Acute Coronary Syndromes Flashcards
7 cards from real Internal Medicine Exam practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Acute Coronary Syndromes flashcards as text
A 58-year-old man with NSTEMI has a TIMI risk score of 5. Which management strategy is most appropriate?
Answer: Early invasive strategy (cardiac catheterization within 24-48 hours)
A high TIMI score (≥3) in NSTEMI favors an early invasive strategy with catheterization within 24-48 hours due to higher risk of adverse outcomes.
Which ECG finding in a patient with chest pain represents a 'STEMI equivalent' requiring immediate reperfusion?
Answer: New left bundle branch block (LBBB) with typical ischemic symptoms
New LBBB in the context of ischemic symptoms is considered a STEMI equivalent because it obscures ST-segment analysis and warrants immediate reperfusion therapy.
A patient with inferior STEMI develops hypotension and elevated JVP without pulmonary congestion. Which diagnosis should be suspected first?
Answer: Right ventricular infarction
Right ventricular infarction commonly accompanies inferior STEMI and presents with hypotension, elevated JVP, and clear lungs (Kussmaul's sign may be present).
Which antiplatelet agent should be AVOIDED in a patient with ACS who requires urgent coronary artery bypass grafting (CABG)?
Answer: Prasugrel
Prasugrel is contraindicated when CABG is planned because its irreversible and potent platelet inhibition significantly increases surgical bleeding risk; it should be held at least 7 days before CABG.
A 62-year-old woman presents with NSTEMI. Her creatinine is 2.8 mg/dL. Which anticoagulant requires the most careful dose adjustment in this setting?
Answer: Enoxaparin (LMWH)
Enoxaparin is renally cleared and accumulates in renal failure, significantly increasing bleeding risk; dose reduction is required when CrCl <30 mL/min, and UFH is often preferred in severe renal impairment.
Which complication of STEMI typically presents 5-10 days after the initial event with new holosystolic murmur and hemodynamic deterioration?
Answer: Ventricular septal defect (VSD)
Post-infarction VSD presents 3-7 days after STEMI with a new harsh holosystolic murmur at the left sternal border, step-up in O2 saturation from right atrium to pulmonary artery, and cardiogenic shock.
Clopidogrel should be avoided in patients who have recently taken which medication due to reduced antiplatelet efficacy?
Answer: Omeprazole
Omeprazole inhibits CYP2C19, the enzyme responsible for converting clopidogrel (a prodrug) to its active metabolite, thereby significantly reducing its antiplatelet effect.