[MCQ] ST-Segment Elevation Myocardial Infarction- Part 2

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ST-Segment Elevation Myocardial Infarction- Part 2

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Question 1

When patients with STEMI undergo reperfusion, which of the following is false about cardiac biomarkers ?

A	Are detected sooner
B	Rise to a higher peak value
C	Decline more rapidly
D	None of the above

Question 1 Explanation:

When patients with STEMI undergo reperfusion, cardiac biomarkers are detected sooner, rise to a higher peak value, but decline more rapidly.

Question 2

Potential sources of total CK elevation are all except ?

A	Muscular dystrophy
B	Myopathies
C	Polymyositis
D	Hyperthyroidism

Question 3

Potential sources of total CK elevation are all except ?

A	Alcohol binge
B	Hypothyroidism
C	Stroke
D	Prolonged immobilization

Question 3 Explanation:

Potential sources of total CK elevation are skeletal muscular diseases (muscular dystrophy, myopathies and polymyositis), electrical cardioversion, hypothyroidism, stroke, surgery, skeletal muscle damage secondary to trauma, convulsions and prolonged immobilization.

Question 4

What ratio (relative index) of CKMB mass:CK activity suggests myocardial infarction ?

A	>=1.2
B	>=1.8
C	>=2.2
D	>=2.5

Question 4 Explanation:

A ratio (relative index) of CKMB mass : CK activity >=2.5 “suggests” myocardial rather than a skeletal muscle source for the CKMB elevation.

Question 5

Which of the following is false about myoglobin in STEMI ?

A	First serum cardiac markers to rise after STEMI
B	High cardiac specificity
C	Rapidly excreted in urine
D	Blood levels return to normal within 24 hours

Question 5 Explanation:

Myoglobin is one of the first serum cardiac markers that rises after STEMI but it lacks cardiac specificity. It is rapidly excreted in urine therefore blood levels return to normal range within 24 hours of the onset of myocardial infarction

Question 6

In acute MI patients with hypoxemia, O2 is administered by nasal prongs or face mask at the rate of ?

A	2 - 4 L/minute
B	4 - 6 L/minute
C	6 - 8 L/minute
D	8 - 10 L/minute

Question 6 Explanation:

In STEMI patients, whose arterial O2 saturation is normal, supplemental O2 is of limited clinical benefit. When hypoxemia is present, O2 is given by nasal prongs or face mask @ 2 - 4 L/minute for the first 6 to 12 hours after infarction and then according to the situation.

Question 7

Therapy with nitrates in STEMI should be avoided in ?

A	Low systolic arterial pressure (< 90 mm Hg)
B	Low systolic arterial pressure (< 90 mm Hg)
C	Who have taken ‘sildenafil’ within preceding 24 hours
D	All of the above

Question 7 Explanation:

All of the above

Question 8

In STEMI, three doses of sublingual nitroglycerin (0.4 mg) should be administered at an interval of ?

A	5 minutes
B	5 minutes
C	5 minutes
D	Three hours

Question 8 Explanation:

Sublingual nitroglycerin can be given safely to most patients with STEMI. Up to three doses of 0.4 mg should be administered at about 5 minute intervals

Question 9

Idiosyncratic hypotensive reaction to nitrates is reversed promptly by ?

A	IV Calcium gluconate
B	IV Atropine
C	IV Norepinephrine
D	IV Fluids

Question 9 Explanation:

An idiosyncratic reaction to nitrates, consisting of sudden marked hypotension can be reversed promptly by the prompt administration of intravenous atropine.

Question 10

Which of the following about morphine in acute MI is false ?

A	Morphine has a vagotonic effect
B	May cause advanced heart block particularly in patients with anterior wall infarction
C	Shoule be given IV rather than subcutaneously
D	None of the above

Question 10 Explanation:

Morphine has vagotonic effect & may cause bradycardia or advanced degrees of heart block particularly in patients with posteroinferior infarction. These side effects respond to atropine. Morphine is routinely administered by repetitive (every 5 min) intravenous injection of small doses (2 - 4 mg) rather than by subcutaneous administration of a larger quantity, because absorption may be unpredictable by subcutaneous route.

Question 11

Which of the following about IV -blockers in acute MI is false ?

A	Useful in the control of pain of STEMI
B	Reduce the risks of reinfarction
C	Reduce the risks of ventricular fibrillation
D	None of the above

Question 11 Explanation:

Intravenous beta blockers are useful in the control of pain of STEMI by diminishing myocardial O2 demand & ischemia. Intravenous beta blockers reduce risks of reinfarction & ventricular fibrillation

Question 12

What proportion of patients with STEMI may achieve spontaneous reperfusion of infarct-related coronary artery within 24 hours ?

A	One - fourth
B	One - third
C	One - half
D	Two - third

Question 12 Explanation:

Up to one - third of patients with STEMI may achieve spontaneous reperfusion of the infarctrelated coronary artery within 24 hours.

Question 13

Which of the following drugs should be avoided in patients with STEMI ?

A	Glucocorticoids
B	Nonsteroidal anti-inflammatory agents
C	Short-acting dihydropyridines calcium antagonists
D	All of the above

Question 13 Explanation:

Short-acting dihydropyridine calcium antagonists may be associated with an increased mortality risk in STEMI. Glucocorticoids and nonsteroidal anti-inflammatory agents (other than aspirin), should be avoided in STEMI as they can impair infarct healing & increase the risk of myocardial rupture, and their use may result in a larger infarct scar. These also increase coronary vascular resistance, thereby potentially reducing flow to ischemic myocardium

Question 14

In STEMI, the goal is to keep total ischemic time within ?

A	30 minutes
B	60 minutes
C	90 minutes
D	120 minutes

Question 14 Explanation:

In STEMI, the goal is to keep total ischemic time within 120 minutes.

Question 15

In STEMI, the golden hour refers to ?

A	First 15 minutes
B	First 30 minutes
C	First 60 minutes
D	First 180 minutes

Question 16

A cardiologist is considered as an “experienced operator” if he has does how many percuteneous coronary intervention (PCI) cases per year ?

A	>=15
B	>=25
C	>=50
D	>=75

Question 16 Explanation:

A cardiologist is considered as an “experienced operator” if he does >=75 percuteneous coronary intervention (PCI) cases per year.

Question 17

A cardiological unit is considered as a “dedicated medical center” if it does how many percuteneous coronary intervention (PCI) cases per year ?

A	>=5
B	>=15
C	>=25
D	>=36

Question 17 Explanation:

>=36

Question 18

In STEMI, fibrinolytic therapy should ideally be initiated within ?

A	10 minutes of presentation
B	30 minutes of presentation
C	60 minutes of presentation
D	90 minutes of presentation

Question 18 Explanation:

In STEMI, fibrinolytic therapy should ideally be initiated within 30 minutes of presentation (doorto-needle time 30 minutes) with a principal goal to promptly restore full coronary arterial patency (TIMI grade 3)

Question 19

Which of the following fibrinolytic agent acts by promoting conversion of plasminogen to plasmin ?

A	Tissue plasminogen activator (tPA)
B	Streptokinase
C	Tenecteplase (TNK)
D	All of the above

Question 19 Explanation:

Tissue plasminogen activator (tPA), streptokinase, tenecteplase (TNK), and reteplase (rPA) are fibrinolytic agents that act by promoting conversion of plasminogen to plasmin, which subsequently lyses fibrinthrombi

Question 20

Which of the following is a ‘bolus fibrinolytic’ agent ?

A	Streptokinase
B	Tenecteplase (TNK)
C	Urokinase
D	Tissue plasminogen activator (tPA

Question 21

Which of the following is a ‘bolus fibrinolytic’ agent ?

A	Streptokinase
B	Reteplase (rPA)
C	Urokinase
D	Urokinase

Question 21 Explanation:

Tenecteplase (TNK) & reteplase (rPA) are bolus fibrinolytics since their administration does not require a prolonged intravenous infusion.

Question 22

Angiographically flow in the culprit coronary artery is assessed by which of the following grading system ?

A	TIMI
B	ISIS
C	CURE
D	CAPRIE

Question 22 Explanation:

When assessed angiographically, flow in the culprit coronary artery is described by a simple qualitative scale called the thrombolysis in myocardial infarction (TIMI) grading system.

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See all quizzes of ST-Segment Elevation Myocardial Infarction at here:

ST-Segment Elevation Myocardial Infarction- Part 1 |ST-Segment Elevation Myocardial Infarction- Part 1|

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

1.When patients with STEMI undergo reperfusion, which of the following is false about cardiac biomarkers ?
A. Are detected sooner
B. Rise to a higher peak value
C. Decline more rapidly
D. None of the above

2. Potential sources of total CK elevation are all except ?
A. Muscular dystrophy
B. Myopathies
C. Polymyositis
D. Hyperthyroidism
3. Potential sources of total CK elevation are all except ?
A. Alcohol binge
B. Hypothyroidism
C. Stroke
D. Prolonged immobilization

4. What ratio (relative index) of CKMB mass:CK activity suggests myocardial infarction ?
A. >=1.2
B. >=1.8
C. >=2.2
D. >=2.5

5. Which of the following is false about myoglobin in STEMI ?
A. First serum cardiac markers to rise after STEMI
B. High cardiac specificity
C. Rapidly excreted in urine
D. Blood levels return to normal within 24 hours

6. In acute MI patients with hypoxemia, O2 is administered by nasal prongs or face mask at the rate of ?
A. 2 – 4 L/minute
B. 4 – 6 L/minute
C. 6 – 8 L/minute
D. 8 – 10 L/minute

7. Therapy with nitrates in STEMI should be avoided in ?
A. Low systolic arterial pressure (< 90 mm Hg)
B. When there is clinical suspicion of RV infarction
C. Who have taken ‘sildenafil’ within preceding 24 hours
D. All of the above

8. In STEMI, three doses of sublingual nitroglycerin (0.4 mg) should be administered at an interval of ?
A. 5 minutes
B. 30 minutes
C. One hour
D. Three hours

9. Idiosyncratic hypotensive reaction to nitrates is reversed promptly by ?
A. IV Calcium gluconate
B. IV Atropine
C. IV Norepinephrine
D. IV Fluids

10. Which of the following about morphine in acute MI is false ?
A. Morphine has a vagotonic effect
B. May cause advanced heart block particularly in patients
with anterior wall infarction
C. Shoule be given IV rather than subcutaneously
D. None of the above

11. Which of the following about IV -blockers in acute MI is false ?
A. Useful in the control of pain of STEMI
B. Reduce the risks of reinfarction
C. Reduce the risks of ventricular fibrillation
D. None of the above
.
12. What proportion of patients with STEMI may achieve spontaneous reperfusion of infarct-related coronary artery within 24 hours ?
A. One – fourth

B. One – third
C. One – half
D. Two – third

13. Which of the following drugs should be avoided in patients with STEMI ?
A. Glucocorticoids
B. Nonsteroidal anti-inflammatory agents
C. Short-acting dihydropyridines calcium antagonists
D. All of the above

14. In STEMI, the goal is to keep total ischemic time within ?
A. 30 minutes
B. 60 minutes
C. 90 minutes
D. 120 minutes

15. In STEMI, the golden hour refers to ?
A. First 15 minutes
B. First 30 minutes
C. First 60 minutes
D. First 180 minutes
16. A cardiologist is considered as an “experienced operator” if he has does how many percuteneous coronary intervention (PCI) cases per year ?
A. >=15
B. >=25
C. >=50
D. >=75

18. A cardiological unit is considered as a “dedicated medical center” if it does how many percuteneous coronary intervention (PCI) cases per year ?
A. >=5
B. >=15
C. >=25
D. >=36

19. In STEMI, fibrinolytic therapy should ideally be initiated within ?

A. 10 minutes of presentation
B. 30 minutes of presentation
C. 60 minutes of presentation
D. 90 minutes of presentation

20. Which of the following fibrinolytic agent acts by promoting conversion of plasminogen to plasmin ?
A. Tissue plasminogen activator (tPA)
B. Streptokinase
C. Tenecteplase (TNK)
D. All of the above

21. Which of the following is a ‘bolus fibrinolytic’ agent ?
A. Streptokinase
B. Tenecteplase (TNK)
C. Urokinase
D. Tissue plasminogen activator (tPA)
22. Which of the following is a ‘bolus fibrinolytic’ agent ?
A. Streptokinase
B. Reteplase (rPA)
C. Urokinase
D. Tissue plasminogen activator (tPA)
.
23. Angiographically flow in the culprit coronary artery is assessed by which of the following grading system ?
A. TIMI
B. ISIS
C. CURE
D. CAPRIE

ST-Segment Elevation Myocardial Infarction

[MCQ] ST-Segment Elevation Myocardial Infarction- Part 2

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ST-Segment Elevation Myocardial Infarction- Part 2

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

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