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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.
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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.