Internal Medicine Exam Acute Coronary Syndromes 5

Question 1

A 68-year-old man on warfarin (INR 2.4) for atrial fibrillation presents with NSTEMI. He undergoes PCI with a drug-eluting stent. What is the optimal antithrombotic regimen post-procedure?

Accepted Answer

Short course of triple therapy, then DOAC + P2Y12 inhibitor (dual therapy) for 12 months

Answer

Current guidelines recommend minimizing triple therapy duration (≤1 month) and transitioning to dual therapy with a DOAC plus P2Y12 inhibitor to reduce bleeding while maintaining thrombotic protection.

Question 2

Which of the following is a contraindication to fibrinolytic therapy in STEMI?

Accepted Answer

Ischemic stroke within the past 3 months

Answer

Ischemic stroke within 3 months is an absolute contraindication to fibrinolysis due to risk of hemorrhagic transformation; prior CABG and advanced age are relative considerations but not absolute contraindications.

Question 3

The GRACE risk score is used in ACS to predict which outcome?

Accepted Answer

In-hospital and 6-month mortality to guide invasive vs. conservative strategy

Answer

The GRACE score stratifies ACS mortality risk (low/intermediate/high) using variables like age, heart rate, BP, creatinine, cardiac arrest, ST deviation, troponin, and Killip class to guide invasive strategy timing.

Question 4

A patient with inferior STEMI is brought to the cath lab. Coronary angiography reveals 100% occlusion of a large dominant RCA. After successful PCI to the RCA, which hemodynamic complication is most likely to respond to IV fluids?

Accepted Answer

Right ventricular failure from RV infarction

Answer

RV infarction causes preload-dependent hemodynamics; aggressive IV fluid resuscitation is the mainstay of treatment, as the failing RV needs adequate filling pressure to maintain forward output.

Question 5

Which duration of dual antiplatelet therapy (DAPT) is generally recommended after drug-eluting stent (DES) placement for ACS?

Accepted Answer

At least 12 months

Answer

Current ACC/AHA guidelines recommend at least 12 months of DAPT after DES placement in ACS patients to reduce stent thrombosis and recurrent ischemic events.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Acute Coronary Syndromes 5