Acute Coronary Syndrome (ACS) and Myocardial Infarction (MI)

What is the key evidence of elevated cardiac troponin values in the diagnosis of acute myocardial
infarction (AMI)?

a. ECG changes

b. Symptoms of myocardial ischemia

c. Pathological Q waves

d. Rise and/or fall of cTn values

According to the Fourth Universal Definition of Myocardial Infarction, what is considered acute
myocardial injury?

a. Symptoms of myocardial ischemia

b. Rise and/or fall of cTn values

c. Imaging evidence of new loss of viable myocardium

d. Development of pathological Q waves

Which of the following is NOT a criterion for the diagnosis of acute myocardial infarction (types 1, 2,
and 3 MI)?

a. New ischaemic ECG changes

b. Imaging evidence of new loss of viable myocardium

c. Identification of a coronary thrombus (for types 2 or 3 MIs)

d. Chest pain relief with sublingual nitroglycerin

In the clinical presentation of ACS, which symptom is NOT commonly associated?

a. Chest pain

b. Diaphoresis

c. Abdominal pain

d. Dyspnea

What is the most typical site of chest pain in ACS?

a. Left side
b. Precordial

c. Epigastric

d. Left arm

Diagnostic Evaluation and Risk Stratification

In the differential diagnosis of acute chest pain, which condition is NOT mentioned?

a. Aortic dissection

b. Pericarditis

c. Pneumothorax

d. Pulmonary embolism

What is the recommended imaging modality for routine evaluation in emergency rooms for patients
with non-ST-segment elevation ACS?

a. Coronary angiography

b. Transthoracic echocardiography

c. Coronary Angio CT

d. Cardiac magnetic resonance imaging

According to the 2020 ESC Guidelines, which troponin is more specific for myocyte necrosis?

a. CK

b. CK MB

c. Myoglobin

d. Troponins

What is the preferred biomarker for short-term prognosis (30 days) of infarct or death?

a. CK

b. CK MB

c. Myoglobin

d. Troponins

What is the role of high sensitivity troponin in the management of non-ST-segment elevation ACS?
a. Rule out ACS in all patients

b. Assess the risk of bleeding

c. Aid in the detection of lower levels of troponin

d. Determine the need for coronary angiography

Treatment Strategies

What is the primary mechanism of action of aspirin in the treatment of ACS?

a. Inhibition of cyclooxygenase (COX-1)

b. Inhibition of ADP-dependent platelet aggregation

c. Direct inhibition of thrombin

d. Enhancement of fibrinolysis

Which P2Y12 receptor blocker is associated with a faster onset of action and faster restoration of
platelet activity compared to clopidogrel?

a. Clopidogrel

b. Prasugrel

c. Ticagrelor

d. Cangrelor

What is the main indication for the use of glycoprotein IIb/IIIa receptor antagonists in ACS?

a. Peripheral vasodilation

b. Coronary vasodilation

c. Inhibition of platelet aggregation

d. Reduction of myocardial oxygen consumption

What is the recommended anticoagulant therapy during percutaneous coronary intervention (PCI)?

a. Unfractionated heparin

b. Low molecular weight heparin (LMWH)

c. Fondaparinux

d. Bivalirudin
In patients with an indication for oral anticoagulation (e.g., atrial fibrillation) and ACS, what is the
recommended triple antithrombotic therapy?

a. Aspirin, clopidogrel, warfarin

b. Aspirin, ticagrelor, apixaban

c. Aspirin, prasugrel, rivaroxaban

d. Aspirin, clopidogrel, dabigatran

Long-term Management

What is the recommended duration of dual antiplatelet therapy (DAPT) following ACS?

a. 3 months

b. 6 months

c. 12 months

d. 24 months

Which of the following medications is NOT part of the long-term treatment strategy for ACS?

a. Beta-blocker

b. ACE inhibitor

c. Calcium channel blocker

d. Anticoagulant

What is the primary purpose of beta-blockers in the long-term management of ACS?

a. Lowering cholesterol levels

b. Reducing myocardial oxygen consumption

c. Improving coronary vasodilation

d. Enhancing fibrinolysis

In patients with ACS and left ventricular dysfunction, which medication has proven mortality benefit?

a. Aspirin

b. Beta-blocker

c. ACE inhibitor

d. Statin
What is the primary goal of long-term treatment in ACS patients?

a. Symptom control

b. Lowering the risk of complications

c. Reducing mortality

d. All of the above

Risk Stratification and Complications

What is a major risk factor for bleeding in patients undergoing triple antithrombotic therapy?

a. Age >75 years

b. Female gender

c. Hypertension

d. Elevated cholesterol levels

According to the GRACE risk score, what score is considered high risk?

a. >100

b. >120

c. >140

d. >160

In patients with NSTE-ACS and dynamic ST-segment or T wave changes, what is recommended for
risk stratification?

a. Continuous ECG monitoring

b. Serial troponin measurements

c. Coronary angiography

d. Echocardiography

Which condition is NOT a determinant for antithrombotic therapy in non-ST elevation ACS?

a. Age

b. Gender

c. Diabetes
d. Hypertension

What is the primary purpose of risk stratification in ACS?

a. Determine the optimal time for revascularization

b. Assess the need for thrombolytic therapy

c. Guide the choice and intensity of antithrombotic therapy

d. Predict the likelihood of developing chest pain

Miscellaneous

Which imaging modality is recommended for routine evaluation in emergency rooms for patients
with suspected ACS?

a. Chest X-ray

b. Coronary angiography

c. Transthoracic echocardiography

d. Nuclear myocardial perfusion imaging

What is the target LDL cholesterol level in patients with ACS?

a. <70 mg/dL

b. <100 mg/dL

c. <130 mg/dL

d. <160 mg/dL

What is the primary purpose of revascularization in the treatment of ACS?

a. Relieve chest pain

b. Improve exercise tolerance

c. Restore blood flow to the ischemic myocardium

d. Reduce the risk of bleeding

In patients with ACS and persistent symptoms despite medical therapy, what is the next step in
management?

a. Increase the dose of antiplatelet agents

b. Add a second antiplatelet agent

c. Perform coronary angiography

d. Administer thrombolytic therapy

What is the main advantage of ticagrelor over clopidogrel in the treatment of ACS?

a. Faster onset of action

b. Irreversible binding to P2Y12 receptor

c. Lower risk of bleeding

d. No need for concomitant aspirin therapy

Answer Key

a
c