Internal Medicine Exam Acute Coronary Syndromes 3

Question 1

A 70-year-old man with anterior STEMI develops cardiogenic shock. His BP is 75/50 mmHg and he is on maximum vasopressors. What is the most appropriate next step?

Accepted Answer

Insert an intra-aortic balloon pump (IABP) and proceed to PCI

Answer

Cardiogenic shock complicating STEMI requires mechanical circulatory support (IABP or more advanced devices) along with emergent PCI, which is the definitive treatment to restore perfusion.

Question 2

Which troponin characteristic best distinguishes Type 2 MI (supply-demand mismatch) from Type 1 MI (plaque rupture)?

Accepted Answer

Clinical context and absence of obstructive coronary disease on angiography in Type 2 MI

Answer

Type 2 MI is distinguished by clinical context (e.g., sepsis, tachyarrhythmia, anemia) causing supply-demand mismatch, often without obstructive CAD on angiography, rather than by troponin kinetics.

Question 3

A post-STEMI patient is started on an ACE inhibitor. What is the PRIMARY evidence-based indication for this therapy?

Accepted Answer

Reduction of LV remodeling and mortality, especially with reduced EF

Answer

ACE inhibitors reduce LV remodeling, HF, and mortality after MI, with greatest benefit in patients with anterior STEMI or reduced ejection fraction (EF ≤40%).

Question 4

Spontaneous coronary artery dissection (SCAD) causing ACS most commonly occurs in which patient population?

Accepted Answer

Young women in the peripartum period or with fibromuscular dysplasia

Answer

SCAD predominantly affects young women, especially peripartum or those with fibromuscular dysplasia, and presents with ACS without typical atherosclerotic risk factors.

Question 5

A patient with STEMI undergoes primary PCI. Post-procedure, the culprit vessel is patent but the patient has no ST resolution and persistent symptoms. What phenomenon best explains this?

Accepted Answer

No-reflow phenomenon

Answer

No-reflow occurs when myocardial perfusion is inadequate despite a patent epicardial artery, caused by microvascular obstruction from embolization of debris and reperfusion injury.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Acute Coronary Syndromes 3