Internal Medicine Exam Acute Coronary Syndromes 4

Question 1

A 55-year-old man with prior PCI (bare-metal stent placed 1 month ago) requires urgent non-cardiac surgery. What is the recommended approach to his dual antiplatelet therapy (DAPT)?

Accepted Answer

Continue both antiplatelet agents perioperatively

Answer

For bare-metal stents within 4 weeks of placement, elective surgery should be deferred; if surgery is truly urgent, continuing DAPT perioperatively is preferred to prevent stent thrombosis.

Question 2

Which biomarker has the fastest rise-and-fall kinetics and was historically used for early diagnosis of re-infarction after STEMI?

Accepted Answer

CK-MB (creatine kinase-MB)

Answer

CK-MB rises and falls more rapidly than troponin (peaks at 24h, normalizes by 48-72h), making it useful for detecting re-infarction when troponin remains elevated from the initial event.

Question 3

Wellens' syndrome (Type A and B T-wave patterns in V2-V3) in a patient with resolved chest pain indicates which critical finding?

Accepted Answer

Critical proximal LAD stenosis with intermittent reperfusion

Answer

Wellens' syndrome represents reperfusion T-wave changes from a critical proximal LAD lesion; stress testing is contraindicated as it can precipitate massive anterior STEMI.

Question 4

A patient with ACS is found to have a platelet count of 48,000/μL after receiving heparin for 7 days. The most likely diagnosis is:

Accepted Answer

Heparin-induced thrombocytopenia (HIT)

Answer

HIT is characterized by a >50% platelet drop 5-10 days after heparin initiation, associated with a prothrombotic state rather than bleeding, and requires immediate heparin cessation and alternative anticoagulation.

Question 5

Which finding on echocardiogram performed after STEMI is associated with the highest risk of systemic embolization?

Accepted Answer

Apical left ventricular thrombus

Answer

LV thrombus, most common after large anterior STEMI with apical akinesis, carries significant risk of systemic embolization and stroke, requiring anticoagulation therapy.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Acute Coronary Syndromes 4