FastTest. You ve read the book now test yourself

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1 FastTest You ve read the book now test yourself To ensure you have learned the key points that will improve your patient care, read the authors questions below. The answers will refer you back to relevant sections of the book to address any areas of uncertainty. Which of the following statements are correct? Note: there may be more than one correct answer per question.

2 1 Pathophysiology 1. Plaque rupture: a) Is more common in men than women b) Nearly always leads to an acute coronary syndrome c) Can produce distal microembolization that causes microvascular obstruction and myocardial ischemia/infarction d) Often occurs at sites of severe arterial stenoses 2. The main determinants of thrombus formation (the classic Virchow triad ) are: a) The thrombogenicity of the plaque material b) The site of the plaque c) Local flow disturbances d) Systemic thrombotic propensity

3 2 Diagnosis, risk stratification and decision-making 3. Chest pain indicative of an acute coronary syndrome (ACS): a) Is usually central (substernal), upper abdominal or epigastric b) Worsens when the chest is pressed c) Can radiate over a large area including one or both arms d) May not be severe e) Can be localized by the patient by pointing a finger

4 4. Routine primary diagnostic tests in patients with suspected ACS should include: a) An assessment of vital signs, jugular venous pressure, heart sounds and murmurs, and peripheral perfusion b) A resting 12-lead ECG within 10 minutes of first medical contact c) A resting 17-lead ECG d) Examination of the abdomen 5. Myocardial injury is characterized by the occurrence of: a) Elevated high-sensitivity troponin b) Elevated creatine kinase-mb (CK-MB) b) Elevated C-reactive protein (CRP) d) All of the above

5 6. Ischemic risk stratification scores include: a) TIMI b) GRACE c) CRUSADE d) ACUITY e) CADILLAC

6 7. Using the TIMI risk stratification score, patients are considered to be at greater risk of a composite endpoint of all-cause mortality, MI and severe recurrent ischemia if they have: a) 5 of 8 variables b) 2 of 7 variables c) 3 of 7 variables d) 3 of 8 variables

7 3 Coronary revascularization 8. The preferred choice of revascularization (percutaneous coronary intervention or coronary artery bypass grafting) depends on: a) Extent and severity of lesions b) Patient s age c) Potential infarct complications (e.g. mitral insufficiency) d) Patient s comorbidities 9. Currently, the most widely used stent is: a) Bare-metal stent b) Drug-eluting stent c) Biodegradable stent d) None of the above

8 10. Potential grafts for coronary artery bypass grafting are: a) Femoral artery from the leg b) Mammary artery from the chest wall c) Saphenous vein from the leg d) Popliteal vein from the leg

9 4 Unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI) 11. NSTEMI is characterized by: a) Chest pain b) No ST-segment elevation c) Normal troponin levels d) Non-occlusive thrombus 12. Patients with UA/NSTEMI: a) Have a higher 4-year mortality rate than patients with STEMI b) If hemodynamically stable, should be treated in an outpatient setting c) Should be considered for early invasive management if assessed as high risk d) Should receive an anticoagulant as soon as possible after presentation, provided there are no contradindications

10 13. Which one of the following agents is NOT a P2Y 12 receptor inhibitor? a) Ticlopidine b) Clopidogrel c) Cangrelor d) Vorapaxar e) Ticagrelor 14. Recommendations for diabetic patients with UA/ NSTEMI include: a) Aggressive glycemic control b) A conservative treatment strategy c) Intravenous GPIIb/IIIa administration as part of initial medical management d) All of the above

11 5 ST-segment elevation myocardial infarction (STEMI) 15. STEMI is typically characterized by: a) ST-segment elevation b) Elevated cardiac biomarkers indicative of necrosis c) Total occlusion of the culprit coronary artery d) A platelet-rich (white) thrombus

12 16. From first medical contact, primary PCI should be performed in STEMI patients within: a) 30 minutes b) 60 minutes c) 90 minutes d) 120 minutes 17. Indications for fibrinolytic therapy for patients with STEMI are: a) Early presentation ( 3 hours from symptom onset) b) More mature clot c) High risk of bleeding and intracranial hemorrhage d) Delay to primary PCI

13 18. Fondaparinux is not recommended at all in primary PCI for acute STEMI patients because of: a) Increased risk of intracranial hemorrhage b) Catheter-related thrombus complications c) High cost d) Increased risk of gastrointestinal bleeding

14 6 Secondary prevention of coronary artery disease 19. The blood pressure goal for patients with ACS should be: a) 120/80 mm Hg b) 130/90 mm Hg or less c) 140/90 mmhg d) None of the above 20. Key goals of weight and lipid management in patients with ACS include: a) An initial reduction in bodyweight of 5 10% from baseline b) A waist circumference of < 35 inches in men c) A target level of < 100 mg/dl LDL cholesterol in very high-risk patients d) At least a 30 40% reduction in LDL cholesterol levels when LDL-lowering medications are used

15 7 Developments 21. Triple antithrombotic therapy (dual antiplatelet therapy plus anticoagulation): a) Is not recommended in patients with atrial fibrillation (AF) b) Increases the risk of major bleeding markedly at 1 year compared to dual antiplatelet therapy c) Is recommended for 12 months in patients treated with drug-eluting stents (Europe and USA) d) Requires gastric protection, preferably with proton pump inhibitors

16 22. Clopidogrel metabolism is influenced by: a) Presence of the CYP2C19 loss-of-function allele b) Renal dysfunction c) Concomitant medications such as proton pump inhibitors, warfarin or calcium-channel blockers d) Diabetes

17 Thank you for taking this FastTest. There is no final score or certificate, but by reinforcing your understanding you have enhanced your clinical skills and practice. Now use the page at the back of the book to write 3 action points that will improve the experience of the next patient you see with an acute coronary syndrome. If you have time to share your action points with us, or have suggestions for improving the book or test, we d love to hear from you: feedback@fastfacts.com. And if you found the book useful, please spread the word about Fast Facts to your colleagues, students and patients.