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Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Cardiovascular Disorders--->Acute Coronary Syndrome
Page: 2

Question 6#Print Question

A 57-year-old male with a history of hyperlipidemia is admitted to the intensive care unit with hypotension necessitating vasopressor support. He had been in his usual state of health, but in the preceding 24 hours, he developed progressively worsening dyspnea, culminating in respiratory failure and necessitating intubation.

His admission electrocardiogram is shown below:

His presenting troponin-T is 2.52 ng/mL (reference <0.03 ng/mL). Shortly after admission, the patient is witnessed to have repeated episodes of self-terminating ventricular tachycardia, the longest of which last up to 45 seconds.

An echocardiogram is performed and demonstrates severe biventricular dysfunction with an estimated left ventricular ejection fraction of 12%.

Which of the following would be the most appropriate next step in management?

a. Urgent coronary angiography with the intent to revascularize
b. Insertion of a percutaneous left ventricular assist device (LVAD)
c. Insertion of an intra-aortic balloon pump (IABP)
d. Cardiac biomarker panel


Question 7#Print Question

A 76-year-old female undergoes uncomplicated coronary angiography via the right femoral artery for evaluation of a newly diagnosed cardiomyopathy. She is found to be without obstructive coronary artery disease. The patient is admitted to the intensive care unit for further monitoring.

Her femoral angiogram is shown in the figure below:

Two days following admission, the patient begins to cough. Shortly thereafter, she is observed to have sudden and rapid expansion of her right lower quadrant, with associated hypotension.

Which of the following is the most appropriate next step?

a. Computed tomography (CT) imaging of the abdomen without contrast
b. Initiation of a massive transfusion protocol
c. Manual pressure proximal to the angiography access site
d. Urgent surgical exploration


Question 8#Print Question

An 88-year-old male with complex coronary disease that includes prior three-vessel coronary artery bypass grafting and prior complete heart block necessitating dual chamber permanent pacemaker implantation presents with substernal chest pain identical in character to his past angina.

His presenting electrocardiogram is:

His presenting troponin-T is 0.54 ng/mL (reference <0.03 ng/mL).

Which of the following is the next best step in management?

a. Emergent coronary angiography with the intent to revascularize
b. Urgent (24-48 hours) coronary angiography with the intent to revascularize
c. Noninvasive risk stratification
d. Intravenous nitroglycerin


Question 9#Print Question

A 67-year-old man presents with 3 days of severe substernal chest pain.

His presenting electrocardiogram is:

A surface echocardiogram reveals an estimated left ventricular ejection fraction of 22% with inferior and inferoseptal akinesis. A 1.5 cm ventricular septal defect at the junction of the inferior wall and septum is noted and is associated with bidirectional shunting. Coronary angiography reveals a 50% narrowing of the ostium of the left main coronary artery, subtotal occlusion of the left anterior descending artery, and total occlusion of the right coronary artery with left to right collaterals. A plan for surgical revascularization, with patch repair of the ventricular septal defect, is formulated. Shortly thereafter, the patient develops progressive cardiogenic shock with ventricular tachycardia.

Which of the following is the next BEST step in management?

 

a. Insertion of an intra-aortic balloon pump
b. Initiation of inotropic support
c. Percutaneous coronary intervention with drug-eluting stent deployment to the left anterior descending artery
d. Veno-arterial extracorporeal membrane oxygenation (ECMO) initiation


Question 10#Print Question

A 58-year-old with active tobacco use, hyperlipidemia, and hypertension presents with substernal chest pain that developed following snow shoveling.

Shortly following his presentation, he is observed to have a witnessed cardiac arrest with multiple episodes of ventricular fibrillation. He required 10 minutes of cardiopulmonary resuscitation with advanced cardiac life support and four defibrillator therapies. Following return of spontaneous circulation (ROSC), the patient was noted to have the following laboratory data. His mental status is not determinable. 

His post-ROSC ECG is shown:

What is the MOST appropriate timing for coronary angiography?

 

a. Urgently post-ROSC
b. Within 24 to 48 hours of presentation
c. Following correction of metabolic derangement
d. Following establishment of a favorable neurologic prognosis




Category: Critical Care Medicine-Cardiovascular Disorders--->Acute Coronary Syndrome
Page: 2 of 2