[MCQ] ST-Segment Elevation Myocardial Infarction- Part 4

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ST-Segment Elevation Myocardial Infarction- Part 4

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Question 1

Which of the undermentioned myocardial infarction has an increased risk of systemic or pulmonary thromboembolism ?

A	Anterior
B	Inferior
C	Posterior
D	Lateral

Question 1 Explanation:

Patients with anterior myocardial infarction, severe LV dysfunction, heart failure, history of embolism, 2D echocardiographic evidence of mural thrombus or atrial fibrillation are at increased risk of systemic or pulmonary thromboembolism

Question 2

Which of the following medication is least useful during the first 24 - 48 hours after the onset of myocardial infarction ?

A	Intravenous nitroglycerin
B	Angiotensin-converting enzyme (ACE) inhibitors
C	Beta blockers
D	Unfractionated heparin (UFH)

Question 2 Explanation:

Benefits of routine use of intravenous nitroglycerin are less in contemporary era where betaadrenoceptor blockers & ACE inhibitors are routinely prescribed for patients with STEMI.

Question 3

Patients with rales at lung bases, S3 gallop, tachypnea, or signs of right heart failure belong to which Killip class ?

A	Killip class I
B	Killip class II
C	Killip class III
D	Killip class IV

Question 3 Explanation:

Killip classification divides patients into four groups. Class I - no signs of pulmonary or venous congestion, class II - rales at lung bases, S3 gallop, tachypnea, or signs of right heart failure, class III - severe heart failure, pulmonary edema and class IV - shock with systolic pressure <90 mmHg, peripheral vasoconstriction, peripheral cyanosis, mental confusion, and oliguria.

Question 4

In STEMI, what proportion of patients present with cardiogenic shock on admission ?

A	1 %
B	5 %
C	10 %
D	20 %

Question 4 Explanation:

Only 10% of patients with STEMI present with cardiogenic shock on admission. 90% develop it during hospitalization.

Question 5

Infarction of what percentage of left ventricle results in cardiogenic shock ?

A	About 20 %
B	About 30 %
C	About 35 %
D	About 40 %

Question 5 Explanation:

Hemodynamic evidence of abnormal LV function appears when contraction is seriously impaired in 20 to 25% of the left ventricle. Infarction of >=40% of left ventricle results in cardiogenic shock.

Question 6

Which of the following is not true for cardiogenic shock ?

A	Sustained systolic arterial pressure of <60 mmHg
B	Sustained systolic arterial pressure of <60 mmHg
C	Sustained systolic arterial pressure of <60 mmHg
D	Generally associated with mortality rate of >50%

Question 6 Explanation:

Cardiogenic shock (CS) is characterized by systemic hypoperfusion due to severe depression of cardiac index [<2.2 (L/min)/m 2] & sustained systolic arterial hypotension (<90 mmHg), despite an elevated filling pressure (PCWP > 18 mmHg). In-hospital mortality rate is >50%

Question 7

What is true for right ventricular myocardial infarction ?

A	Associated with occlusion of proximal RCA
B	ST-segment elevation of >1 mm in lead V4R
C	Upright T wave in lead V4R during initial hours
D	All of the above

Question 8

Ventricular tachycardia or fibrillation refractory to electroshock is more responsive after patient is treated with ?

A	Epinephrine
B	Bretylium
C	Amiodarone
D	All of the above

Question 8 Explanation:

Ventricular tachycardia or fibrillation that is refractory to electroshock may be more responsive after patient is treated with epinephrine (1 mg intravenously or 10 mL of a 1:10,000 solution via the intracardiac route), bretylium (5-mg/kg bolus) or amiodarone (75 to 150-mg bolus).

Question 9

Implantable cardioverter/defibrillator (ICD) is recommended for which of the following ?

A	LVEF is <30-40% and NYHA class II
B	LVEF is <30-40% and NYHA class III
C	LVEF is <30-35% and NYHA class I
D	All of the above

Question 9 Explanation:

Patients with depressed left ventricular function at least 40 days post-STEMI are referred for insertion of an implantable cardioverter/defibrillator (ICD) if the LVEF is <30–40% with NYHA class II-III or if LVEF is <30–35% with NYHA class I functional status. Patients with preserved left ventricular function (LVEF >40%) do not receive an ICD regardless of NYHA functional class.

Question 10

Which of the following is false about recurrent post STEMI angina ?

A	Develops in ~25% of patients hospitalized for STEMI
B	More frequent in those who have successful fibrinolysis
C	Repeat fibrinolysis is an alternative
D	None of the above

Question 10 Explanation:

Recurrent angina develops in ~25% of patients hospitalized for STEMI. It is even higher in patients who undergo successful fibrinolysis. Repeat administration of a fibrinolytic agent is an alternative to early mechanical revascularization

Question 11

Usual duration of hospitalization for an uncomplicated STEMI is about ?

A	3 days
B	5 days
C	7 days
D	10 days

Question 11 Explanation:

Usual duration of hospitalization for an uncomplicated STEMI is about 5 days.

Question 12

Intravenous antiplatelet drugs include ?

A	Abciximab
B	Eptifibatide
C	Tirofiban
D	All of the above

Question 12 Explanation:

Three potent parenteral GpIIb/IIIa inhibitors are Abciximab (chimeric monoclonal Fab fragment of human & murine protein that binds to GpIIb/IIIa), Eptifibatide (synthetic cyclic heptapeptide with a KGD sequence) and Tirofiban (synthetic peptidomimetic based on the RGD sequence)

Question 13

ATP in “National Cholesterol Education Project ATP III” stands for ?

A	Adult Treatment Panel
B	Advanced Treatment Panel
C	Aggressive Treatment Panel
D	Angina Treatment Panel

Question 13 Explanation:

Adult Treatment Panel III (ATP III).

Question 14

The technique “Percuteneous transluminal coronary angioplasty” (PTCA) was first introduced by ?

A	Andreas Gruntzig
B	Denton Cooley
C	Micheal DeBakey
D	Micheal DeBakey

Question 14 Explanation:

In 1977, Andreas Gruntzig introduced percutaneous transluminal coronary angioplasty (PTCA).

Question 15

During percutaneous coronary intervention (PCI), steerable guidewire put into coronary artery lumen has a diameter of ?

A	< 0.4 mm
B	< 0.6 mm
C	< 0.8 mm
D	< 1 mm

Question 15 Explanation:

During PCI, steerable guidewire put into coronary artery lumen has a diameter of < 0.4 mm.

Question 16

What suggests involvement of right coronary artery rather than left circumflex artery as the culprit vessel in inferior MI ?

A	Greater ST-segment elevation in lead II than in lead III &ST-segment depression of >1 mm in leads I & aVL
B	Greater ST-segment elevation in lead III than in lead II &ST-segment depression of >1 mm in leads I & aVL
C	Greater ST-segment elevation in lead aVF than in lead II orIII & ST-segment depression of >1 mm in leads I & aVL
D	Greater ST-segment elevation in lead II & III than in lead aVF & ST-segment depression of >1 mm in leads I & aVL

Question 17

In inferior MI, ST-segment depression in leads V1 and V2 suggest concomitant infarction of ?

A	Lateral wall of left ventricle
B	Posterior wall of left ventricle
C	Anterior wall of left ventricle
D	Atrial infarction

Question 18

Most sensitive electrocardiographic sign of right ventricular infarction is ?

A	ST-segment elevation of >1 mm in V4R with upright T wave during first 12 hours
B	ST-segment elevation of >1 mm in V4R with inverted T wave during first 12 hours
C	ST-segment elevation of >1 mm in V4R with upright T wave after first 12 hours
D	ST-segment elevation of >1 mm in V4R with inverted T wave after first 12 hours

Question 19

Proximal occlusion of the left anterior descending artery is indicated by ?

A	Anterior wall MI, ST elevation in V1, V2, and V3
B	Anterior wall MI, ST elevation in V1, V2, and V3 & aVL
C	Anterior wall MI, ST elevation in V1, V2, V3 & aVL with ST depression of >1 mm in lead aVF
D	Anterior wall MI, ST elevation in V1, V2, V3 & aVL with ST depression of >1 mm in lead II, III and aVF

Question 20

Which of the following statements about blood supply of sinus node is true ?

A	Supplied by RCA in 60 % of people and by the left circumflex artery in 40 %
B	Supplied by RCA in 40 % of people and by left circumflex artery in 60 %
C	Supplied by RCA in 80 % of people and by left circumflex artery in 20 %
D	Supplied by RCA in 60 % of people and by left anterior decending artery in 40 %

Question 21

Which of the following statements about blood supply of atrioventricular node is true ?

A	Supplied by RCA in 50 % of people and by left circumflex artery in 50 %
B	Supplied by RCA in 60 % of people and by left circumflex artery in 40 %
C	Supplied by RCA in 75 % of people and by left circumflex artery in 25 %
D	Supplied by RCA in 90 % of people and by left circumflex artery in 10 %

Question 22

Which of the following statements about blood supply of bundle of His is true ?

A	Supplied by atrioventricular nodal branch of LAD
B	Supplied by atrioventricular nodal branch of RCA + septal perforators of LAD
C	Supplied by atrioventricular nodal branch of left circumflex artery + septal perforators of LAD
D	Supplied by septal branch of left circumflex artery

Question 23

Which of the following statements about blood supply of right bundle branch is true ?

A	Supplied by septal perforators of LAD
B	Supplied by septal perforators of RCA
C	Supplied by septal perforators of left circumflex artery
D	None of the above

Question 24

Which of the following is an electrocardiographic predictor of myocardial reperfusion following thrombolysis ?

A	T-wave inversion in < 4 hours after MI
B	ST-segment resolution during first 90 minutes
C	Accelerated idioventricular rhythm
D	All of the above

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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.Which of the undermentioned myocardial infarction has an increased risk of systemic or pulmonary thromboembolism ?
A. Anterior
B. Inferior
C. Posterior
D. Lateral

2. Which of the following medication is least useful during the first 24 – 48 hours after the onset of myocardial infarction ?
A. Intravenous nitroglycerin

B. Angiotensin-converting enzyme (ACE) inhibitors
C. Beta blockers
D. Unfractionated heparin (UFH)

3. Patients with rales at lung bases, S3 gallop, tachypnea, or signs of right heart failure belong to which Killip class ?
A. Killip class I
B. Killip class II
C. Killip class III
D. Killip class IV

4. In STEMI, what proportion of patients present with cardiogenic shock on admission ?
A. 1 %
B. 5 %
C. 10 %
D. 20 %
.
5. Infarction of what percentage of left ventricle results in cardiogenic shock ?
A. About 20 %
B. About 30 %
C. About 35 %
D. About 40 %

6. Which of the following is not true for cardiogenic shock ?
A. Sustained systolic arterial pressure of <60 mmHg
B. Cardiac index < 2.2 L/(min/m2)
C. Elevated pulmonary capillary wedge pressure (>18 mmHg)
D. Generally associated with mortality rate of >50%

7. What is true for right ventricular myocardial infarction ?
A. Associated with occlusion of proximal RCA
B. ST-segment elevation of >1 mm in lead V4R
C. Upright T wave in lead V4R during initial hours
D. All of the above
8. Ventricular tachycardia or fibrillation refractory to electroshock is more responsive after patient is treated with ?
A. Epinephrine
B. Bretylium
C. Amiodarone
D. All of the above

9. Implantable cardioverter/defibrillator (ICD) is recommended for which of the following ?
Harrison’s 18th Ed. 2033, Figure 245-6
A. LVEF is <30-40% and NYHA class II
B. LVEF is <30-40% and NYHA class III
C. LVEF is <30-35% and NYHA class I
D. All of the above

10. Which of the following is false about recurrent post STEMI angina ?
A. Develops in ~25% of patients hospitalized for STEMI
B. More frequent in those who have successful fibrinolysis
C. Repeat fibrinolysis is an alternative
D. None of the above

11. Usual duration of hospitalization for an uncomplicated STEMI is about ?
A. 3 days
B. 5 days
C. 7 days
D. 10 days

12. Intravenous antiplatelet drugs include ?
A. Abciximab
B. Eptifibatide
C. Tirofiban
D. All of the above

13. ATP in “National Cholesterol Education Project ATP III” stands for ?
A. Adult Treatment Panel
B. Advanced Treatment Panel
C. Aggressive Treatment Panel
D. Angina Treatment Panel

14. The technique “Percuteneous transluminal coronary angioplasty” (PTCA) was first introduced by ?
A. Andreas Gruntzig
B. Denton Cooley
C. Micheal DeBakey
D. Christian Bernard

15. During percutaneous coronary intervention (PCI), steerable guidewire put into coronary artery lumen has a diameter of ?
A. < 0.4 mm
B. < 0.6 mm
C. < 0.8 mm
D. < 1 mm

16. What suggests involvement of right coronary artery rather than left circumflex artery as the culprit vessel in inferior MI ?
A. Greater ST-segment elevation in lead II than in lead III & ST-segment depression of >1 mm in leads I & aVL
B. Greater ST-segment elevation in lead III than in lead II & ST-segment depression of >1 mm in leads I & aVL
C. Greater ST-segment elevation in lead aVF than in lead II or III & ST-segment depression of >1 mm in leads I & aVL
D. Greater ST-segment elevation in lead II & III than in lead aVF & ST-segment depression of >1 mm in leads I & aVL
17. In inferior MI, ST-segment depression in leads V1 and V2 suggest concomitant infarction of ?
A. Lateral wall of left ventricle
B. Posterior wall of left ventricle
C. Anterior wall of left ventricle
D. Atrial infarction
18. Most sensitive electrocardiographic sign of right ventricular infarction is ?
A. ST-segment elevation of >1 mm in V4R with upright T wave during first 12 hours
B. ST-segment elevation of >1 mm in V4R with inverted T wave during first 12 hours
C. ST-segment elevation of >1 mm in V4R with upright T wave after first 12 hours
D. ST-segment elevation of >1 mm in V4R with inverted T wave after first 12 hours
19. Proximal occlusion of the left anterior descending artery is indicated by ?
A. Anterior wall MI, ST elevation in V1, V2, and V3
B. Anterior wall MI, ST elevation in V1, V2, and V3 & aVL

C. Anterior wall MI, ST elevation in V1, V2, V3 & aVL with ST depression of >1 mm in lead aVF
D. Anterior wall MI, ST elevation in V1, V2, V3 & aVL with ST depression of >1 mm in lead II, III and aVF
20. Which of the following statements about blood supply of sinus node is true ?
A. Supplied by RCA in 60 % of people and by the left circumflex artery in 40 %
B. Supplied by RCA in 40 % of people and by left circumflex artery in 60 %
C. Supplied by RCA in 80 % of people and by left circumflex artery in 20 %
D. Supplied by RCA in 60 % of people and by left anterior decending artery in 40 %
21. Which of the following statements about blood supply of atrioventricular node is true ?
A. Supplied by RCA in 50 % of people and by left circumflex artery in 50 %
B. Supplied by RCA in 60 % of people and by left circumflex artery in 40 %
C. Supplied by RCA in 75 % of people and by left circumflex artery in 25 %
D. Supplied by RCA in 90 % of people and by left circumflex artery in 10 %
22. Which of the following statements about blood supply of bundle of His is true ?
A. Supplied by atrioventricular nodal branch of LAD
B. Supplied by atrioventricular nodal branch of RCA + septal perforators of LAD
C. Supplied by atrioventricular nodal branch of left circumflexartery + septal perforators of LAD
D Supplied by septal branch of left circumflex artery
23. Which of the following statements about blood supply of right bundle branch is true ?
A. Supplied by septal perforators of LAD
B. Supplied by septal perforators of RCA
C. Supplied by septal perforators of left circumflex artery
D. None of the above
24. Which of the following is an electrocardiographic predictor of myocardial reperfusion following thrombolysis ?
A. T-wave inversion in < 4 hours after MI
B. ST-segment resolution during first 90 minutes
C. Accelerated idioventricular rhythm
D. All of the above

ST-Segment Elevation Myocardial Infarction

[MCQ] ST-Segment Elevation Myocardial Infarction- Part 4

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ST-Segment Elevation Myocardial Infarction- Part 4

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