Acute Coronary Syndrome Quiz! Trivia

1. Which of the following is NOT classified as an acute coronary syndrome (ACS)?

Unstable angina

Atherosclerosis

Non-ST-segment elevation myocardial infarction

ST-segment elevation myocardial infarction

Though atherosclerosis is NOT classified as an ACS, it is part of the etiology of ACS.

Explanation

Though atherosclerosis is NOT classified as an ACS, it is part of the etiology of ACS.

2. An acute coronary syndrome with total occlusion is most consistent with which of the following?

Plaque Rupture

Unstable Angina

Non-ST segment elevation myocardial infarction

ST segment elevation myocardial infarction

An acute coronary syndrome with total occlusion is most consistent with ST segment elevation myocardial infarction. This is because ST segment elevation myocardial infarction (STEMI) occurs when there is a complete blockage of a coronary artery, leading to a lack of blood flow and oxygen to the heart muscle. Plaque rupture can cause a STEMI, as it leads to the formation of a blood clot that completely blocks the artery. Unstable angina and non-ST segment elevation myocardial infarction (NSTEMI) are also acute coronary syndromes, but they do not involve total occlusion of the coronary artery.

Explanation

An acute coronary syndrome with total occlusion is most consistent with ST segment elevation myocardial infarction. This is because ST segment elevation myocardial infarction (STEMI) occurs when there is a complete blockage of a coronary artery, leading to a lack of blood flow and oxygen to the heart muscle. Plaque rupture can cause a STEMI, as it leads to the formation of a blood clot that completely blocks the artery. Unstable angina and non-ST segment elevation myocardial infarction (NSTEMI) are also acute coronary syndromes, but they do not involve total occlusion of the coronary artery.

3. A Percutaneous Coronary Intervention (PCI) has a lower bleeding risk than a fibrinolytic.

True

False

A Percutaneous Coronary Intervention (PCI) is a minimally invasive procedure used to treat blocked or narrowed coronary arteries. It involves inserting a catheter into the blood vessels to open up the blocked artery and restore blood flow to the heart. Compared to a fibrinolytic, which is a medication used to dissolve blood clots, PCI has a lower bleeding risk. This is because PCI is a targeted procedure that directly treats the blocked artery, while fibrinolytics are systemic medications that can affect the entire body, increasing the risk of bleeding complications. Therefore, the statement is true.

Explanation

A Percutaneous Coronary Intervention (PCI) is a minimally invasive procedure used to treat blocked or narrowed coronary arteries. It involves inserting a catheter into the blood vessels to open up the blocked artery and restore blood flow to the heart. Compared to a fibrinolytic, which is a medication used to dissolve blood clots, PCI has a lower bleeding risk. This is because PCI is a targeted procedure that directly treats the blocked artery, while fibrinolytics are systemic medications that can affect the entire body, increasing the risk of bleeding complications. Therefore, the statement is true.

4. Which antiplatelet has the lowest risk of bleeding?

Clopidogrel

Prasugrel

Ticagrelor

Clopidogrel has the lowest risk of bleeding compared to Prasugrel and Ticagrelor. This is because Clopidogrel is a less potent antiplatelet drug, which means it has a lower effect on platelet function and therefore a lower risk of bleeding. Prasugrel and Ticagrelor are more potent antiplatelet drugs and have a higher risk of bleeding as a side effect. Hence, Clopidogrel is considered to be a safer option in terms of bleeding risk.

Explanation

Clopidogrel has the lowest risk of bleeding compared to Prasugrel and Ticagrelor. This is because Clopidogrel is a less potent antiplatelet drug, which means it has a lower effect on platelet function and therefore a lower risk of bleeding. Prasugrel and Ticagrelor are more potent antiplatelet drugs and have a higher risk of bleeding as a side effect. Hence, Clopidogrel is considered to be a safer option in terms of bleeding risk.

5. The "A" in MONA-B stands for "acute pain management".

True

False

This is false. The "A" in MONA-B stands for antiplatelet/anticoagulation. The "M" in MONA-B stands for morphine, which would fall under "acute pain management".

Explanation

This is false. The "A" in MONA-B stands for antiplatelet/anticoagulation. The "M" in MONA-B stands for morphine, which would fall under "acute pain management".

6. Which of the following is NOT a correct recommendation for patients prior to hospital arrival?

Patients should use transdermal nitroglycerin (if available), then wait to see if symptoms subside within 5 minutes

Patients should use sublingual nitroglycerin (if available), then wait to see if symptoms subside within 5 minutes

Patients should chew a non-enteric coated ASA

Patients should seek emergency help (i.e. call 911) if symptoms do not resolve within 5 minutes

With this question, it is a matter of onset of action of the drug. Sublingual nitroglycerin has a rapid onset of action which is important in an acute exacerbation in which the patient would have to seek medical attention (i.e. go to the hospital). On the other hand, transdermal nitroglycerin has a much longer onset because of the dosage formulation. The drug must be released from the patch, penetrate the skin, then make its way into the blood stream. This will not provide the relief needed in an acute exacerbation.

Explanation

With this question, it is a matter of onset of action of the drug. Sublingual nitroglycerin has a rapid onset of action which is important in an acute exacerbation in which the patient would have to seek medical attention (i.e. go to the hospital). On the other hand, transdermal nitroglycerin has a much longer onset because of the dosage formulation. The drug must be released from the patch, penetrate the skin, then make its way into the blood stream. This will not provide the relief needed in an acute exacerbation.

7. Which is not an ABSOLUTE contraindication to fibrinolytic?

Previous intracranial hemorrhage

Suspected aortic dissection

Current use of anticoagulants

Known structural vascular lesion

Current use of anticoagulants is not an absolute contraindication to fibrinolytic therapy. While anticoagulants increase the risk of bleeding, they can be managed and reversed if necessary. On the other hand, previous intracranial hemorrhage, suspected aortic dissection, and known structural vascular lesion are absolute contraindications to fibrinolytic therapy as they significantly increase the risk of bleeding and other complications.

Explanation

Current use of anticoagulants is not an absolute contraindication to fibrinolytic therapy. While anticoagulants increase the risk of bleeding, they can be managed and reversed if necessary. On the other hand, previous intracranial hemorrhage, suspected aortic dissection, and known structural vascular lesion are absolute contraindications to fibrinolytic therapy as they significantly increase the risk of bleeding and other complications.

8. Which is not a goal in unstable angina?

Prevent total occlusion

Limit infarct size

Control chest pain

Control other symptoms

Since there is no infarction in UA, this would not be an appropriate treatment goal.

Explanation

Since there is no infarction in UA, this would not be an appropriate treatment goal.

9. Which CYP is responsible for the interaction between PPIs (e.g. omeprazole) and clopidogrel?

CYP 3A4

CYP 2C9

CYP 2C19

CYP 2D6

CYP 2C19 is responsible for the interaction between PPIs (e.g. omeprazole) and clopidogrel. This enzyme is involved in the metabolism of both drugs, and when PPIs are co-administered with clopidogrel, they can inhibit CYP 2C19 activity, leading to decreased conversion of clopidogrel to its active form. This can result in reduced antiplatelet effects of clopidogrel and potentially increase the risk of cardiovascular events. Therefore, it is important to consider this interaction when prescribing these medications together.

Explanation

CYP 2C19 is responsible for the interaction between PPIs (e.g. omeprazole) and clopidogrel. This enzyme is involved in the metabolism of both drugs, and when PPIs are co-administered with clopidogrel, they can inhibit CYP 2C19 activity, leading to decreased conversion of clopidogrel to its active form. This can result in reduced antiplatelet effects of clopidogrel and potentially increase the risk of cardiovascular events. Therefore, it is important to consider this interaction when prescribing these medications together.

10. Which of the following is NOT true in regards to Coronary Artery Bypass Graft (CABG)?

It relieves angina and risk of mortality in ACS

Vasculature is normally taken from the heart to bypass the arthersclerotic lesions

The procedure requires the heart to be stopped

The number of bypasses (e.g. triple bypass) is equivalent to the number of coronary arteries involved in the procedure

This option is false because normally, vasculature is taken from another part of the body in order to bypass the atherosclerotic lesion.

Explanation

This option is false because normally, vasculature is taken from another part of the body in order to bypass the atherosclerotic lesion.

11. Which are typical clinical presentations of ACS?

Angina

Diaphoresis

Shortness of breath

Headache

Nausea and vomiting

Diarrhea

Typical clinical presentations of ACS include angina, diaphoresis, shortness of breath, and nausea and vomiting. Angina refers to chest pain or discomfort, often described as pressure or squeezing, that occurs when there is reduced blood flow to the heart. Diaphoresis refers to excessive sweating, which can be a symptom of ACS due to increased sympathetic nervous system activity. Shortness of breath can occur due to reduced oxygen supply to the heart muscle. Nausea and vomiting can be caused by the body's response to the stress and pain associated with ACS.

Explanation

Typical clinical presentations of ACS include angina, diaphoresis, shortness of breath, and nausea and vomiting. Angina refers to chest pain or discomfort, often described as pressure or squeezing, that occurs when there is reduced blood flow to the heart. Diaphoresis refers to excessive sweating, which can be a symptom of ACS due to increased sympathetic nervous system activity. Shortness of breath can occur due to reduced oxygen supply to the heart muscle. Nausea and vomiting can be caused by the body's response to the stress and pain associated with ACS.

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12. A male patient is being discharged from the hospital after having a STEMI. The patient has an LDL of 100 mg/dL and an HDL of 45 mg/dL with no contraindications to a statin but is not currently taking one. Which of the following choices BEST describes how to discharge statin therapy should be handled in this patient.

Since this patient has abnormal cholesterol lab values, atorvastatin 10mg should be started and lab values should be drawn in one month to determine any dosage changes needed.

Since this patient has normal cholesterol lab values, a statin is not needed.

Since this patient has normal cholesterol lab values but recently had a STEMI, atorvastatin 10mg would be the best choice for therapy.

Since this patient has normal cholesterol lab values but recently had a STEMI, atorvastatin 80mg would be the best choice for therapy.

Following a STEMI, a high intensity statin (e.g. atorvastatin 80mg) is recommended in ALL patients with no contraindications to a statin.

Explanation

Following a STEMI, a high intensity statin (e.g. atorvastatin 80mg) is recommended in ALL patients with no contraindications to a statin.

13. Which antiplatelet is indicated for PCI only?

Clopidogrel

Prasugrel

Ticagrelor

Prasugrel is the correct answer because it is specifically indicated for use in patients undergoing percutaneous coronary intervention (PCI), also known as angioplasty. PCI is a procedure used to open blocked arteries in the heart, and prasugrel is a potent antiplatelet medication that helps prevent blood clots during and after the procedure. Clopidogrel and Ticagrelor are also antiplatelet drugs, but they have broader indications and can be used in various cardiovascular conditions, not exclusively for PCI.

Explanation

Prasugrel is the correct answer because it is specifically indicated for use in patients undergoing percutaneous coronary intervention (PCI), also known as angioplasty. PCI is a procedure used to open blocked arteries in the heart, and prasugrel is a potent antiplatelet medication that helps prevent blood clots during and after the procedure. Clopidogrel and Ticagrelor are also antiplatelet drugs, but they have broader indications and can be used in various cardiovascular conditions, not exclusively for PCI.