[MCQ] ST-Segment Elevation Myocardial Infarction- Part 1

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ST-Segment Elevation Myocardial Infarction- Part 1

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Congratulations - you have completed ST-Segment Elevation Myocardial Infarction- Part 1. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

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Question 1

Early (30-day) mortality rate from acute MI is ?

A	~ 10 %
B	~ 20 %
C	~ 30 %
D	~ 40 %

Question 1 Explanation:

Early (30-day) mortality rate from AMI is ~30%, with more than half of these deaths occurring before the patient reaches hospital.

Question 2

Which of the following statements about acute coronary syndromes is false ?

A	Majority of patients with ST-segment elevation ultimately develop Q-wave on ECG (QwMI)
B	Majority of patients without ST-segment elevation (NSTEMI) ultimately develop Q-wave on ECG (QwMI)
C	Mortality due to AMI is fourfold higher in elderly (>75 years) as compared with younger patients
D	None of the above

Question 2 Explanation:

Mortality is approximately fourfold higher in elderly patients (over age 75) compared with younger patients. Of patients with ST-segment elevation, the majority ultimately develop a Q-wave on the ECG (QwMI). Majority of patients presenting with NSTEMI do not develop a Q-wave on the ECG.

Question 3

Histologically, coronary plaques prone to disruption are those with ?

A	Rich lipid core and thin fibrous cap
B	Rich lipid core and thick fibrous cap
C	Poor lipid core and thin fibrous cap
D	Poor lipid core and thick fibrous cap

Question 3 Explanation:

Poor lipid core and thick fibrous cap

Question 4

Agonists that promote platelet activation at the site of ruptured plaque include all except ?

A	Collagen
B	ATP
C	Epinephrine
D	Serotonin

Question 4 Explanation:

After an initial platelet monolayer forms at the site of the ruptured plaque, various agonists like collagen, ADP, epinephrine and serotonin promote platelet activation. After agonist stimulation of platelets, there are production and release of thromboxane A2 (a potent local vasoconstrictor), further platelet activation, and potential resistance to thrombolysis.

Question 5

Which of the following best describes thromboxane A2 ?

A	Adhesive protein
B	Local vasoconstrictor
C	Resistance to fibrinolysis
D	Platelet aggregator

Question 5 Explanation:

At the site of disrupted plaque, agonists like collagen, ADP, epinephrine, serotonin promote platelet activation and from them thromboxane A2 - a potent local vasoconstrictor is released and potential resistance to fibrinolysis develops.

Question 6

Out of the following, which is the least likely condition that increases risk of developing STEMI ?

A	Collagen vascular disease
B	Unstable angina
C	Cocaine abuse
D	Alcohol abuse

Question 6 Explanation:

Patients at increased risk of developing STEMI include those with multiple coronary risk factors and those with unstable angina or Prinzmetal’s variant angina. Less common underlying medical conditions predisposing patients to STEMI include hypercoagulability, collagen vascular disease, cocaine abuse, and intracardiac thrombi or masses that can produce coronary emboli.

Question 7

Which of the following best relates to management of STEMI ?

A	The linking theory
B	Attention to time
C	Chain of survival
D	The weak link

Question 7 Explanation:

Management of STEMI aims at providing expeditious implementation of a reperfusion strategy through a highly integrated system termed as “chain of survival” which involves prehospital care that extends to early hospital management.

Question 8

STEMI tends to occur most commonly at ?

A	Early morning, few hours before awakening
B	Morning, within a few hours after awakening
C	After meals
D	Late evening, following return from work

Question 8 Explanation:

Although STEMI may commence at any time of the day or night, circadian variations have been reported such that clusters are seen in the morning within a few hours of awakening.

Question 9

Which of the following is false regarding ‘pain’ in STEMI ?

A	Most common presenting complaint
B	Deep and visceral
C	Different in character to discomfort of angina pectoris
D	May radiate as high as occipital area

Question 9 Explanation:

Pain is the most common presenting complaint in STEMI. Pain is deep & visceral. It is similar in character to discomfort of angina pectoris but is more severe, lasts longer and does not usually subside with cessation of activity. Typically. pain involves central portion of chest and/ or epigastrium & on occasion it radiates to arms

Question 10

Which of the following is false regarding ‘pain’ in STEMI ?

A	Does not radiate below umbilicus
B	May radiate to trapezius
C	Pain does not subside with cessation of activity
D	Painless STEMIs is greater in diabetics

Question 11

Sympathetic nervous system hyperactivity is more common in ?

A	Anterior infarction
B	Inferior infarction
C	Posterior infarction
D	Lateral infarction

Question 12

Parasympathetic nervous system hyperactivity is more common in ?

A	Anterior infarction
B	Inferior infarction
C	Posterior infarction
D	Lateral infarction

Question 12 Explanation:

Combination of substernal chest pain lasting >30 minutes & diaphoresis suggests STEMI. 25% patients with anterior infarction have manifestations of sympathetic nervous system hyperactivity (tachycardia and/or hypertension), and up to one-half with inferior infarction show parasympathetic hyperactivity (bradycardia and/or hypotension).

Question 13

Which of the following is not an auscultatory finding in myocardial infarction ?

A	Decreased intensity of S1
B	Paradoxical splitting of S2
C	Early systolic apical systolic murmur
D	Pericardial friction rub

Question 13 Explanation:

A transient midsystolic or late systolic apical systolic murmur due to dysfunction of the mitral valve apparatus may be present in myocardial infarction.

Question 14

In most patients with transmural myocardial infarction, systolic pressure declines by how much from the preinfarction state ?

A	~ 5 - 10 mm Hg
B	~ 10 - 15 mm Hg
C	~ 15 - 20 mm Hg
D	~ 20 - 25 mm Hg

Question 14 Explanation:

In most patients with transmural myocardial infarction, systolic pressure declines by ~ 10 - 15 mmHg from the preinfarction state.

Question 15

In temporal staging of myocardial infarction, acute stage is ?

A	First few hours
B	First few hours to 3 days
C	First few hours to 5 days
D	First few hours to 7 days

Question 16

In temporal staging of myocardial infarction, healing stage is ?

A	3 to 10 days
B	7 to 15 days
C	10 to 21 days
D	7 to 28 days

Question 17

Development of a Q wave on ECG is more dependent on ?

A	Transmurality of myocardial infarction
B	Volume of infarcted myocardial tissue
C	Thickness of the opposite myocardial wall
D	All of the above

Question 17 Explanation:

Contemporary studies using MRI suggest that the development of a Q wave on the ECG is more dependent on the volume of infarcted myocardial tissue rather than transmurality of infarction

Question 18

Which of the following about cardiac biomarkers is false ?

A	Detected in serum
B	Cardiac biomarkers are proteins
C	Released from necrotic heart muscle
D	None of the above

Question 18 Explanation:

Serum cardiac biomarkers are proteins released from necrotic heart muscle after STEMI.

Question 19

Levels of cTnI and cTnT may remain elevated for how many days after STEMI ?

A	1 to 3 days
B	2 to 5 days
C	7 to 10 days
D	10 to 21 days

Question 19 Explanation:

Levels of cardiac-specific troponin T (cTnT) and cardiac-specific troponin I (cTnI) detected by highly specific monoclonal antibodies may remain elevated for 7 to 10 days after STEMI

Question 20

Cardiac biomarkers that are released into the interstitium are first cleared by ?

A	Arterioles
B	Venules
C	Capillaries
D	Lymphatics

Question 20 Explanation:

Cardiac biomarkers that are released into the interstitium are first cleared by lymphatics followed subsequently by spillover into the venous system

Question 21

Which of the following is true for levels of creatine phosphokinase (CK) in STEMI ?

A	Rises within 10 to 30 minutes
B	Rises within 30 minutes to 1 hour
C	Rises within 1 to 4 hours
D	Rises within 4 to 8 hours

Question 22

Which of the following is true for levels of creatine phosphokinase (CK) in STEMI ?

A	Returns to normal within 24 hours
B	Returns to normal by 24 to 48 hours
C	Returns to normal by 48 to 72 hours
D	Returns to normal by 72 to 96 hours

Question 22 Explanation:

CK rises within 4 to 8 hours and generally returns to normal by 48 to 72 hours

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ST-Segment Elevation Myocardial Infarction- Part 3| ST-Segment Elevation Myocardial Infarction- Part 4

1.Early (30-day) mortality rate from acute MI is ?
A. ~ 10 %
B. ~ 20 %
C. ~ 30 %
D. ~ 40 %

2. Which of the following statements about acute coronary syndromes is false ?
A. Majority of patients with ST-segment elevation ultimately develop Q-wave on ECG (QwMI)
B. Majority of patients without ST-segment elevation (NSTEMI) ultimately develop Q-wave on ECG (QwMI)
C. Mortality due to AMI is fourfold higher in elderly (>75 years) as compared with younger patients
D. None of the above

3. Histologically, coronary plaques prone to disruption are those with ?
A. Rich lipid core and thin fibrous cap
B. Rich lipid core and thick fibrous cap
C. Poor lipid core and thin fibrous cap
D. Poor lipid core and thick fibrous cap

4. Agonists that promote platelet activation at the site of ruptured plaque include all except ?
A. Collagen
B. ATP
C. Epinephrine
D. Serotonin

5. Which of the following best describes thromboxane A2 ?
A. Adhesive protein
B. Local vasoconstrictor
C. Resistance to fibrinolysis
D. Platelet aggregator

6. Out of the following, which is the least likely condition that increases risk of developing STEMI ?
A. Collagen vascular disease
B. Unstable angina
C. Cocaine abuse
D. Alcohol abuse

7. Which of the following best relates to management of STEMI ?
A. The linking theory
B. Attention to time
C. Chain of survival
D. The weak link

8. STEMI tends to occur most commonly at ?
A. Early morning, few hours before awakening
B. Morning, within a few hours after awakening
C. After meals
D. Late evening, following return from work

9. Which of the following is false regarding ‘pain’ in STEMI ?
A. Most common presenting complaint
B. Deep and visceral
C. Different in character to discomfort of angina pectoris
D. May radiate as high as occipital area

10. Which of the following is false regarding ‘pain’ in STEMI ?
A. Does not radiate below umbilicus
B. May radiate to trapezius
C. Pain does not subside with cessation of activity
D. Painless STEMIs is greater in diabetics

11. Sympathetic nervous system hyperactivity is more common in ?
A. Anterior infarction
B. Inferior infarction
C. Posterior infarction
D. Lateral infarction
12.Parasympathetic nervous system hyperactivity is more common in ?
A. Anterior infarction
B. Inferior infarction
C. Posterior infarction
D. Lateral infarction

13. Which of the following is not an auscultatory finding in myocardial infarction ?
A. Decreased intensity of S1
B. Paradoxical splitting of S2
C. Early systolic apical systolic murmur
D. Pericardial friction rub

14. In most patients with transmural myocardial infarction, systolic pressure declines by how much from the preinfarction state ?
A. ~ 5 – 10 mm Hg
B. ~ 10 – 15 mm Hg
C. ~ 15 – 20 mm Hg
D. ~ 20 – 25 mm Hg

15. In temporal staging of myocardial infarction, acute stage is ?
A. First few hours
B. First few hours to 3 days
C. First few hours to 5 days
D. First few hours to 7 days
16. In temporal staging of myocardial infarction, healing stage is ?
A. 3 to 10 days
B. 7 to 15 days
C. 10 to 21 days
D. 7 to 28 days

17. Development of a Q wave on ECG is more dependent on ?
A. Transmurality of myocardial infarction
B. Volume of infarcted myocardial tissue
C. Thickness of the opposite myocardial wall
D. All of the above

18. Which of the following about cardiac biomarkers is false ?
A. Detected in serum
B. Cardiac biomarkers are proteins
C. Released from necrotic heart muscle
D. None of the above

19. Levels of cTnI and cTnT may remain elevated for how many days after STEMI ?
A. 1 to 3 days
B. 2 to 5 days
C. 7 to 10 days
D. 10 to 21 days

20. Cardiac biomarkers that are released into the interstitium are first cleared by ?
A. Arterioles
B. Venules
C. Capillaries
D. Lymphatics

21. Which of the following is true for levels of creatine phosphokinase (CK) in STEMI ?
A. Rises within 10 to 30 minutes
B. Rises within 30 minutes to 1 hour
C. Rises within 1 to 4 hours
D. Rises within 4 to 8 hours
22. Which of the following is true for levels of creatine phosphokinase (CK) in STEMI ?
A. Returns to normal within 24 hours
B. Returns to normal by 24 to 48 hours
C. Returns to normal by 48 to 72 hours
D. Returns to normal by 72 to 96 hours

ST-Segment Elevation Myocardial Infarction

[MCQ] ST-Segment Elevation Myocardial Infarction- Part 1

I. Start the exam by click the “Start” button

ST-Segment Elevation Myocardial Infarction- Part 1

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