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Question 1

The type III lesion is characterized by pools of intracellular lipid and collagen

Answer 1

F

Question 2

The individual risk for plaque progression to complete occlusion is higher in nonobstructive lesions

Answer 2

F

Question 3

Smooth muscle cells are responsible for weakening the fibrous cap

Answer 3

F

Question 4

Class I American College of Cardiology/American Heart Association (ACC/AHA 2007) guidelines regarding early risk stratification for the management of patients with UA and non-ST segment elevation MI (NSTEMI) include all of the following, except

Answer 4

If the initial ECG is not diagnostic but the patient remains symptomatic and there is high clinical suspicion for ACS, serial ECGs, initially at 30 to 60 min intervals, should be performed to detect the potential for development of ST-segment elevation or depression.

Question 5

Class I ACC/AHA guidelines (2007) regarding immediate management of patients with UA and NSTEMI include all of the following

Answer 5

In patients with suspected ACS with a low or intermediate probability of CAD, in whom the follow-up 12-lead ECG and cardiac biomarker measurements are normal, performance of a noninvasive coronary imaging test (i.e., coronary CT angiography) is reasonable as an alternative to stress testing.

Question 6

With which of the following cardiac markers of necrosis is the earliest initial rise seen?

Answer 6

myoglobin

Question 7

Which area of the myocardium is more vulnerable to ischemic damage ?

Answer 7

subendocardium

Question 8

Class I ACC/AHA guidelines (2007) regarding antiischemic therapy for patients with UA and NSTEMI include all of the following

Answer 8

In the absence of contraindications to its use, it is reasonable to administer morphine sulfate intravenously to UA/NSTEMI patients if there is uncontrolled ischemic chest
discomfort despite NTG, provided that additional therapy is used to manage the underlying ischemia.

Question 9

Diagnosis utama yang paling sesuaiuntukkasus No.10 di atasadalah:

Answer 9

Bukansalahsatudiatas

Question 10

Tatalaksanaawal yang harusdiberikanpadakasus di atas (kasus no.10) adalah

Answer 10

Nitrat, oksigen, aspirin kunyah-kunyah, morfin, IV line.

Question 11

Iskemi daerah dinding lateral miokard ditunjukkan oleh rekaman EKG sadapan

Answer 11

I, aVL, V5, V6

Question 12

Melanjutkankasus No.10, pemeriksaanhasillaboratoriummenunjukkanHb 14,4 g/dl, Ht 39 vol%, Trop T 1,2 CKMB 187. Diagnosis kasus no.10 adalah:

Answer 12

Non STEMI akut

Question 13

Strategi tatalaksana selanjutnya adalah

Answer 13

Stratifikasi risiko dan heparinisasi

Question 14

Diagnosis banding kelainan EKG dengan ST elevasiadalah

Answer 14

Semuadiatasbena

Question 15

Which of the following statements is false regarding coronary thrombosis in UAP and non STEMI?

Answer 15

Thrombosis reduces embolization and facilitates intervention

Question 16

Penentuan kategori diagnostik untuk rekurensi Demam Rheuma yang disertai dengan penyakit jantung rheuma sesuai dengan kriteria WHO 2002-2003 adalah :

Answer 16

Ditandai dengan adanya 1 kriteria mayor dan 2 kriteria minor dan bukti adanya infeksi bakteri Streptokokus grup A

Question 17

Pharmacotherapies known to reduce the occurrence of death or myocardial infarction (MI) among patients with NonSTEMI include all of the following, except:

Answer 17

Fibrinolytics agent

Question 18

As compared with second and third generation fibrinolytic agents, which of the following statements regarding streptokinase is false?

Answer 18

Streptokinase has the shortest half life

Question 19

Which of the following is not an absolute contraindication for thrombolytic therapy?

Answer 19

Active menses

Question 20

A 55 year old man with hyperlipidemia and obesity undergoes PCI with sirolimus eluting stenting to LAD to treat his non STEMI. The PCI is successful. His BP is not elevated. Post PCI echocardiogram reveals normal ventricular function and mild mitral regurgitation. His discharge medications should include:

Answer 20

Aspirin 81 mg daily, clopidogrel 75 mg daily, a statin and a beta blocker

Question 21

A 72 year old woman in severe respiratory distress was taken to the ER by paramedics who intubated her in the field. According to her husband, she started experiencing chest pain 2
hours ago. She has a history of hypertension and hyperlipidemia only and has been healthy until she experienced chest pain 2 hours ago. According to the ER physician, her BP is 80/60 mmHg on levophed and her HR is 110 bpm. Her ECG shows 5 mm ST elevation in the anterior leads. The ER is located 3 hours from your hospital with cath lab. The ER physician is certified to place IABP. What should be done next?

Answer 21

Fibrinolytic therapy, IABP and emergency transfer

Question 22

The patient above is transferred to your hospital. You are waiting for her in the cath lab. She still has ST elevation and she still on levophed with a BP of 80/60 and HR of 120 bpm. She undergo emergent catheterization and is found to have multivessel disease with chronically occluded long RCA stenosis, 80% type A lesion in a moderate size CX artery and 100% LAD lesion. The proximal LAD is filled with thrombus but is a PCI approachable lesion. What should be done next?

Answer 22

Refer to CABG

Question 23

After primary PCI, which of the following findings is associated with the worst mortality?

Answer 23

TIMI 2 myocardial perfusion grade

Question 24

Immediate beta blockers should not be used in which of the following situations?

Answer 24

Systolic blood pressure < 100 mmHg

Question 25

Which of the following time delays in primary PCI is associated with the highest mortality?

Answer 25

Symptoms to balloon time

Question 26

Goals for reperfusion therapy for STEMI are

Answer 26

Door to needle time < 30 minutes and door to balloon time < 90 minutes

Question 27

A 64 year old woman is seen the emergency department with severe shortness of breath for the last hour. Her ECG shows ST segment elevations with hyperacute T waves in leads II,III,aVF. On physical examination, her BP is 140/70 mmHg with HR of 85 bpm. The remainder of the physical examination is unremarkable. What is the best reperfusion strategy in this patient?

Answer 27

Fibrinolytic therapy or primary PCI

Question 28

In patients < 75 years old receiving fibrin specific fibrinolytic agents as the main strategy for reperfusion, which of the following is the most efficacious anticoagulation regimen?

Answer 28

Enoxaparin 1 mg/kg SC, twice daily

Question 29

A 72-year-old white female, previously well controlled on a once-dailycombination pill containing atenolol 50 mg and hydrochlorothiazide 25 mg, presentswith a rise in her blood pressure to 170/110. You add 5 mg of lisinopril, and hercreatinine rises from 1.1 to 1.9. What do you suspect?

Answer 29

Atherosclerotic renal artery stenosis

Question 30

Which of the following scenarios illustrates the most appropriate first-lineselection of antihypertensive agent in the hypertensive patient described?

Answer 30

A 32- year-old with chronic migraines is prescribed metoprolol

Question 31

A 47-year-old male with diabetes presents as a new patient to your clinic. Hedoes not recall any abnormal blood pressure readings. You find his blood pressure tobe 138/86 on two readings during this visit. You should

Answer 31

Provide lifestyle counseling and recheck blood pressure within a few months

Question 32

In which of the following patients is the goal LDL cholesterol not less than 100mg/dL?

Answer 32

A 63-year-old man with hypertension, tobacco use, and a low HDL

Question 33

Which of the following statements is false with respect to STEMI versusNSTEMI?

Answer 33

The thrombus in a STEMI is more platelet rich than is the thrombus of aNSTEMI

Question 34

A 60-year-old man presents with an acute anterior MI. He receives tPA in theemergency room one hour after onset of symptoms with rapid resolution of pain andST elevations. He is admitted to the coronary care unit feeling well, pain free, andwith stable blood pressure and pulse. Which intervention is least appropriate next?

Answer 34

Urgent cardiac catheterization with possible percutaneous coronary intervention

Question 35

A 72-year-old woman presents to your office with dyspnea and peripheraledema. On examination, her BP is 180/70 mm Hg and her pulse is 100 bpm. She haselevated jugular venous pressure, peripheral edema of the ankles, and a fourth heartsound. All of the following would be reasonable to obtain in the near future except

Answer 35

24-hour Holter monitor

Question 36

A 65-year-old man presents with class III symptoms of heart failure and a known ischemic cardiomyopathy with prior myocardial infarctions. His EF is 18%. HisECG shows a QRS duration of 110 ms. Appropriate therapy for this man wouldinclude all of the following except

Answer 36

A biventricular pacing ICD

Question 37

A 62-year-old man with chronic congestive heart failure (CHF) due to coronaryartery disease has been on a stable medical regimen of lisinopril, aspirin, andfurosemide for years. He has been extremely compliant with medications and officevisits. He closely monitors his weight daily. In addition to his CHF, he hashypertension, diabetes, and gout. Last month, he suffered a gout flare-up that isbeing treated with indomethacin. Over the last three weeks he has noticed a gradualdecline in exercise tolerance, a weight gain of 5 pounds, and worsening pedaledema. What is the most appropriate course of action?

Answer 37

Discontinue the indomethacin

Question 38

A 75-year-old man is diagnosed with aortic stenosis. What is the most likelyetiology of his valvular disorder?

Answer 38

Degenerative calcific valve

Question 39

A 65-year-old man with a history of rheumatic fever as a child underwent a rootcanal four weeks ago. Two weeks ago, he presented to the emergency departmentwith fever, myalgias, and fatigue. Admission creatinine was 1.8 with microscopichematuria. An echocardiogram revealed mitral valve vegetation, and he was startedon intravenous antibiotics for presumed endocarditis. Blood cultures subsequentlygrow Stetococcusviridans. He responds well, with resolution of his fever and returnof his creatinine to normal. However, on the day of discharge, you are calledurgently to his room because of sudden shortness of breath. His examination isnotable for labored breathing, a blood pressure of 90/55, crackles in the bases of thelungs, and II/VI systolic murmur. An ECG is notable for sinus tachycardia at 110 bpmbut no ischemic changes. What is the best course of action?

Answer 39

Urgent echocardiogram and surgical consultation

Question 40

A 31-year-old woman is 28 weeks pregnant with her first child. She is relativelyhealthy and has had an uneventful pregnancy. Her obstetrician asked her to call youbecause she has had increasing difficulty breathing at night. In fact she is now usingthree pillows and occasionally wakes up gasping for air. In your office she appearsdyspneic when speaking in full sentences. Her blood pressure is 95/65 and her pulseis 118. Lung examination is notable for crackles at both bases. Cardiac exam revealsa loud S1, and an extra sound in diastole. ECG shows deep inverted P waves in V1and a rightward QRS axis. She has 1+ pitting edema in the lower extremities. Whichof the following is true?

Answer 40

The likely diagnosis is mitral stenosis, and she should respond to furosemideand β-blockers