[MCQ] Unstable Angina and NonST-Segment Elevation Myocardial Infarction

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Unstable Angina and NonST-Segment Elevation Myocardial Infarction

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Congratulations - you have completed Unstable Angina and NonST-Segment Elevation Myocardial Infarction. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

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Question 1

Acute coronary syndrome (ACS) includes ?

A	ST-segment elevation MI
B	Non-ST-segment elevation MI
C	Unstable angina (UA)
D	All of the above

Question 1 Explanation:

Patients with IHD fall into two large groups - those with stable angina secondary to chronic coronary artery disease and patients with acute coronary syndromes (ACS). ACS is composed of patients with acute myocardial infarction (MI) with ST-segment elevation on their presenting electrocardiogram (STEMI) and those with unstable angina (UA) and non-ST-segment elevation MI (UA/NSTEMI)

Question 2

Which of the following is true for unstable angina (UA) ?

A	Occurs at rest lasting > 10 minutes
B	New onset angina pectoris
C	Occurs with a crescendo pattern
D	All of the above

Question 2 Explanation:

UA is defined as angina pectoris or equivalent ischemic discomfort with at least one of three features: it occurs at rest usually lasting > 10 minutes, it is severe and of new onset, and/or it occurs with a crescendo pattern. The diagnosis of NSTEMI is established if a patient with the clinical features of UA develops evidence of myocardial necrosis, as reflected in elevated cardiac biomarkers.

Question 3

Which of the following is the most common pathophysiologic process in the development of UA ?

A	Plaque rupture with superimposed nonocclusive thrombus
B	Dynamic obstruction
C	Progressive mechanical obstruction
D	Increased myocardial oxygen demand and/or decreased supply

Question 3 Explanation:

UA/NSTEMI can be caused by a reduction in oxygen supply and/or by an increase in myocardial oxygen demand (tachycardia or severe anemia) superimposed on a coronary obstruction. Pathophysiologic processes leading to UA are plaque rupture or erosion with superimposed nonocclusive thrombus (most common cause), dynamic obstruction [coronary spasm, as in Prinzmetal’s variant angina), progressive mechanical obstruction [rapidly advancing coronary atherosclerosis or restenosis following percutaneous coronary intervention (PCI)] & secondary UA related to increased myocardial oxygen demand and/or decreased supply (anemia). More than one of these processes may be involved in many patients.

Question 4

Among patients with UA/NSTEMI, what percentage would have left main stenosis coronary artery disease ?

A	5 %
B	15 %
C	30 %
D	40 %

Question 5

Among patients with UA/NSTEMI, what percentage would have three-vessel coronary artery disease ?

A	5 %
B	15 %
C	30 %
D	40 %

Question 6

Among patients with UA/NSTEMI, what percentage would have single-vessel coronary artery disease ?

A	5 %
B	15 %
C	30 %
D	40 %

Question 7

Among patients with UA/NSTEMI, what percentage would have no critical coronary artery stenosis ?

A	5 %
B	10 %
C	30 %
D	40 %

Question 7 Explanation:

Among patients with UA/NSTEMI studied at angiography, ~5% have left main stenosis, 15% have three-vessel coronary artery disease, 30% have two-vessel disease, 40% have singlevessel disease, and 10% have no critical coronary stenosis; some of the latter have Prinzmetal’s variant angina

Question 8

The clinical hallmark of UA/NSTEMI is chest pain that is ?

A	Substernal
B	Retrosternal
C	Suprasternal
D	Any of the above

Question 8 Explanation:

Clinical hallmark of UA/NSTEMI is chest pain, typically located in the substernal region or sometimes in epigastrium, that radiates to the neck, left shoulder, and/or the left arm.

Question 9

Cardiac biomarkers include ?

A	C-reactive protein
B	B-type natriuretic peptide
C	CD-40 ligand
D	All of the above

Question 9 Explanation:

Elevated levels of CK-MB & troponin distinguish patients with NSTEMI from those with UA. There is a direct relationship between the degree of troponin elevation & mortality. Other cardiac biomarkers C-reactive protein, B-type natriuretic peptide & CD-40 ligand correlate independently with increased mortality & recurrent cardiac events in patients presenting with UA/NSTEMI.

Question 10

Minor troponin elevations can be caused by ?

A	Congestive heart failure
B	Myocarditis
C	Pulmonary embolism
D	All of the above

Question 10 Explanation:

Minor troponin elevations are due to congestive heart failure, myocarditis or pulmonary embolism

Question 11

Risk factor for CAD include ?

A	Elevated levels of creatinine
B	Brain natriuretic peptides
C	C-reactive protein
D	All of the above

Question 11 Explanation:

Besides the seven independent risk factors in Thrombolysis in Myocardial Infarction (TIMI) Trials, other risk factors are diabetes mellitus, left ventricular dysfunction & elevated levels of creatinine, brain natriuretic peptides & C-reactive protein.

Question 12

B-type natriuretic peptide is a marker of ?

A	Vascular inflammation
B	Increased myocardial wall tension
C	Plaque rupture
D	All of the above

Question 12 Explanation:

C-reactive protein is a marker of vascular inflammation and B-type natriuretic peptide is a marker of increased myocardial wall tension.

Question 13

Nitrates must not be administered if sildenafil (Viagra) has been used by the patient within the previous ?

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

Question 13 Explanation:

Absolute contraindications to the use of nitrates are hypotension or the use of sildenafil (Viagra) or other drugs in that class within the previous 24 hours.

Question 14

Letter “C” in CURE trial stands for ?

A	Coronary
B	Carotid
C	Clopidogrel
D	Cardiac

Question 15

Prasugrel is contraindicated in patients with ?

A	Peripheral artery disease
B	Prior stroke or transient ischemic attack
C	Tuberculosis
D	Hypertension

Question 15 Explanation:

Thienopyridine drug prasugrel has a more rapid onset, and higher level of platelet inhibition than clopidogrel. Dose is 60 mg load followed by 10 mg/day for up to 15 months. It is contraindicated in patients with prior stroke or transient ischemic attack

Question 16

With prasugrel therapy, which of the following was prone to serious bleeding ?

A	Elderly
B	Underweight
C	Patients with previous stroke or transient ischemic attack
D	All of the above

Question 16 Explanation:

With prasugrel therapy, three subgroups appeared to be particularly prone to serious bleeding - the elderly, the underweight, and patients with a previous stroke or transient ischemic attack.

Question 17

Which of the following is a reversible ADP inhibitor ?

A	Clopidogrel
B	Prasugrel
C	Ticagrelor
D	All of the above

Question 17 Explanation:

Ticagrelor is a reversible and direct-acting oral antagonist of the adenosine diphosphate receptor P2Y12. It reduces the risk of cardiovascular death, MI, or stroke by 16% compared with clopidogrel in ACS patients without increasing the risk of total bleeding.

Question 18

Which of the following is a direct thrombin inhibitor ?

A	Heparin
B	Bivalirudin
C	Fondaparinux
D	Enoxaparin

Question 18 Explanation:

Fondaparinux is a Factor Xa inhibitor. Bivalirudin is a direct thrombin inhibitor. Enoxaparin is a low molecular weight heparin (LMWH)

Question 19

Laboratory test used to measure the antiplatelet effects of aspirin is ?

A	Optical platelet aggregation
B	Skin bleeding time
C	Urinary 11-dehydrothromboxane B2
D	All of the above

Question 20

Prinzmetal’s variant angina is due to ?

A	Focal spasm of an epicardial coronary artery
B	. Focal spasm of an intramyocardial coronary artery
C	Diffuse spasm of an epicardial coronary artery
D	Diffuse spasm of an intramyocardial coronary artery

Question 20 Explanation:

Described by Prinzmetal in 1959, Prinzmetal’s variant angina is due to focal spasm of an epicardial coronary artery, leading to severe myocardial ischemia. It may be related to hypercontractility of vascular smooth muscle due to vasoconstrictor mitogens, leukotrienes, or serotonin.

Question 21

Prinzmetal’s variant angina may be associated with ?

A	Migraine
B	Raynaud’s phenomenon
C	Aspirin-induced asthma
D	All of the above

Question 21 Explanation:

Prinzmetal’s variant angina is a manifestation of a vasospastic disorder and is associated with migraine, Raynaud’s phenomenon or aspirin-induced asthma.

Question 22

In Prinzmetal’s variant angina, focal spasm is most common in ?

A	Ergonovine
B	Acetylcholine
C	Hyperventilation
D	All of the above

Question 22 Explanation:

Ergonovine, acetylcholine & hyperventilation can provoke focal coronary stenosis. It is used to establish the diagnosis of Prinzmetal’s variant angina.

Question 23

Which of the following is false regarding Prinzmetal’s variant angina ?

A	Nitrates and Ca++ channel blockers are main treatments
B	Ca++ channel blockers given in maximally tolerated doses
C	Prazosin is of no therapeutic value
D	Aspirin may increase the severity of ischemic episodes

Question 23 Explanation:

Nitrates & calcium channel blockers are the main treatments for Prinzmetal’s variant angina. Calcium antagonists are extremely effective in preventing coronary artery spasm of variant angina & they should be prescribed in maximally tolerated doses. Prazosin, a selective alpha adrenoreceptor blocker, has also been found to be of value in some patients, while aspirin may increase the severity of ischemic episodes. The response to beta blockers is variable.

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See all quizzes of Unstable Angina and NonST-Segment Elevation Myocardial Infarction at here:

1.Acute coronary syndrome (ACS) includes ?
A. ST-segment elevation MI
B. Non-ST-segment elevation MI
C. Unstable angina (UA)
D. All of the above

2. Which of the following is true for unstable angina (UA) ?
A. Occurs at rest lasting > 10 minutes
B. New onset angina pectoris
C. Occurs with a crescendo pattern
D. All of the above

3. Which of the following is the most common pathophysiologic process in the development of UA ?
A. Plaque rupture with superimposed nonocclusive thrombus
B. Dynamic obstruction
C. Progressive mechanical obstruction
D. Increased myocardial oxygen demand and/or decreased supply

4. Among patients with UA/NSTEMI, what percentage would have left main stenosis coronary artery disease ?
A. 5 %
B. 15 %
C. 30 %
D. 40 %
5. Among patients with UA/NSTEMI, what percentage would have three-vessel coronary artery disease ?
A. 5 %
B. 15 %
C. 30 %
D. 40 %

6. Among patients with UA/NSTEMI, what percentage would have single-vessel coronary artery disease ?
A. 5 %
B. 15 %
C. 30 %
D. 40 %
7. Among patients with UA/NSTEMI, what percentage would have no critical coronary artery stenosis ?
A. 5 %
B. 10 %
C. 30 %
D. 40 %

8. The clinical hallmark of UA/NSTEMI is chest pain that is ?
A. Substernal
B. Retrosternal
C. Suprasternal
D. Any of the above

9. Cardiac biomarkers include ?
A. C-reactive protein
B. B-type natriuretic peptide
C. CD-40 ligand
D. All of the above

10. Minor troponin elevations can be caused by ?
A. Congestive heart failure
B. Myocarditis
C. Pulmonary embolism
D. All of the above

11. Risk factor for CAD include ?
A. Elevated levels of creatinine
B. Brain natriuretic peptides
C. C-reactive protein
D. All of the above

12. B-type natriuretic peptide is a marker of ?
A. Vascular inflammation
B. Increased myocardial wall tension
C. Plaque rupture
D. All of the above

13. Nitrates must not be administered if sildenafil (Viagra) has been used by the patient within the previous ?
A. 3 hours
B. 6 hours
C. 12 hours
D. 24 hours

14. Letter “C” in CURE trial stands for ?
A. Coronary
B. Carotid
C. Clopidogrel
D. Cardiac

15. Prasugrel is contraindicated in patients with ?
A. Peripheral artery disease
B. Prior stroke or transient ischemic attack
C. Tuberculosis
D. Hypertension

16. With prasugrel therapy, which of the following was prone to mserious bleeding ?
A. Elderly
B. Underweight
C. Patients with previous stroke or transient ischemic attack
D. All of the above
\
17. Which of the following is a reversible ADP inhibitor ?
A. Clopidogrel
B. Prasugrel
C. Ticagrelor
D. All of the above

18. Which of the following is a direct thrombin inhibitor ?
A. Heparin
B. Bivalirudin
C. Fondaparinux
D. Enoxaparin

19. Laboratory test used to measure the antiplatelet effects of aspirin is ?
A. Optical platelet aggregation
B. Skin bleeding time
C. Urinary 11-dehydrothromboxane B2
D. All of the above
20. Prinzmetal’s variant angina is due to ?
A. Focal spasm of an epicardial coronary artery
B. Focal spasm of an intramyocardial coronary artery
C. Diffuse spasm of an epicardial coronary artery
D. Diffuse spasm of an intramyocardial coronary artery

21. Prinzmetal’s variant angina may be associated with ?
A. Migraine
B. Raynaud’s phenomenon
C. Aspirin-induced asthma
D. All of the above

22. In Prinzmetal’s variant angina, focal spasm is most common in ?
A. Right coronary artery
B. Left anterior descending coronary artery
C. Left circumflex coronary artery
D. Posterior descending coronary artery

23. Which of the following can be used to provoke focal coronary spasm in Prinzmetal’s variant angina ?
A. Ergonovine
B. Acetylcholine
C. Hyperventilation
D. All of the above

24. Which of the following is false regarding Prinzmetal’s variant angina ?

A. Nitrates and Ca++ channel blockers are main treatments
B. Ca++ channel blockers given in maximally tolerated doses
C. Prazosin is of no therapeutic value
D. Aspirin may increase the severity of ischemic episodes

Unstable Angina and NonST-Segment Elevation Myocardial Infarction

[MCQ] Unstable Angina and NonST-Segment Elevation Myocardial Infarction

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

Unstable Angina and NonST-Segment Elevation Myocardial Infarction

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