A 68-year-old woman with type 2 diabetes mellitus and hypertension presents with intermittent central chest heaviness at rest over the preceding four hours, with the longest episode lasting 30 minutes. She is now pain-free. Her pulse is 84 beats/min, blood pressure is 146/86 mmHg, and oxygen saturation is 96% on room air. There are no clinical signs of heart failure. ECG demonstrates 2 mm horizontal ST-segment depression in leads V4–V6 and T-wave inversion in leads I and aVL. High-sensitivity troponin T is 86 ng/L on arrival and rises to 310 ng/L three hours later (upper reference limit 14 ng/L). Her creatinine is 82 µmol/L, and she has received aspirin 300 mg.
What is the most likely diagnosis?
Anonymous Quiz
0%
A. Unstable angina without acute myocardial injury.
76%
B. Non-ST-elevation myocardial infarction (NSTEMI).
9%
C. ST-elevation myocardial infarction with persistent ST elevation.
9%
D. Acute pericarditis with diffuse inflammatory ECG changes.
6%
E. Stable angina without evidence of acute coronary syndrome.
❤4
A 61-year-old man presents to a hospital without PCI facilities 13 hours after the onset of severe chest pain. ECG demonstrates persistent ST-segment elevation in leads V2–V6, and he continues to experience chest discomfort despite initial medical treatment. He is haemodynamically stable and has no contraindication to antithrombotic therapy. A PCI-capable centre can accept him for urgent transfer.
Which reperfusion strategy is most appropriate?
A. Administer fibrinolysis routinely because the patient remains within the first 24 hours.
B. Withhold reperfusion because the first 12 hours have already elapsed.
C. Arrange urgent transfer for primary PCI because persistent ischaemia warrants invasive reperfusion assessment.
D. Continue medical treatment alone and arrange an outpatient exercise test after discharge.
E. Repeat troponin testing for six hours before deciding whether coronary angiography is needed.
Which reperfusion strategy is most appropriate?
A. Administer fibrinolysis routinely because the patient remains within the first 24 hours.
B. Withhold reperfusion because the first 12 hours have already elapsed.
C. Arrange urgent transfer for primary PCI because persistent ischaemia warrants invasive reperfusion assessment.
D. Continue medical treatment alone and arrange an outpatient exercise test after discharge.
E. Repeat troponin testing for six hours before deciding whether coronary angiography is needed.
Q1138. A 58-year-old man is recovering after successful fibrinolysis for an anterior STEMI. His chest pain has resolved, serial ECGs show no evidence of recurrent ischaemia, and he has no clinical signs of heart failure. He is being prepared for discharge, and his left ventricular function has not yet been assessed.
Which investigation is recommended before discharge to guide treatment and estimate his risk of subsequent complications?
A. Routine symptom-limited exercise testing for every patient one week after infarction.
B. Coronary calcium scoring to estimate the extent of calcified coronary plaque.
C. Transthoracic echocardiography to assess ejection fraction, wall motion and mechanical complications.
D. Twenty-four-hour ambulatory ECG monitoring as a substitute for ventricular function assessment.
E. Repeat troponin testing until the concentration returns completely to normal.
Which investigation is recommended before discharge to guide treatment and estimate his risk of subsequent complications?
A. Routine symptom-limited exercise testing for every patient one week after infarction.
B. Coronary calcium scoring to estimate the extent of calcified coronary plaque.
C. Transthoracic echocardiography to assess ejection fraction, wall motion and mechanical complications.
D. Twenty-four-hour ambulatory ECG monitoring as a substitute for ventricular function assessment.
E. Repeat troponin testing until the concentration returns completely to normal.
❤2
الـّ Case ممكن تكون طويلة واول ما تشوفها تقول صعبة
لكن المطلوب منك تفكير منطقي بس، وماتقعدش خايف من انك تجاوب
لكن المطلوب منك تفكير منطقي بس، وماتقعدش خايف من انك تجاوب
❤1
لان كل كيس مهما كانت طويلة مطلوب منك تركز على حاجات معينة فقط وتطلعلك الاجابة طول
Q1139. An 80-year-old man presents with an anterior STEMI at a hospital where timely primary PCI is unavailable. His medical history includes an ischaemic stroke eight years earlier, without any history of intracranial haemorrhage. His blood pressure is 170/100 mmHg, and he received streptokinase six months ago for a previous myocardial infarction.
Which statement most accurately describes his eligibility for fibrinolysis?
A. Age over 75 years alone absolutely contraindicates every fibrinolytic agent.
B. Any previous ischaemic stroke absolutely contraindicates fibrinolysis, regardless of timing.
C. A blood pressure of 170/100 mmHg is an absolute contraindication in every circumstance.
D. None of these findings alone is an absolute contraindication to all fibrinolytic agents, but repeat streptokinase should be avoided.
E. Previous streptokinase exposure requires withholding all reperfusion treatment.
Which statement most accurately describes his eligibility for fibrinolysis?
A. Age over 75 years alone absolutely contraindicates every fibrinolytic agent.
B. Any previous ischaemic stroke absolutely contraindicates fibrinolysis, regardless of timing.
C. A blood pressure of 170/100 mmHg is an absolute contraindication in every circumstance.
D. None of these findings alone is an absolute contraindication to all fibrinolytic agents, but repeat streptokinase should be avoided.
E. Previous streptokinase exposure requires withholding all reperfusion treatment.
❤2
Q1147. A 60-year-old man presents with acute STEMI and is being assessed for fibrinolysis because primary PCI cannot be delivered within the recommended timeframe. His history includes several previous medical and surgical conditions.
Which of the following is not, by itself, an absolute contraindication to fibrinolytic therapy?
Anonymous Quiz
11%
A. Active internal bleeding at the time of assessment.
53%
B. An uncomplicated laparoscopic cholecystectomy performed eight weeks earlier.
16%
C. A previous intracranial haemorrhage, regardless of how long ago it occurred.
5%
D. A suspected acute aortic dissection causing the presenting chest pain.
16%
E. An ischaemic stroke that occurred six weeks before the current presentation.
Q1153. A 58-year-old man presents with an acute anterior STEMI 90 minutes after the onset of chest pain. The nearest PCI-capable centre is several hours away, and fibrinolysis is being considered. His history reveals that he underwent major abdominal surgery 10 days ago. He has no active external bleeding, and his blood pressure is 138/84 mmHg.
Which is the most appropriate approach to reperfusion?
A. Administer full-dose fibrinolysis immediately because the ECG confirms STEMI.
B. Delay all reperfusion until the postoperative wound has completely healed.
C. Prefer urgent primary PCI because recent major surgery substantially increases the bleeding risk of fibrinolysis.
D. Give half-dose fibrinolysis routinely to eliminate the bleeding risk associated with surgery.
E. Continue anticoagulation alone and arrange outpatient coronary angiography.
Which is the most appropriate approach to reperfusion?
A. Administer full-dose fibrinolysis immediately because the ECG confirms STEMI.
B. Delay all reperfusion until the postoperative wound has completely healed.
C. Prefer urgent primary PCI because recent major surgery substantially increases the bleeding risk of fibrinolysis.
D. Give half-dose fibrinolysis routinely to eliminate the bleeding risk associated with surgery.
E. Continue anticoagulation alone and arrange outpatient coronary angiography.