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ACS, or acute coronary syndromes, are a cluster of syndromes characteristed by insufficient perfusion of the coronary arterial circulation to the myocardium. The result is ischaemic chest pain during various levels of activity. This MCQ tests your knowledge on some fundamental ACS facts. Good luck!

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Acute Coronary Syndromes

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Question 1
How would you define the quality of ischaemic chest pain?
A
Central
B
Crushing
C
Sharp, localised
D
Replicated with palpation
Question 2
A patient presents with crushing chest pain that is not relieved with rest. `The patient has a five year history of controlled stable angina.  He has no ischaemic ECG changes, but cardiac troponin is raised.  Which of the following is the best supported diagnosis?
A
STEMI
B
NSTEMI
C
Unstable angina
D
Stable angina
Question 3
Which sign below is less likely on physical examination of an ACS patient?
A
Relieved when leaning forward
B
S3 heart sound
C
Bibasal lung field crackles
D
Central cyanosis
E
Pain not relieved with rest or ISMN administration
Question 3 Explanation: 
Pain relief when sitting forwards is characteristic of pericarditis which you would be more likely to see in patients with inflammatory conditions such as rheumatoid arthritis or ankylosing spondylitis.
Question 4
Unstable angina refers to ...
A
The propensity for cardiac arrest
B
The elevated troponin C levels in the serum
C
The fact that rest does not relieve symptoms
D
ST elevation
Question 5

Stem 1 of 5

A patient with history of unstable angina is blue-lighted into ED with bradycardia, raised JVP, reduced LOC and noted hypotension.
How is JVP measured?
A
Measure from the sternal angle
B
Measure from the suprasternal notch
C
Measure from the xiphoid process
D
Measure circumferentially about the cervical region
Question 6

Stem 2 of 5

Which initial examination would you not conduct?
A
Cardiovascular physical exam to listen for heart sounds
B
Respiratory physical exam to listen for oedema
C
ECG to check for ischaemic changes
D
Abdominal examination to assess hepatosplenomegaly secondary to raised JVP
Question 7

Stem 3 of 5

Investigations are returned with noted troponin elevation. BUN and sCreat are also raised. What accounts for the latter findings?
A
AKI
B
CKD
C
CGD
D
TF exposure
Question 7 Explanation: 
BUN (blood urea nitrogen) and sCreat (serum creatinine) are both markers of kidney function. When they are raised, it can indicate that the kidneys are not functioning properly. In this case, the low blood pressure (hypotension) means the kidneys are not being perfused sufficiently.
Question 8

Stem 4 of 5

ECG ischaemic changes are noted in the V3 lead. Which of the following vessels are most likely to be occluded?
A
LAD
B
PIVA
C
Circumflex
D
Marginal
Question 9

Stem 5 of 5

Which of the following is not a trigger of the platelet plug formation?
A
Collagen
B
vWF
C
Platelet degranulation
D
Tissue factor
Question 10
On post-mortem a patient who died of myocardial infarction is found to have a marginal branch thrombus that is described on pathology report as:
Red, fibrin-rich and stable
Which of the following best matches this occlusive event?
A
NSTEMI
B
STEMI
C
Unstable angina
D
Stable angina
Question 11
Of the following ECG changes, which suggest an historic infarct?
A
Inverted T wave
B
ST-elevation
C
ST-depression
D
Pathological Q wave
Question 12
During primary haemostasis, which factor - of those below - is degranulated by thrombocytes?
A
ATP
B
ANP
C
ADP
D
GMP
Question 13
Which of the following are antiplatelet medications?
A
Clopidogrel
B
Heparin
C
Warfarin
D
Dabigatran
Question 14
Which is not a surgical treatment for MI?
A
PCI
B
Stenting
C
REBOA
D
CABG
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There are 14 questions to complete.

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