Internal Medicine Acute Coronary Syndromes Questions and Answers

Question 1

A 68-year-old male with a history of hypertension and hyperlipidemia presents with 2 hours of substernal chest pain.
An ECG shows ST-segment elevation in leads II, III, and aVF.
His blood pressure is 85/50 mmHg, heart rate is 50 bpm, and lungs are clear to auscultation.
Jugular venous pressure is elevated.
Which of the following is the most appropriate initial management step?

Accepted Answer

Administer a 500 mL bolus of normal saline

Answer

Administer intravenous nitroglycerin

Answer

Administer intravenous metoprolol

Answer

Place an intra-aortic balloon pump

Question 2

A 55-year-old female is evaluated for an acute coronary syndrome. According to the TIMI risk score for UA/NSTEMI, which of the following patient characteristics is NOT considered a risk factor?

Accepted Answer

Systolic blood pressure < 100 mmHg

Answer

Age ≥ 65 years

Answer

Known coronary artery disease with >50% stenosis

Answer

Aspirin use in the past 7 days

Question 3

A 76-year-old male with a history of a transient ischemic attack (TIA) 2 years ago is admitted with an NSTEMI and undergoes percutaneous coronary intervention with placement of a drug-eluting stent. Which of the following P2Y12 inhibitors is contraindicated in this patient?

Accepted Answer

Prasugrel

Answer

Clopidogrel

Answer

Ticagrelor

Answer

Cangrelor

Question 4

A 62-year-old man is brought to the emergency department with severe chest pain. His ECG is consistent with an acute ST-elevation myocardial infarction (STEMI). He admits to using cocaine approximately one hour prior to the onset of his symptoms. He is hypertensive and tachycardic. In addition to aspirin and emergent reperfusion therapy, which of the following is the most appropriate initial medication?

Accepted Answer

Intravenous lorazepam

Answer

Intravenous labetalol

Answer

Intravenous diltiazem

Answer

Intravenous esmolol

Question 5

Five days after an extensive anterior wall myocardial infarction, a 70-year-old female becomes acutely hypotensive and develops respiratory distress. On examination, a new, loud, harsh holosystolic murmur is heard best at the left lower sternal border, accompanied by a palpable thrill. Which of the following is the most likely diagnosis?

Accepted Answer

Ventricular septal rupture

Answer

Papillary muscle rupture

Answer

Ventricular free wall rupture

Answer

Dressler syndrome

Question 6

A 58-year-old male with NSTEMI undergoes successful PCI with the placement of a new-generation drug-eluting stent in the left anterior descending artery. He has no history of bleeding disorders and is considered at low bleeding risk. According to current ACC/AHA guidelines, what is the minimum recommended duration of dual antiplatelet therapy (DAPT) for this patient?

Accepted Answer

12 months

Answer

3 months

Answer

6 months

Answer

24 months