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BCR 1 > Pathology - Angina and acute coronary syndromes > Flashcards

Pathology - Angina and acute coronary syndromes Flashcards

1
Q

what is the most common cause of ischaemic heart disease

a. old age
b. atheroma
c. hypertension
d. smoking
c. hyperlipidaemia

A

b.atheroma

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2
Q

following formation of a fatty streak after endothelial injury what then occurs?

a. macrophage accumulation and inflammation
b. smooth muscle migration
c. progressive lumen narrowing and reduced blood delivery
d. microcircularatory compensation

A

a.macrophage accumulation and inflammation

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3
Q

what type of muscle migrates to an atheroma?

a. smooth
b. skeletal
c. cardiac

A

a.smooth

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4
Q

following history taking and full cardiac exam what is the next stage of angina investigation?

a. ECG
b. MRI
c. Chest X ray

A

a.ECG

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5
Q

what is the first line disease modifying drug for preventing thrombosis in atheroma?

a. clopidogrel
b. ezetimibe
c. rosuvastatin
d. aspirin

A

d.aspirin

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6
Q

after acute coronary syndromes what is given to prevent thrombosis?

a. single anti platelet agent
b. dual antiplatlet agents
c. statins

A

b.dual antiplatlet agents

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7
Q

what is given to reduce cholesterol in patients with ACS?

a. anti platelets
b anti coagulants
c. statins
d. fibrates

A

c. statins

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8
Q

which of these drugs works by improving supply to the heart?

a. beta blockers
b. diltiazem
c. ivabradine
d. nitrates

A

d.nitrates

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9
Q

which of these drugs works by reducing demand to the heart?

a. ivabradine
b. nitrates
c. calcium antagonists
d. nicorandil

A

a.ivabradine

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10
Q

first line for stable angina?

a. beta blocker/CCB
b. statin
c. nitrate
d. anticoagulant

A

a.beta blocker/CCB

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11
Q

patient on BB for stable angina, not well tolerated what should be offered as an alternative?

a. CCB
b. nitrate
c. anticoagulant

A

a.CCB

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12
Q

what should be offered for acute symptomatic relief in stable angina?

a. BB
b. CCB
c. Statins
d. GTN

A

d.GTN

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13
Q

patient on BB monotherapy and symptoms uncontrolled. CCB is contraindicated due to heart failure what should be offered in addition?

a. long acting nitrate
b. warfarin
c. DOAC
d. thiazide like diuretic

A

a.long acting nitrate

or ivabradine/nicorandil/ranolazine

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14
Q

patient on BB and ivabradine, symptoms of stable angina still uncontrolled. what is the best course of action?

a. BB monotherapy
b. CCB monotherapy
c. PCI
d. Coronary angiography

A

d.Coronary angiography

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15
Q

what is the purpose of a coronary angiography?

a. diagnosis
b. treatment
c. guide treatment

A

c.guide treatment

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16
Q

which of these results in chronic coronary syndrome?

a. ischaemia
b. infarction

A

a. ischaemia

17
Q

which of these results in acute coronary syndrome?

a. ischaemia
b. infarction

A

b. infarction

18
Q

a coronary atheroma with a thin fibrous cap, lipid rich necrotic core and active inflammation is known as?

a. vulnerable
b. precarious
c. chronic
d. ischaemic

A

a.vulnerable

19
Q

what is a thrombus formed from?

a. thrombin and fibrin
b. platelet and fibrin
c. cholesterol and lipids

A

b.platelet and fibrin

20
Q

what forms after an atheromatous plaque ruptures?

a.embolism
b.thrombus
c,aneurysm

A

b.thrombus

21
Q

rupturing of an atheromatous plaque leads to..

a. ischaemia
b. infarction

A

b. infarction

22
Q

patient has acute myocardial ischaemia, over time symptoms have accelerated, angiography shows no cardiac injury and bloods show no rise in cTn what is the most likely diagnosis?

a. myocardial infarction
b. unstable angina
c. stable angina

A

b.unstable angina

23
Q

which of these does not occur in unstable angina?

a. rise in cardiac troponin
b. variable ECG changes
c. no cardiac damage
d. accelerating symptoms

A

a.rise in cardiac troponin

24
Q

what happens to cTn in myocardial infarction?

a. rise
b. fall
c. no change

A

a.rise

25
Q

patient with rest symptoms following acute myocardial ischaemia . ECG done and shows changes. which is most likley?

a. myocardial infarction
b. unstable angina
c. hypertension

A

a.myocardial infarction

26
Q

patient has acute myocardial injury with clinical evidence of acute myocardial ischaemia and a change in cTn values above the 99th percentile. In order to diagnose MI they must have at least one from which of these groups?

a. symptoms of ischaemia, new ischaemic ECG change, imaging evidence of loss of myocardium or new wall motion abnormality, identification of coronary thrombus by angiography
b. symptoms of MI, new ischaemic ECG change , imaging evidence of loss of myocardium, previous coronary syndrome, chest x ray evidence

A

a.symptoms of ischaemia, new ischaemic ECG change, imaging evidence of loss of myocardium or new wall motion abnormality, identification of coronary thrombus by angiography

27
Q

clinical criteria for MI includes myocardial injury in conjunction with evidence of acute myocardial ischaemia from symptoms and ECG. How is myocardial injury demonstrated?

a. angiography
b. autopsy
c. ECG

A

c. ECG

28
Q

what is the appropriate first action in STEMI?

a. call 999
b. give aspirin 300 mg daily
c. assess for reperfusion therapy
d. PCI

A

a.call 999

29
Q

which reperfusion therapy is performed in STEMI?

a. CABG
b. PCI

A

b.PCI

30
Q

which type of MI usually results from complete arterial occlusion?

a. STEMI
b. NSTEMI

A

a. STEMI

31
Q

patient on an oral anticoagulant presents with NSTEMI <12 hrs after symptoms began with PCI available within 200 mins what should be done?

a. angiography and PCI
b. prasugrel with aspirin
c. clopidogrel and aspirin

A

c. clopidogrel and aspirin

32
Q

what should be given as first line treatment for NSTEMI?

a. dual antiplatelet therapy
b. dual anticoagulant therapy
c. Angiography

A

a.dual antiplatelet therapy

33
Q

what is usually performed within 3 day of an NSTEMI?

a. ECG
b. PCI
c. CABG
d. Angiography

A

d.Angiography

34
Q

what is used to calculate risk for revascularisation in NSTEMI?

a. QRISK 3
b. GRACE ACS
c. QRISK

A

b. GRACE ACS

35
Q

which anticoagulant is usually used in management of NSTEMI?

a. warfarin
b. DOAC
c. LMWH
d. UFH

A

c. LMWH

36
Q

what does GRACE ACS calculate?

a. 6 month mortality for patients with acute coronary syndrome from admission
b. 10 year risk of mortality for patients with ACS from admission
c. 10 year risk of mortality for patients with ACS from start of symptoms
a. 6 month mortality for patients with acute coronary syndrome from start of symptoms

A

a.6 month mortality for patients with acute coronary syndrome from admission

BCR 1 (60 decks)

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