[MCQ] ST-Segment Elevation Myocardial Infarction- Part 3

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ST-Segment Elevation Myocardial Infarction- Part 3

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Congratulations - you have completed ST-Segment Elevation Myocardial Infarction- Part 3. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

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Question 1

Method of angiographic assessment of the efficacy of fibrinolysis is ?

A	TIMI flow grade
B	TIMI frame count
C	TIMI myocardial perfusion grade
D	All of the above

Question 1 Explanation:

Qualitative scale to angiographically assess flow in the culprit coronary artery is the thrombolysis in myocardial infarction (TIMI) grading system. Grade 0 - complete occlusion of infarct-related artery (IRA), grade 1 - some penetration of contrast material beyond the point of obstruction but without perfusion of distal coronary bed, grade 2 - perfusion of entire infarct vessel into distal bed, but with flow that is delayed compared with that of a normal artery and grade 3 - full perfusion of the infarct vessel with normal flow. Additional methods of angiographic assessment

Question 2

Which TIMI flow grade indicates full perfusion of infarct vessel with normal flow following reperfusion therapy ?

A	TIMI 1
B	TIMI 2
C	TIMI 3
D	TIMI 3

Question 2 Explanation:

TIMI grade 3 indicates full perfusion of the infarct vessel with normal flow which is the goal of reperfusion therapy.

Question 3

In STEMI, fibrinolytic therapy can reduce the relative risk of in hospital death by up to ?

A	10 %
B	25 %
C	50 %
D	75 %

Question 3 Explanation:

In STEMI, fibrinolytic therapy can reduce the relative risk of in-hospital death by up to 50% when administered within the first hour of the onset of symptoms. Benefit is maintained for at least 10 years.

Question 4

Which of the following is given as a “single” weight-based intravenous bolus ?

A	Tissue plasminogen activator (tPA)
B	Reteplase (rPA)
C	Tenecteplase (TNK)
D	Streptokinase (STK)

Question 4 Explanation:

TNK is given as a “single” weight-based intravenous bolus of 0.53 mg/kg over 10 seconds.

Question 5

Which of the following fibrinolytic agent is administered in a double-bolus regimen ?

A	Tissue plasminogen activator (tPA)
B	Reteplase (rPA)
C	Tenecteplase (TNK)
D	Streptokinase (STK)

Question 5 Explanation:

tPA is given as a 15 mg bolus followed by 50 mg intravenously over the first 30 minutes, followed by 35 mg over the next 60 minutes. Streptokinase is administered as 1.5 million units (MU) intravenously over 1 hour. rPA is administered in a double-bolus regimen consisting of a 10-MU bolus given over 2 - 3 minutes, followed by a second 10-MU bolus 30 minutes later.

Question 6

Combination reperfusion regimens involve giving a fibrinolytic agent with which of the following ?

A	Aspirin
B	Clopidogrel
C	Intravenous glycoprotein IIb/IIIa inhibitor
D	Percutaneous coronary intervention (PCI)

Question 6 Explanation:

Combination reperfusion regimens for coronary reperfusion combine an intravenous glycoprotein IIb/IIIa inhibitor with a reduced dose of a fibrinolytic agent.

Question 7

Clear contraindications to the use of fibrinolytic agents are all except ?

A	Cerebrovascular hemorrhage at any time
B	Nonhemorrhagic stroke at any time
C	Suspicion of aortic dissection
D	Active internal bleeding

Question 7 Explanation:

Clear contraindications to the use of fibrinolytic agents include a history of cerebrovascular hemorrhage at any time, a nonhemorrhagic stroke or other cerebrovascular event within the past year, marked hypertension (>180/110 mmHg) at any time during acute presentation, suspicion of aortic dissection, and active internal bleeding (excluding menses).

Question 8

In STEMI, which of the following is a relative contraindication to fibrinolytic therapy ?

A	Current use of anticoagulants (INR >=2)
B	Pregnancy
C	Hemorrhagic diabetic retinopathy
D	All of the above

Question 8 Explanation:

Relative contraindications to fibrinolytic therapy, which require clinical consideration of risk:benefit ratio include current use of anticoagulants (INR >=2), a recent (<2 weeks) invasive or surgical procedure or prolonged (>10 minute) cardiopulmonary resuscitation, known bleeding diathesis, pregnancy, a hemorrhagic ophthalmic condition (hemorrhagic diabetic retinopathy), active peptic ulcer disease, and a history of severe hypertension that is currently adequately controlled.

Question 9

For what period, streptokinase should not given, if the patient has received it in past ?

A	Never in life
B	5 days to 2 years
C	1 to 2 years
D	1 to 2 years

Question 9 Explanation:

Because of the risk of an allergic reaction, patients should not receive streptokinase if that agent had been received within the preceding 5 days to 2 years.

Question 10

Allergic reactions to streptokinase occur in about what percentage of patients who receive it ?

A	1 %
B	2 %
C	3 %
D	4 %

Question 10 Explanation:

Allergic reactions to streptokinase occur in ~2% of patients who receive it.

Question 11

Minor degree of hypotension occurs in what percentage of patients who receive streptokinase ?

A	4 - 10 %
B	10 - 16 %
C	16 - 30 %
D	16 - 30 %

Question 11 Explanation:

Minor hypotension occurs in 4 - 10 % of patients given STK, marked hypotension occurs rarely

Question 12

Hemorrhagic stroke occurs in about what percentage of patients who receive streptokinase ?

A	0.1 - 0.5 %
B	0.5 - 0.9 %
C	0.9 - 1.5 %
D	1.5 - 2.4 %

Question 12 Explanation:

Hemorrhagic stroke, the most serious complication, occurs in ~0.5 - 0.9% of patients receiving fibrinolytic agents. Rate of intracranial hemorrhage with tPA or rPA is slightly higher than with STK

Question 13

Patients with confirmed STEMI and low risk may be safely transferred out of the coronary care unit within ?

A	6 hours
B	12 hours
C	24 hours
D	48 hours

Question 13 Explanation:

Patients with confirmed STEMI & low risk (no prior MI & no persistent chest discomfort, CHF, hypotension or cardiac arrhythmias) may be safely transferred out of CCU within 24 hours

Question 14

Patients with STEMI should be kept at bed rest for the first ?

A	3 hours
B	6 hours
C	12 hours
D	24 hours

Question 14 Explanation:

Patients with STEMI should be at bed rest for the first 12 hours. In the absence of complications, patients should be encouraged, under supervision, to resume an upright posture by dangling their feet over the side of the bed & sitting in a chair within the first 24 hours. By day 3 after MI, patients should increase their ambulation progressively to a goal of 185 meters (600 ft) three times a day

Question 15

In STEMI, diet rich in which of the following is recommended ?

A	Potassium
B	Magnesium
C	Fiber
D	All of the above

Question 15 Explanation:

In STEMI, foods that are high in potassium, magnesium, and fiber, but low in sodium are recommended

Question 16

Which of the following drugs used in coronary care unit can produce delirium, particularly in the elderly ?

A	Atropine
B	H2 blockers
C	Narcotics
D	Narcotics

Question 16 Explanation:

Atropine, H2 blockers & narcotics can produce delirium, particularly in the elderly.

Question 17

In STEMI, goal of treatment with antiplatelet and anticoagulant agents is ?

A	To maintain patency of infarct-related artery (IRA)
B	To reduce likelihood of mural thrombus formation
C	To reduce likelihood of deep venous thrombosis
D	All of the above

Question 18

Data from Antiplatelet Trialists’ Collaboration shows a relative reduction in mortality of how much in patients with MI receiving antiplatelet agents ?

A	12 %
B	21 %
C	27 %
D	34 %

Question 18 Explanation:

Data from Antiplatelet Trialists’ Collaboration patients with MI showed a relative reduction of 27% in mortality rate, from 14.2% in control patients to 10.4% in patients receiving antiplatelet agents.

Question 19

In STEMI, the maximum recommended dose of UFH given as an initial bolus is ?

A	2500 U
B	4000 U
C	4000 U
D	7500 U

Question 20

In STEMI, the maximum recommended dose of UFH given after the initial bolus is ?

A	500 U / hour
B	1000 U / hour
C	1000 U / hour
D	2000 U / hour

Question 21

In STEMI, with the use of UFH, activated partial thromboplastin time during maintenance therapy should be ?

A	1.5 times the control value
B	1.5 - 2 times the control value
C	1.5 - 2 times the control value
D	3 - 3.5 times the control value

Question 21 Explanation:

In STEMI, the recommended dose of UFH is an initial bolus of 60 U/kg (maximum 4000 U) followed by an initial infusion of 12 U/kg per hour (maximum 1000 U/hour). Activated partial thromboplastin time during maintenance therapy should be 1.5 - 2 times the control value.

Question 22

In STEMI, which of the following can be used as an alternative to UFH for anticoagulation ?

A	Fondaparinux
B	Bivalirudin
C	Bivalirudin
D	Bivalirudin

Question 22 Explanation:

Advantages of low-molecular-weight heparin (LMWH) preparations include high bioavailability permitting administration subcutaneously, reliable anticoagulation without monitoring, and greater antiXa:IIa activity.

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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.Method of angiographic assessment of the efficacy of fibrinolysis is ?
A. TIMI flow grade
B. TIMI frame count
C. TIMI myocardial perfusion grade
D. All of the above

2.Which TIMI flow grade indicates full perfusion of infarct vessel with normal flow following reperfusion therapy ?
A. TIMI 1
B. TIMI 2
C. TIMI 3
D. TIMI 4

3. In STEMI, fibrinolytic therapy can reduce the relative risk of in hospital death by up to ?
A. 10 %
B. 25 %
C. 50 %
D. 75 %

4. Which of the following is given as a “single” weight-based intravenous bolus ?
A. Tissue plasminogen activator (tPA)
B. Reteplase (rPA)
C. Tenecteplase (TNK)
D. Streptokinase (STK)

5. Which of the following fibrinolytic agent is administered in a double-bolus regimen ?
A. Tissue plasminogen activator (tPA)
B. Reteplase (rPA)
C. Tenecteplase (TNK)
D. Streptokinase (STK)

4. Combination reperfusion regimens involve giving a fibrinolytic agent with which of the following ?
A. Aspirin
B. Clopidogrel
C. Intravenous glycoprotein IIb/IIIa inhibitor
D. Percutaneous coronary intervention (PCI)

5. Clear contraindications to the use of fibrinolytic agents are all except ?

A. Cerebrovascular hemorrhage at any time
B. Nonhemorrhagic stroke at any time
C. Suspicion of aortic dissection
D. Active internal bleeding

6. In STEMI, which of the following is a relative contraindication to fibrinolytic therapy ?
A. Current use of anticoagulants (INR >=2)
B. Pregnancy
C. Hemorrhagic diabetic retinopathy
D. All of the above

7. For what period, streptokinase should not given, if the patient has received it in past ?
A. Never in life
B. 5 days to 2 years
C. 1 to 2 years
D. 3 to 5 years

8. Allergic reactions to streptokinase occur in about what percentage of patients who receive it ?
A. 1 %
B. 2 %
C. 3 %
D. 4 %

9. Minor degree of hypotension occurs in what percentage of patients who receive streptokinase ?
A. 4 – 10 %
B. 10 – 16 %
C. 16 – 30 %
D. 30 – 40 %

10. Hemorrhagic stroke occurs in about what percentage of patients who receive streptokinase ?
A. 0.1 – 0.5 %
B. 0.5 – 0.9 %
C. 0.9 – 1.5 %

D. 1.5 – 2.4 %

11. Patients with confirmed STEMI and low risk may be safely transferred out of the coronary care unit within ?
A. 6 hours
B. 12 hours
C. 24 hours
D. 48 hours

12. Patients with STEMI should be kept at bed rest for the first ?
A. 3 hours
B. 6 hours
C. 12 hours
D. 24 hours
\
13. In STEMI, diet rich in which of the following is recommended ?
A. Potassium
B. Magnesium
C. Fiber
D. All of the above

14. Which of the following drugs used in coronary care unit can produce delirium, particularly in the elderly ?
A. Atropine
B. H2 blockers
C. Narcotics
D. All of the above

15. In STEMI, goal of treatment with antiplatelet and anticoagulant agents is ?
A. To maintain patency of infarct-related artery (IRA)
B. To reduce likelihood of mural thrombus formation
C. To reduce likelihood of deep venous thrombosis
D. All of the above
16. Data from Antiplatelet Trialists’ Collaboration shows a relative reduction in mortality of how much in patients with MI receiving antiplatelet agents ?
A. 12 %
B. 21 %

C. 27 %
D. 34 %

17. In STEMI, the maximum recommended dose of UFH given as an initial bolus is ?
A. 2500 U
B. 4000 U
C. 5000 U
D. 7500 U
18. In STEMI, the maximum recommended dose of UFH given after the initial bolus is ?
A. 500 U / hour
B. 1000 U / hour
C. 1500 U / hour
D. 2000 U / hour
19. In STEMI, with the use of UFH, activated partial thromboplastin time during maintenance therapy should be ?
A. 1.5 times the control value
B. 1.5 – 2 times the control value
C. 2.5 – 3 times the control value
D. 3 – 3.5 times the control value

20. In STEMI, which of the following can be used as an alternative to UFH for anticoagulation ?
A. Fondaparinux
B. Bivalirudin
C. Enoxaparin
D. All of the above

ST-Segment Elevation Myocardial Infarction

[MCQ] ST-Segment Elevation Myocardial Infarction- Part 3

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ST-Segment Elevation Myocardial Infarction- Part 3

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