventriculography
B. Echocardiography
C. Cardiac MRI with late enhancement
D. Myocardial perfusion imaging
C
45
Which of the following echocardiographic findings has prognostic value in STEMI by indicating the need for renin-angiotensin-aldosterone system inhibitors?
A. Detection of a ventricular aneurysm
B. Presence of mitral regurgitation
C. Reduced left ventricular (LV) function
D. Detection of a pericardial effusion
46
Doppler echocardiography is particularly useful in detecting which of the following serious complications of STEMI?
A. LV thrombus and RV infarction
B. Ventricular septal defect and mitral regurgitation
C. Myocardial perfusion defect and aneurysm
D. Pulmonary embolism and pericardial effusion
B
47
Which imaging technique is used less frequently than echocardiography in STEMI due to limitations in sensitivity and specificity?
A. Cardiac MRI
B. Radionuclide imaging
C. Doppler echocardiography
D. Coronary angiography
B
48
What is a limitation of myocardial perfusion imaging with [201 Tl] or [99m Tc]sestamibi in diagnosing acute myocardial infarction?
A. It cannot detect any form of perfusion defect.
B. It cannot distinguish acute infarcts from chronic scars.
C. It requires invasive administration of contrast agents.
D. It is not sensitive to changes in myocardial blood flow.
B
49
Radionuclide ventriculography is particularly helpful in which of the following situations?
A. Differentiating STEMI from NSTEMI
B. Assessing the hemodynamic consequences of infarction
C. Detecting pericardial effusion
D. Identifying pulmonary embolism
B
50
Cardiac MRI using late enhancement with gadolinium contrast is highly effective in detecting myocardial infarction because:
A. Gadolinium accumulates in the intercellular region of infarcted myocardium, creating a bright contrast against normal tissue.
B. Gadolinium specifically binds to ischemic myocytes.
C. It does not differentiate between infarcted and normal myocardium.
D. It requires no delay after contrast administration.
A
51
Most out-ofhospital deaths from STEMI result from the sudden development of ___
ventricular fibrillation.
52
The vast majority of deaths due to ventricular fibrillation occur within the ___ of the onset of symptoms, and of these, over half occur in the first hour.
first 24 h
53
Which of the following is a primary goal in the emergency department management of patients with suspected STEMI?
A. Avoiding the administration of aspirin
B. Ensuring rapid identification of candidates for urgent reperfusion therapy
C. Prioritizing triage to outpatient follow-up
D. Discharging patients with low-risk chest pain
B
54
What is the ideal timeframe for initiating PCI in a patient with STEMI from the time of first medical contact?
A. Within 30 minutes
B. Within 60 minutes
C. Within 90 minutes
D. Within 120 minutes
D
55
In the context of suspected STEMI, what is the initial recommended dose of aspirin to be administered in the emergency department?
A. 40–80 mg orally
B. 75–100 mg chewed
C. 160–325 mg chewed
D. 500 mg swallowed whole
C
56
The mechanism of action of aspirin in the management of STEMI involves inhibition of which enzyme in platelets?
A. Cyclooxygenase-1
B. Cyclooxygenase-2
C. Thromboxane synthase
D. Phospholipase A2
A
57
For a patient with suspected STEMI and normal arterial oxygen saturation, what is the recommended use of supplemental oxygen in the emergency department?
A. Administer oxygen continuously for the first 24 hours.
B. Oxygen is not routinely required in the absence of hypoxemia.
C. Administer oxygen only if the patient is experiencing chest pain.
D. Oxygen should be given only if the patient has low blood pressure.
B
58
After the initial administration of aspirin in the emergency department, what is the recommended daily dose of aspirin for ongoing management?
A. 10–50 mg orally
B. 75–162 mg orally
C. 200–400 mg orally
D. 325 mg every 6 hours
B
59
In the emergency department management of STEMI, which of the following statements about supplemental oxygen is correct?
A. Oxygen is only administered if the patient has chest discomfort.
B. If hypoxemia is present, administer 2–4 L/min by nasal prongs or face mask.
C. Oxygen is administered intravenously for rapid effect.
D. Oxygen administration is only required in patients with arrhythmias.
B
60
Which of the following statements is true regarding the role of aspirin in the emergency management of STEMI?
A. It should be delayed until after reperfusion therapy.
B. It acts by increasing thromboxane A2 levels.
C. It is effective across the entire spectrum of acute coronary syndromes.
D. It is only beneficial in patients with confirmed myocardial infarction.
C
61
In suspected STEMI, what is the benefit of transferring a patient from a non-PCI hospital to a PCI-capable hospital?
A. Minimizes the need for aspirin administration
B. Allows for PCI within the targeted 120-minute window from first medical contact
C. Reduces the likelihood of needing reperfusion therapy
D. Prevents the need for supplemental oxygen
B
62
How should sublingual nitroglycerin be administered for a patient with STEMI?
A. One dose of 0.4 mg every 10 minutes, up to three doses
B. Up to three doses of 0.4 mg at 5-minute intervals
C. One dose of 1 mg every 5 minutes, up to three doses
D. Continuous dosing until pain is completely relieved
B
63
In patients with STEMI, nitroglycerin helps alleviate chest discomfort by:
A. Reducing myocardial oxygen demand through preload reduction
B. Increasing myocardial oxygen supply by dilating infarct-related vessels
C. Both A and B
D. Only when administered intravenously
C
64
In which of the following situations should nitroglycerin be avoided in a STEMI patient?
A. Systolic blood pressure >100 mmHg
B. Suspected RV infarction
C. Prior use of beta blockers
D. Heart rate >90 beats per minute
B
65
Why should nitrates be avoided in STEMI patients who have taken a phosphodiesterase-5 inhibitor within the past 24 hours?
A. Risk of severe hypotension
B. Increased risk of arrhythmias
C. Potential for coronary spasm
D. Risk of myocardial infarction recurrence
A
66
In the management of STEMI, which of the following describes the ideal method of administering morphine for pain control?
A. A single large subcutaneous dose
B. Repetitive small intravenous doses every 5 minutes
C. Intramuscular injection every 15 minutes
D. A single large intravenous bolus
B
67
Which of the following beta blocker regimens is commonly used in the initial management of STEMI if the patient has no contraindications?
A. Intravenous metoprolol, 5 mg every 2–5 minutes for three doses, followed by oral dosing
B. Oral metoprolol 100 mg daily without any intravenous loading
C. Continuous intravenous infusion of metoprolol over 24 hours
D. Single dose of 5 mg metoprolol orally
A
68
hen is it appropriate to start oral beta blocker therapy in patients with STEMI?
A. Immediately upon arrival to the hospital
B. Within 24 hours if the patient has no signs of heart failure or other contraindications
C. Only after reperfusion therapy has been completed
D. Only if intravenous beta blockers were not effective
B
69
Which of the following is a contraindication to beta blocker therapy in the setting of STEMI?
A. Heart rate >60 beats/min
B. Systolic pressure >100 mmHg
C. Second-degree heart block
D. Mild reactive airway disease with stable symptoms
C
CI:
(1) signs of heart failure
(2) evidence of a low-output state
(3) increased risk for cardiogenic shock, or (4) other relative contraindications to beta blockade (PR interval >0.24 s, second- or third-degree heart block, active asthma, or reactive airway disease).
70
The primary tool for screening patients and making triage decisions is the initial ___.
12-lead ECG
71
When ST-segment elevation of at least __ mm in __ contiguous precordial leads and __ mm in ___ adjacent limb leads is present, a patient should be considered a candidate for reperfusion therapy
2mm
2 contiguous
1mm
2 adjacent
72
In the absence of ST-segment elevation, ____ is not helpful, and evidence exists suggesting that it may be harmful.
fibrinolysis
73
___ and ____, with the exception of aspirin, should be avoided in patients with STEMI.
Glucocorticoids
nonsteroidal anti-inflammatory agents
74
__ and __ are referred to as bolus fibrinolytics since their administration does not require a prolonged intravenous infusion.
TNK
rPA
75
In a PCI-capable hospital, what is the recommended goal for first medical contact (FMC)-to-device time for STEMI patients?
A. ≤30 minutes
B. ≤60 minutes
C. ≤90 minutes
D. ≤120 minutes
C
76
For a STEMI patient initially seen at a non-PCI-capable hospital, what is the target door-in-door-out (DIDO) time for transfer to a PCI-capable facility?
A. ≤15 minutes
B. ≤30 minutes
C. ≤45 minutes
D. ≤60 minutes
B
77
When should fibrinolytic therapy be administered at a non-PCI-capable hospital if the anticipated FMC-to-device time exceeds 120 minutes?
A. Within 15 minutes of arrival
B. Within 30 minutes of arrival
C. Within 45 minutes of arrival
D. Within 1 hour of arrival
B
78
What is the next step for a patient at a non-PCI-capable hospital who receives fibrinolytic therapy but later shows evidence of failed reperfusion or reocclusion?
A. Continue medical therapy only
B. Urgent transfer for PCI
C. Schedule routine PCI within a week
D. Repeat fibrinolytic therapy
B
79
What is the recommended timeframe for angiography and revascularization for STEMI patients who have received fibrinolytic therapy and do not show evidence of reocclusion?
A. Within 1–3 hours
B. Within 3–24 hours
C. Within 24–48 hours
D. Within 48–72 hours
B
80
For STEMI patients with cardiogenic shock or severe heart failure initially seen at a non-PCI-capable hospital, what is the recommendation for management?
A. Immediate administration of fibrinolytics
B. Transfer for catheterization and revascularization as soon as possible, regardless of time from MI onset
C. Initiate medical therapy and reassess in 24 hours
D. Only provide supportive care if FMC-to-device time is >120 minutes
B
81
Which of the following statements is true regarding primary PCI for STEMI patients initially seen at a non-PCI-capable hospital?
A. It should only be performed if the patient does not respond to fibrinolytic therapy.
B. Transfer for primary PCI is preferred if FMC-to-device time can be achieved within 120 minutes.
C. Fibrinolytic therapy is generally preferred over primary PCI.
D. Primary PCI should only be performed within 6 hours of symptom onset.
B
82
Clear contraindications to the use of fibrinolytic agents
History of cerebrovascular hemorrhage
Nonhemorrhagic stroke within the past year.
Severe hypertension (systolic >180 mmHg or diastolic >110 mmHg).
Suspected aortic dissection.
Active internal bleeding (excluding menses).
83
Relative contraindications to fibrinolytic therapy, which require assessment of the risk-to-benefit ratio, include
Current anticoagulant use (INR ≥2).
Recent invasive or surgical procedures (<2 weeks).
Recent prolonged CPR (>10 min).
Known bleeding diathesis, pregnancy, hemorrhagic ophthalmic conditions, active peptic ulcer disease, and well-controlled severe hypertension.
Recent streptokinase use (within the past 5 days to 2 years) due to allergic potential.
84
___ is the most frequent and potentially the most serious complication of fibrinolysis
Hemorrhage
85
___is the most serious complication and occurs in ~0.5–0.9% of patients being treated with fibrinolytic agents.
Hemorrhagic stroke
86
What is the recommended door-to-needle time for initiating fibrinolytic therapy in eligible STEMI patients?
A. ≤10 minutes
B. ≤30 minutes
C. ≤45 minutes
D. ≤60 minutes
B
87
Which of the following fibrinolytic agents is administered as a single, weight-based intravenous bolus in STEMI?
A. Streptokinase
B. Tenecteplase (TNK)
C. Reteplase (rPA)
D. Tissue plasminogen activator (tPA)
B
88
Which TIMI grade represents the desired outcome of fibrinolytic therapy, with full perfusion and normal flow in the infarct-related artery?
A. Grade 0
B. Grade 1
C. Grade 2
D. Grade 3
D
89
For a STEMI patient who has a systolic blood pressure of 185 mmHg upon presentation, which of the following should be considered regarding fibrinolytic therapy?
A. Proceed with fibrinolytics immediately
B. Adjust the dosage of fibrinolytics
C. Avoid fibrinolytic therapy due to severe hypertension
D. Use a different class of medications
C
90
Which of the following is considered a relative contraindication to fibrinolytic therapy in STEMI?
A. Hemorrhagic stroke more than a year ago
B. Nonhemorrhagic stroke within the past year
C. Known bleeding diathesis
D. History of cerebrovascular hemorrhage at any time
C
91
In addition to fibrinolytic agents, what type of therapy is typically administered to enhance reperfusion and prevent re-thrombosis in STEMI?
A. Diuretics
B. Antiplatelet and antithrombotic drugs
C. Calcium channel blockers
D. ACE inhibitors
B
92
What is the most serious complication associated with fibrinolytic therapy in STEMI?
A. Severe headache
B. Hemorrhagic stroke
C. Allergic reaction
D. Minor hypotension
B
93
Cardiac catheterization and coronary angiography should be carried out after fibrinolytic therapy if there is evidence of either
(1) failure of reperfusion (persistent chest pain and ST-segment elevation >90 min), in which case a rescue PCI should be considered;
or (2) coronary artery reocclusion (re-elevation of ST segments and/or recurrent chest pain) or the development of recurrent ischemia (such as recurrent angina in the early hospital course or a positive exercise stress test before discharge), in which case an urgent PCI should be considered.
94
Which of the following is now considered the preferred reperfusion strategy in STEMI management?
A. Fibrinolytic therapy alone
B. Integrated pharmacologic and catheter-based approaches
C. Primary PCI
D. Elective coronary artery bypass surgery
C
95
Rescue PCI should be considered after fibrinolytic therapy in STEMI if there is evidence of:
A. Complete resolution of chest pain
B. Persistent chest pain and ST-segment elevation >90 minutes
C. ST-segment depression without chest pain
D. A positive stress test before discharge
B
96
Which of the following situations warrants urgent PCI following fibrinolytic therapy in STEMI patients?
A. Persistent ST-segment elevation without chest pain
B. Development of recurrent ischemia, such as recurrent angina during early hospital stay
C. Negative exercise stress test before discharge
D. Complete resolution of initial symptoms without ST-segment changes
B
97
or patients with STEMI, how long should they remain on bed rest initially to help reduce infarct size?
A. 12–24 hours
B. 24–48 hours
C. 6–12 hours
D. 48–72 hours
C
98
When should a STEMI patient be encouraged to resume an upright posture, such as sitting in a chair, after admission to the CCU?
A. After 48 hours
B. After 24 hours
C. As soon as they arrive in the CCU
D. Within the first 24 hours, if there are no complications
D
99
What is the recommended diet composition for STEMI patients in the coronary care unit?
A. 40% fat, 30% protein, and 30% carbohydrates
B. ≤30% of total calories from fat and 50–55% from complex carbohydrates
C. High-fat diet to support myocardial energy needs
D. Only clear liquids for the first 24 hours and then a regular diet
B
100
Which of the following is recommended for bowel management in STEMI patients to prevent constipation?
A. Bedpan for all toileting needs
B. Use of a bedside commode and a diet rich in bulk
C. Intravenous laxatives only
D. Frequent use of strong laxatives
B
101
Which of the following medications is commonly used to provide sedation for STEMI patients in the CCU?
A. Diazepam, oxazepam, or lorazepam
B. Aspirin or acetaminophen
C. Furosemide or hydrochlorothiazide
D. Ibuprofen or naproxen
A
102
Which of the following should be avoided in STEMI patients during the first 4–12 hours due to the risk of emesis and aspiration?
A. Clear liquids only
B. Large, high-fat meals
C. Food and drink by mouth (NPO status) or only clear liquids
D. Fiber supplements
C
103
What is the primary goal of antithrombotic therapy in the management of STEMI?
A. To lower blood pressure
B. To maintain patency of the infarct-related artery
C. To reduce cholesterol levels
D. To alleviate chest pain
B
104
Which P2Y₁₂ inhibitor is recommended in addition to aspirin for STEMI patients and has shown to reduce the risk of reocclusion following fibrinolytic therapy?
A. Prasugrel
B. Clopidogrel
C. Ticagrelor
D. Abciximab
B
105
Compared with clopidogrel, which of the following P2Y₁₂ inhibitors has shown increased efficacy in preventing ischemic complications in STEMI patients undergoing PCI, albeit with a higher bleeding risk?
A. Abciximab
B. Prasugrel and Ticagrelor
C. Aspirin
D. Eptifibatide
B
106
Which anticoagulant is considered the standard in clinical practice for STEMI and is often used in combination with fibrin-specific fibrinolytic agents?
A. Low-molecular-weight heparin (LMWH)
B. Warfarin
C. Unfractionated heparin (UFH)
D. Bivalirudin
C
107
In the initial treatment of STEMI, what is the recommended loading dose of unfractionated heparin (UFH)?
A. 10 U/kg
B. 60 U/kg (maximum 4000 U)
C. 100 U/kg (maximum 6000 U)
D. 5 mg/kg
B
. The recommended dose of UFH is an initial bolus of 60 U/kg (maximum 4000 U) followed by an initial infusion of 12 U/kg per h (maximum 1000 U/h).
108
Which anticoagulant has been shown to reduce the composite endpoints of death/nonfatal reinfarction and urgent revascularization compared with UFH in STEMI patients receiving fibrinolysis, though with a higher bleeding risk?
A. Enoxaparin
B. Fondaparinux
C. Bivalirudin
D. Aspirin
A
109
The activated partial thromboplastin time during maintenance therapy of UFH should be ___ times the control value.
1.5–2
110
Why should fondaparinux not be used alone at the time of coronary angiography and PCI?
A. It increases the risk of reinfarction
B. It is ineffective for anticoagulation
C. It has a risk of catheter thrombosis
D. It causes excessive bleeding
C
111
In STEMI patients with high risk of systemic or pulmonary thromboembolism, such as those with anterior infarction or severe LV dysfunction, how long should anticoagulation with warfarin be continued after hospitalization?
A. 1 month
B. 3 months
C. 6 months
D. Indefinitely
B
112
Owing to the risk of catheter thrombosis, fondaparinux should not be used alone at the time of coronary angiography and PCI but should be combined with another anticoagulant with antithrombin activity such as ___
UFH or bivalirudin.
113
Which of the following is NOT an effect of acute intravenous beta blockade in STEMI?
A. Reduction in infarct size
B. Decrease in pain
C. Increase in myocardial oxygen supply-demand mismatch
D. Decrease in incidence of serious ventricular arrhythmias
C
114
In patients with STEMI who undergo fibrinolysis early, beta blockers primarily reduce which of the following outcomes?
A. Long-term mortality
B. Recurrent ischemia and reinfarction
C. Need for coronary artery bypass surgery
D. Blood pressure
B
115
Thus, beta-blocker therapy after STEMI is useful for most patients (including those treated with an angiotensin-converting enzyme [ACE] inhibitor) except those in whom it is specifically contraindicated which are
patients with heart failure or severely compromised LV function
heart block
orthostatic hypotension
or a history of asthma
116
What is the primary benefit of using ACE inhibitors in patients with STEMI?
A. Increased blood pressure
B. Mortality reduction
C. Enhanced oxygen delivery to the myocardium
D. Immediate relief of chest pain
B
117
In which group of STEMI patients is the mortality benefit of ACE inhibitors most significant?
A. Patients younger than 50 years with no prior history of heart disease
B. High-risk patients, such as the elderly or those with anterior infarction or globally depressed LV function
C. Patients with normal LV function and no history of infarction
D. Patients with mild chest pain only
B
118
The mechanism by which ACE inhibitors reduce the risk of CHF in STEMI patients involves:
A. Decreasing blood viscosity
B. Increasing myocardial oxygen consumption
C. Reducing ventricular remodeling after infarction
D. Enhancing sympathetic nervous system activity
C
119
Which of the following is an indication for indefinite ACE inhibitor therapy in STEMI patients?
A. Low blood pressure
B. Clinically evident CHF
C. No evidence of myocardial infarction
D. Systolic blood pressure <100 mmHg
B
ACE inhibitors should be continued indefinitely in patients who have clinically evident CHF, in patients in whom an imaging study shows a reduction in global LV function or a large regional wall motion abnormality, or in those who are hypertensive.
120
ngiotensin receptor blockers (ARBs) are recommended in STEMI patients who:
A. Are intolerant of ACE inhibitors and have signs of heart failure
B. Have normal LV function
C. Are under 40 years of age
D. Have stable angina with no prior infarction
A
121
Mineralocorticoid receptor inhibitors such as spironolactone or eplerenone should be considered in STEMI patients with which of the following conditions?
A. Renal dysfunction with creatinine ≥2.5 mg/dL
B. LV ejection fraction ≤40% and either symptomatic heart failure or diabetes mellitus
C. Potassium ≥5.5 mEq/L
D. Patients not on ACE inhibitors
B
122
What was the original rationale for using intravenous nitroglycerin in the first 24–48 hours after STEMI onset?
A. To enhance renal perfusion
B. To reduce blood pressure in hypertensive patients
C. To improve the ischemic process and aid in ventricular remodeling
D. To replace beta blockers in managing STEMI
C
123
Which of the following statements is true regarding the routine use of intravenous nitroglycerin in the contemporary management of STEMI?
A. It is recommended over beta blockers and ACE inhibitors.
B. It is less beneficial now due to routine use of beta blockers and ACE inhibitors.
C. It is the primary treatment to prevent arrhythmias.
D. It is preferred over aspirin for reducing infarct size.
B
124
In STEMI patients, routine use of calcium antagonists is:
A. Recommended for all patients to reduce mortality
B. Effective in patients with prior MI
C. Not recommended due to lack of proven benefit
D. Required only in patients with diabetes
C
125
Why is strict blood glucose control important in diabetic patients with STEMI?
A. It reduces the incidence of arrhythmias
B. It has been shown to reduce mortality rates
C. It prevents recurrent infarctions
D. It increases the effectiveness of ACE inhibitors
B
126
Why should serum magnesium be measured in all STEMI patients upon admission?
A. To assess renal function
B. To predict the need for beta blockers
C. To minimize the risk of arrhythmias by correcting deficits
D. To determine eligibility for intravenous nitroglycerin
B
127
___ is now the primary cause of in-hospital death from STEMI.
Pump failure
128
hat is now the primary cause of in-hospital death in patients with STEMI?
A. Recurrent myocardial infarction
B. Pump failure
C. Pulmonary embolism
D. Arrhythmias
B
129
According to the Killip classification, which class is defined by the presence of shock with systolic pressure <90 mmHg, peripheral cyanosis, mental confusion, and oliguria?
A. Class I
B. Class II
C. Class III
D. Class IV
D
class I, no signs of pulmonary or venous congestion;
class II, moderate heart failure as evidenced by rales at the lung bases, S 3gallop, tachypnea, or signs of failure of the right side of the heart, including venous and hepatic congestion;
class III, severe heart failure, pulmonary edema; and class IV, shock with systolic pressure <90 mmHg and evidence of peripheral vasoconstriction, peripheral cyanosis, mental confusion, and oliguria. W
130
Which of the following is a key caution when using loop diuretics, such as furosemide, in STEMI patients with CHF?
A. Risk of hyperkalemia
B. Potential for excessive diuresis leading to decreased plasma volume, cardiac output, and systemic blood pressure
C. Risk of increasing total plasma volume
D. Potential for raising LV filling pressure
B
130
Compared to diuretics, what is an advantage of using nitrates in the management of CHF symptoms in STEMI?
A. Nitrates increase total plasma volume
B. Nitrates decrease preload through venodilation without reducing total plasma volume
C. Nitrates improve renal function directly
D. Nitrates decrease systemic blood pressure significantly
B
131
Typically, patients who develop cardiogenic shock have severe multivessel coronary artery disease with evidence of ___ necrosis extending outward from the original infarct zone.
“piecemeal”
132
Clinical Signs of RV Failure:
Severe RV failure signs may include:
Jugular venous distention (JVD).
Kussmaul’s sign.
Hepatomegaly.
With or without hypotension.
133
Which of the following statements about ventricular premature beats (VPBs) in STEMI patients is correct?
A. VPBs are rare in STEMI patients and require immediate treatment.
B. Sporadic VPBs are common in STEMI patients and generally do not require therapy.
C. VPBs in STEMI patients are an indication for routine antiarrhythmic therapy.
D. Frequent VPBs indicate a need for urgent coronary intervention.
B
134
Why is prophylactic antiarrhythmic therapy with intravenous lidocaine no longer recommended for VPBs in STEMI patients?
A. It increases the risk of recurrent MI.
B. It has no effect on arrhythmias.
C. It may increase mortality due to risks of bradycardia and asystole.
D. It is only effective in patients with atrial arrhythmias.
C
135
Which electrolyte levels should be monitored and corrected to reduce the risk of ventricular fibrillation in STEMI patients with VPBs?
A. Sodium and calcium
B. Potassium and magnesium
C. Chloride and phosphate
D. Calcium and phosphate
B
serum potassium concentration should be adjusted to ~4.5 mmol/L and magnesium to ~2.0 mmol/L.
136
Why is routine prophylactic use of intravenous lidocaine no longer recommended in STEMI patients to prevent VF?
A. It has not been shown to reduce overall mortality and may increase the risk of bradycardia and asystole.
B. It has been found to be completely ineffective at preventing ventricular arrhythmias.
C. It is contraindicated due to a high risk of causing renal impairment.
D. It has no effect on reducing infarct size.
A
137
Which medication is the preferred first-line treatment for sustained, hemodynamically stable ventricular tachycardia in STEMI?
A. Lidocaine
B. Amiodarone
C. Verapamil
D. Procainamide
B
(bolus of 150 mg over 10 min, followed by infusion of 1.0 mg/min for 6 h and then 0.5 mg/min)
138
For sustained VT in STEMI patients, what is the recommended initial bolus dose of intravenous amiodarone?
A. 50 mg over 10 minutes
B. 150 mg over 10 minutes
C. 300 mg over 30 minutes
D. 200 mg over 5 minutes
B
139
What is the indicated treatment for a STEMI patient with hemodynamically unstable VT that does not respond to medication?
A. Synchronized electroshock with 100 J
B. Immediate unsynchronized discharge of 200–300 J (monophasic waveform)
C. Intravenous beta-blockers
D. Oral amiodarone
B
140
In cases where VT or VF is refractory to electroshock, which of the following agents may increase the likelihood of success with subsequent shocks?
A. Magnesium sulfate
B. Epinephrine (1 mg IV) or additional amiodarone
C. Atropine
D. Digoxin
B
141
What is the long-term prognosis for STEMI patients who experience primary ventricular fibrillation within the first 48 hours but survive to hospital discharge?
A. Poor long-term survival
B. Excellent long-term survival
C. High risk of recurrence within 1 month
D. Requires routine ICD placement
B
142
For STEMI patients who develop VT or VF more than 48 hours after admission, what is the recommended next step?
A. Immediate discharge from the hospital
B. Consideration for electrophysiologic study and ICD implantation
C. Administration of routine beta-blockers only
D. Switching to oral amiodarone
B
143
Which is the most common supraventricular arrhythmia seen in STEMI patients?
A. Atrial fibrillation
B. Atrial flutter
C. Sinus tachycardia
D. Junctional tachycardia
C
144
In a STEMI patient with sinus tachycardia due to a secondary cause (e.g., fever or anemia), what should be the primary approach to management?
A. Administer a beta blocker
B. Treat the underlying cause
C. Use digoxin
D. Start anticoagulation therapy
B
145
Which medication is the treatment of choice for atrial flutter or atrial fibrillation in a STEMI patient with heart failure?
A. Beta blockers
B. Digoxin
C. Verapamil
D. Diltiazem
B
146
In a STEMI patient without heart failure, which medications are suitable alternatives to digoxin for controlling ventricular rate in atrial fibrillation or flutter?
A. Amiodarone and procainamide
B. Beta blockers, verapamil, and diltiazem
C. Lidocaine and magnesium
D. ACE inhibitors and nitrates
B
147
Which of the following indicates the need for synchronized electroshock in a STEMI patient with a supraventricular arrhythmia?
A. Heart rate below 120 beats per minute
B. Persistent arrhythmia with a ventricular rate >120 beats per minute causing heart failure, shock, or ischemia
C. Presence of sinus tachycardia alone
D. Lack of response to digoxin
B
148
In STEMI patients, which supraventricular arrhythmia is typically associated with LV failure?
A. Sinus tachycardia
B. Atrial fibrillation
C. Junctional rhythm
D. Ventricular tachycardia
B
149
Atropine is the most useful drug for increasing heart rate and should be given intravenously in doses of ___ mg initially. If the rate remains <50–60 beats/min, additional doses of 0.2mg , up to a total of ____ mg, may be given. Persistent bradycardia (____beats/min) despite atropine may be treated with electrical pacing.
0.5 mg
0.2 mg
2.0 mg
<40 beats/min
150
Which of the following is true regarding the mortality rates in patients with STEMI who develop complete AV block?
A. The mortality rate is higher in patients with complete AV block and inferior infarction.
B. The mortality rate is higher in patients with complete AV block and anterior infarction.
C. Mortality rates are the same for anterior and inferior infarctions with AV block.
D. Complete AV block has no impact on mortality rates in STEMI patients.
B
151
In patients with anterior wall infarction, complete AV block is typically associated with which of the following?
A. Increased vagal tone
B. Transient conduction abnormalities
C. Ischemic malfunction of the conduction system
D. Reversible electrolyte imbalance
C
152
In patients with inferior wall infarction, heart block is typically associated with which of the following?
A. Increased vagal tone
B. Transient conduction abnormalities
C. Ischemic malfunction of the conduction system
D. Reversible electrolyte imbalanc
A
153
In patients with STEMI, right ventricular (RV) infarction may impair response to ventricular pacing. Which pacing method may be required in such cases?
A. Transcutaneous pacing
B. Dual-chamber AV sequential pacing
C. Demand-mode ventricular pacing only
D. Atrial pacing alone
B
154
External noninvasive pacing electrodes should be placed in a demand mode for which of the following conditions in STEMI patients?
A. First-degree AV block only
B. Mobitz II second-degree AV block, third-degree heart block, or bilateral bundle branch block
C. All patients with STEMI
D. Only in patients with refractory angina
B
155
Which of the following is the primary concern when a STEMI patient experiences recurrent chest discomfort?
A. It indicates a successful reperfusion
B. It may signal extension of the original infarct or reinfarction, increasing mortality risk
C. It suggests a non-cardiac cause of pain
D. It indicates the need for discharge planning
B
156
Which medication is recommended for managing pericardial pain and friction rubs in STEMI patients?
A. Aspirin (650 mg four times daily)
B. Beta-blockers
C. Anticoagulants
D. Furosemide
A
157
In STEMI patients, what is a common origin of arterial emboli that may lead to complications such as hemiparesis or renal infarction?
A. Pulmonary arteries
B. LV mural thrombi
C. Coronary arteries
D. Peripheral veins
B
158
For STEMI patients with a large area of regional wall motion abnormality or a confirmed LV thrombus, what is the recommended management to reduce embolic complications?
A. Observation without intervention
B. Systemic anticoagulation if no contraindications are present
C. Diuretics and nitrates
D. Aspirin monotherapy
B
159
Left ventricular (LV) aneurysms are often detected weeks to months after STEMI and are associated with all of the following complications EXCEPT:
A. Congestive heart failure
B. Arterial embolism
C. Spontaneous rupture
D. Ventricular arrhythmias
Answer: C
C
160
What physical finding is most valuable in diagnosing an LV aneurysm after STEMI?
A. Absent apical impulse
B. Double, diffuse, or displaced apical impulse
C. Loud S3 sound
D. Widespread crackles in the lungs
B
161
Why is surgical repair recommended for pseudoaneurysms detected after STEMI?
A. Pseudoaneurysms resolve spontaneously with medication
B. They are stable and rarely rupture
C. They have a high risk of spontaneous rupture
D. They improve cardiac output without intervention
C
162
Which of the following is considered a major risk factor for increased cardiovascular mortality following recovery from STEMI?
A. LV ejection fraction >60%
B. Persistent ischemia, spontaneous or provoked
C. Age under 50 years
D. Absence of ventricular arrhythmias
B
persistent ischemia (spontaneous or provoked), depressed LV ejection fraction (<40%), rales above the lung bases on physical examination or congestion on chest radiograph, and symptomatic ventricular arrhythmias
163
Which of the following is recommended for stable post-STEMI patients prior to discharge to evaluate residual ischemia and provide exercise guidelines?
A. Maximal (symptom-limited) exercise stress test
B. Submaximal exercise stress test
C. Coronary angiography
D. Cardiac MRI
B
164
In post-STEMI patients, a maximal (symptom-limited) exercise stress test is typically performed at which time interval after the infarction?
A. Within 24 hours
B. 1–2 weeks after infarction
C. 4–6 weeks after infarction
D. Only after 6 months
C
165
In the classification of heart failure (HF), an ejection fraction (EF) of ≤40% is referred to as:
A. HF with preserved ejection fraction (HFpEF)
B. Systolic heart failure
C. HF with reduced ejection fraction (HFrEF)
D. Diastolic heart failure
C
166
