MI Practice Questions

Question 1

A 53-year-old man with a past medical history significant for hyperlipidemia, hypertension, and hyperhomocysteinemia presents to the emergency department complaining of 10/10 crushing, left-sided chest pain radiating down his left arm and up his neck into the left side of his jaw. His ECG shows ST-segment elevation in leads V2-V4. He is taken to the cardiac catheterization laboratory for successful balloon angioplasty and stenting of a complete blockage in his left anterior descending coronary artery. Echocardiogram the following day shows decreased left ventricular function and regional wall motion abnormalities. A follow-up echocardiogram 14 days later shows a normal ejection fraction and no regional wall motion abnormalities. This post-infarct course illustrates which of the following concepts?

Accepted Answer

Myocardial stunning

Answer

Coronary collateral circulation

Answer

Ventricular remodeling

Answer

Myocardial hibernation

Answer

Reperfusion injury

Question 2

A 64-year-old man presents to his physician for a scheduled follow-up visit. He has chronic left-sided heart failure with systolic dysfunction. His current regular medications include captopril and digoxin, which were started after his last episode of symptomatic heart failure approximately 3 months ago. His last episode of heart failure was accompanied by atrial fibrillation, which followed an alcohol binge over a weekend. Since then he stopped drinking. He reports that he has no current symptoms at rest and is able to perform regular physical exercise without limitation. On physical examination, mild bipedal edema is noted. The physician suggested to him that he should discontinue digoxin and continue captopril and scheduled him for the next follow-up visit. Which of the following statements best justifies the suggestion made by the physician?

Accepted Answer

Digoxin is useful to treat atrial fibrillation, but does not benefit patients with systolic dysfunction who are in sinus rhythm.

Answer

Long-term digoxin therapy produces significant survival benefits in patients with heart failure, but at the cost of increased heart failure-related admissions.

Answer

Both captopril and digoxin are likely to improve the long-term survival of the patient with heart failure, but digoxin has more severe side effects.

Answer

Captopril is likely to improve the long-term survival of the patient with heart failure, unlike digoxin.

Answer

Digoxin does not benefit patients with left-sided heart failure in the absence of atrial fibrillation.

Question 3

A 54-year-old man is brought to the emergency department 1 hour after the sudden onset of shortness of breath, severe chest pain, and sweating. He has hypertension and type 2 diabetes mellitus. He has smoked one pack and a half of cigarettes daily for 20 years. An ECG shows ST-segment elevations in leads II, III, and avF. The next hospital with a cardiac catheterization unit is more than 2 hours away. Reperfusion pharmacotherapy is initiated. Which of the following is the primary mechanism of action of this medication?

Accepted Answer

Conversion of plasminogen to plasmin

Answer

Inhibition of glutamic acid residue carboxylation

Answer

Blocking of adenosine diphosphate receptors

Answer

Direct inhibition of thrombin activity

Answer

Prevention of thromboxane formation

Question 4

A 66-year-old female with hypertension and a recent history of acute ST-elevation myocardial infarction (STEMI) 6 days previous, treated with percutaneous transluminal angioplasty (PTA), presents with sudden onset chest pain, shortness of breath, diaphoresis, and syncope. Vitals are temperature 37°C (98.6°F), blood pressure 80/50 mm Hg, pulse 125/min, respirations 12/min, and oxygen saturation 92% on room air. On physical examination, the patient is pale and unresponsive. Cardiac exam reveals tachycardia and a pronounced holosystolic murmur loudest at the apex and radiates to the back. Lungs are clear to auscultation. Chest X-ray shows cardiomegaly with clear lung fields. ECG is significant for ST elevations in the precordial leads (V2-V4) and low-voltage QRS complexes. Emergency transthoracic echocardiography shows a left ventricular wall motion abnormality along with a significant pericardial effusion. The patient is intubated, and aggressive fluid resuscitation is initiated. What is the next best step in management?

Accepted Answer

Immediate transfer to the operating room

Answer

Immediate cardiac catheterization

Answer

Emergency pericardiocentesis

Answer

Intra-aortic balloon counterpulsation

Answer

Administer dobutamine 5-10 mcg/kg/min IV

Question 5

A 49-year-old man with a past medical history of hypertension on amlodipine presents to your office to discuss ways to lessen his risk of complications from heart disease. After a long discussion, he decides to significantly decrease his intake of trans fats in an attempt to lower his risk of coronary artery disease. Which type of prevention is this patient initiating?

Accepted Answer

Primary prevention

Answer

Secondary prevention

Answer

Delayed prevention

Answer

Quaternary prevention

Answer

Tertiary prevention

Question 6

A 56-year-old man presents to the emergency room with severe substernal chest pain associated with a 2-hour history of breathlessness and sweating. An electrocardiogram shows an ST-segment elevation myocardial infarction. Cardiac enzyme levels confirm a diagnosis of acute myocardial infarction. The patient is rushed to the catheter lab for angioplasty with stenting. The patient complains of recurrent chest pain in the ICU 56 hours post-angioplasty. Which of the following enzymes facilitates the patient’s diagnosis based on his current symptoms?

Accepted Answer

Creatine kinase (CK)-MB

Answer

Creatine kinase – MM

Answer

Troponin T

Answer

Troponin I

Answer

Lactate dehydrogenase (LDH)

Question 7

A 61-year-old man is brought to the emergency department by ambulance because of severe retrosternal chest pain and shortness of breath for 30 minutes. Paramedics report that an ECG recorded en route to the hospital showed ST-segment elevation in I, aVL, and the precordial leads. On arrival, the patient is unresponsive to painful stimuli. Examination shows neither respiration nor pulse. Despite appropriate lifesaving measures, he dies 10 minutes later. Which of the following is the most likely cause of death in this patient?

Accepted Answer

Ventricular fibrillation

Answer

Left ventricular failure

Answer

Cardiac free wall rupture

Answer

Ventricular aneurysm

Answer

Hemorrhagic stroke

Question 8

A 55-year-old man comes to the emergency department because of left-sided chest pain and difficulty breathing for the past 30 minutes. His pulse is 88/min. He is pale and anxious. Serum studies show increased cardiac enzymes. An ECG shows ST-elevations in leads I, aVL, and V5-V6. A percutaneous coronary intervention is performed. In order to localize the site of the lesion, the catheter must pass through which of the following structures?

Accepted Answer

Left coronary artery → left circumflex artery

Answer

Right coronary artery → posterior descending artery

Answer

Left coronary artery → left anterior descending artery

Answer

Right coronary artery → right marginal artery

Answer

Left coronary artery → posterior descending artery

Question 9

A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

Accepted Answer

"Can you tell me more about the symptoms you have been experiencing?"

Answer

"Does the diarrhea typically precede the constipation, or vice-versa?"

Answer

"Is the diarrhea foul-smelling?"

Answer

"Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"

Answer

"Are the symptoms worse in the morning or at night?"

Question 10

A 70-year-old man with diabetes, hypertension, and chronic kidney disease (eGFR 35 mL/min/1.73m²) presents with NSTEMI. Troponin is elevated at 8.5 ng/mL. ECG shows 2mm ST depression in V2-V5. GRACE score is 165 (high risk). He is hemodynamically stable. Cardiologist recommends early invasive strategy within 24 hours. Nephrologist is concerned about contrast-induced nephropathy potentially requiring dialysis. Patient is on metformin. Evaluate the management strategy integrating multiple specialist perspectives and evidence.

Accepted Answer

Proceed with angiography within 24 hours using iso-osmolar contrast and intravenous hydration, hold metformin

Answer

Perform coronary CT angiography as alternative to invasive angiography

Answer

Delay catheterization for 72 hours to optimize renal function with hydration

Answer

Prophylactic hemodialysis before and after catheterization to remove contrast

Answer

Medical management only with dual antiplatelet therapy, avoid catheterization

MI

Study Resources

Lessons

Questions

Flashcards

Lessons

Initial assessment and triage

ECG interpretation in MI

Biomarker interpretation

STEMI management algorithm

NSTEMI management algorithm

Reperfusion strategies (fibrinolysis vs PCI)

Antithrombotic therapies

Antiplatelet management

Beta-blockers, ACE-I/ARBs, statins

Mechanical complications management

Arrhythmic complications management

Cardiogenic shock management

Post-MI secondary prevention

Practice Questions

Flashcards

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