Internal Medicine Exam Acute Coronary Syndromes 2

Question 1

A 58-year-old man with NSTEMI has a TIMI risk score of 5. Which management strategy is most appropriate?

Accepted Answer

Early invasive strategy (cardiac catheterization within 24-48 hours)

Answer

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.

Question 2

Which ECG finding in a patient with chest pain represents a 'STEMI equivalent' requiring immediate reperfusion?

Accepted Answer

New left bundle branch block (LBBB) with typical ischemic symptoms

Answer

New LBBB in the context of ischemic symptoms is considered a STEMI equivalent because it obscures ST-segment analysis and warrants immediate reperfusion therapy.

Question 3

A patient with inferior STEMI develops hypotension and elevated JVP without pulmonary congestion. Which diagnosis should be suspected first?

Accepted Answer

Right ventricular infarction

Answer

Right ventricular infarction commonly accompanies inferior STEMI and presents with hypotension, elevated JVP, and clear lungs (Kussmaul's sign may be present).

Question 4

Which antiplatelet agent should be AVOIDED in a patient with ACS who requires urgent coronary artery bypass grafting (CABG)?

Accepted Answer

Prasugrel

Answer

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.

Question 5

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?

Accepted Answer

Enoxaparin (LMWH)

Answer

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.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Acute Coronary Syndromes 2