ACS

Question 1

What conditions are included under acute coronary syndrome?
A. Stable angina only
B. Unstable angina, NSTEMI and STEMI
C. Heart failure and angina
D. Arrhythmias only

Answer 1

Acute coronary syndrome includes unstable angina, NSTEMI and STEMI.

Question 2

Which of the following is a risk factor for acute coronary syndrome?
A. Low fat diet
B. Smoking
C. Regular exercise
D. Low cholesterol

Answer 2

Smoking increases the risk of acute coronary syndrome.

Question 3

Which dietary factor increases the risk of acute coronary syndrome?
A. High fibre diet
B. High fruit intake
C. High fat diet
D. Mediterranean diet

Answer 3

A high fat diet increases the risk of acute coronary syndrome.

Question 4

Which medical condition increases the risk of acute coronary syndrome?
A. Asthma
B. Diabetes
C. Hypothyroidism
D. Anaemia

Answer 4

Diabetes increases the risk of acute coronary syndrome.

Question 5

Which lipid abnormality increases the risk of acute coronary syndrome?
A. Low cholesterol
B. High HDL
C. High cholesterol
D. Low triglycerides

Answer 5

High cholesterol increases the risk of acute coronary syndrome.

Question 6

Which blood pressure status increases the risk of acute coronary syndrome?
A. Hypotension
B. Normal blood pressure
C. High blood pressure
D. Postural hypotension

Answer 6

High blood pressure increases the risk of acute coronary syndrome.

Question 7

Which body weight category increases the risk of acute coronary syndrome?
A. Underweight
B. Normal weight
C. Overweight or obese
D. Low BMI

Answer 7

Being overweight or obese increases the risk of acute coronary syndrome.

Question 8

A patient presents with crushing chest pain, clammy skin and collapses. What is the most appropriate immediate action?
A. Arrange GP review
B. Give oral aspirin and observe
C. Call 999
D. Give GTN and send home

Answer 8

Emergency services should be called immediately by dialling 999.

Question 9

What initial investigations are performed in hospital for suspected ACS?
A. Chest X-ray only
B. ECG and cardiac biomarkers such as troponin
C. Blood pressure monitoring only
D. CT scan of the chest

Answer 9

Patients undergo ECG and measurement of cardiac biomarkers such as troponin.

Question 10

Which test is used to exclude myocardial infarction by detecting cardiac muscle damage?
A. Creatinine
B. Troponin
C. CRP
D. INR

Answer 10

Troponin is used to detect cardiac muscle damage.

Question 11

Hospital tests determine which diagnoses in suspected ACS?
A. Stable angina only
B. Unstable angina, NSTEMI or STEMI
C. Heart failure
D. Arrhythmia only

Answer 11

Tests differentiate between unstable angina, NSTEMI and STEMI.

Question 12

If STEMI is diagnosed, what urgent intervention is required?
A. Aspirin only
B. PCI within 2 hours
C. Statin therapy
D. Beta-blocker only

Answer 12

STEMI requires urgent PCI within 2 hours.

Question 13

What happens after acute management of STEMI?
A. No further treatment
B. Discharge immediately
C. Secondary prevention is started
D. Lifestyle advice only

Answer 13

Secondary prevention is started after acute management.

Question 14

Which statement best describes STEMI?
A. Partial narrowing of artery
B. Complete and prolonged blockage of a coronary artery
C. Temporary spasm only
D. No myocardial damage

Answer 14

STEMI is caused by complete and prolonged blockage of a coronary artery.

Question 15

What ECG finding is seen in STEMI?
A. ST depression
B. Normal ECG
C. ST elevation
D. Prolonged QT

Answer 15

ST elevation is seen on ECG in STEMI.

Question 16

What happens to cardiac biomarkers in STEMI?
A. No change
B. Decrease
C. Increase
D. Variable

Answer 16

Cardiac biomarkers such as troponin are increased in STEMI.

Question 17

Which statement best describes NSTEMI?
A. Complete arterial blockage
B. Severe narrowing of a coronary artery
C. No coronary artery disease
D. Coronary spasm only

Answer 17

NSTEMI is caused by severe narrowing of a coronary artery.

Question 18

What ECG change is seen in NSTEMI?
A. ST elevation
B. ST depression only
C. ST segment not elevated
D. Normal ECG always

Answer 18

NSTEMI does not show ST elevation on ECG.

Question 19

What happens to cardiac biomarkers in NSTEMI?
A. No elevation
B. Decrease
C. Increase
D. Remain normal

Answer 19

Cardiac biomarkers are increased in NSTEMI.

Question 20

Which statement best describes unstable angina?
A. Complete blockage of artery
B. Severe narrowing of a coronary artery
C. No coronary artery disease
D. Permanent myocardial damage

Answer 20

Unstable angina is caused by severe narrowing of a coronary artery.

Question 21

What ECG finding is typical in unstable angina?
A. ST elevation
B. ST segment not elevated
C. Prolonged QT
D. Heart block

Answer 21

Unstable angina does not show ST elevation on ECG.

Question 22

What happens to cardiac biomarkers in unstable angina?
A. Increase
B. Decrease
C. No elevation
D. Fluctuate

Answer 22

Cardiac biomarkers are not elevated in unstable angina.

Question 23

What loading dose of aspirin is given in confirmed ACS?
A. 75 mg
B. 150 mg
C. 300 mg
D. 600 mg

Answer 23

A loading dose of aspirin 300 mg is given in confirmed ACS.

Question 24

What is appropriate pain relief in acute coronary syndrome?
A. Paracetamol only
B. GTN with or without intravenous morphine
C. Ibuprofen
D. Codeine

Answer 24

Pain relief includes GTN with or without intravenous morphine.

Question 25

When should oxygen be given in acute coronary syndrome? A. Always B. If oxygen saturation is below 94 percent C. Only if unconscious D. Never

Answer 25

Oxygen is given if oxygen saturation is less than 94 percent.

Question 26

How is hyperglycaemia managed in acute coronary syndrome? A. Oral hypoglycaemics B. No treatment C. Insulin D. Diet only

Answer 26

Hyperglycaemia is treated with insulin in acute coronary syndrome.

Question 27

Which anticoagulant is used in NSTEMI or unstable angina if bleeding risk is low? A. Heparin B. Warfarin C. Fondaparinux D. Apixaban

Answer 27

Fondaparinux is used in NSTEMI or unstable angina if bleeding risk is not high.

Question 28

What is the preferred reperfusion strategy for STEMI? A. Aspirin only B. PCI within 2 hours or fibrinolysis C. Statin therapy D. Beta-blocker

Answer 28

STEMI is treated with PCI within 2 hours or fibrinolysis.

Question 29

In STEMI, which antiplatelet is used with aspirin if the patient is NOT on an oral anticoagulant? A. Clopidogrel B. Ticagrelor C. Prasugrel D. Dipyridamole

Answer 29

Prasugrel is used with aspirin if the patient is not on an oral anticoagulant.

Question 30

In STEMI, which antiplatelet is used with aspirin if the patient IS on an oral anticoagulant? A. Prasugrel B. Ticagrelor C. Clopidogrel D. Dipyridamole

Answer 30

Clopidogrel is used with aspirin if the patient is on an oral anticoagulant.

Question 31

When is heparin used in STEMI management? A. Always B. If PCI is performed via radial access C. Only if bleeding risk is high D. Only in NSTEMI

Answer 31

Heparin is used if PCI is performed via radial access.

Question 32

Which drug class is used for secondary prevention after ACS? A. Calcium channel blockers B. ACE inhibitors or ARBs C. Nitrates only D. Antiarrhythmics

Answer 32

ACE inhibitors or ARBs are used for secondary prevention.

Question 33

What antiplatelet strategy is used for secondary prevention after ACS? A. Aspirin only B. Dual antiplatelet therapy with lifelong aspirin and 12 months of a second agent C. Anticoagulant only D. No antiplatelets

Answer 33

Secondary prevention includes lifelong aspirin and 12 months of dual antiplatelet therapy.

Question 34

Which antiplatelet agents may be used for 12 months in secondary prevention? A. Warfarin only B. Clopidogrel, ticagrelor or prasugrel C. Dipyridamole only D. Aspirin only

Answer 34

Clopidogrel, ticagrelor or prasugrel are used for 12 months.

Question 35

For how long should beta-blockers be used after ACS? A. 1 month B. 6 months C. 12 months D. Lifelong for all patients

Answer 35

Beta-blockers are used for 12 months, or lifelong if left ventricular ejection fraction is reduced.

Question 36

When should beta-blockers be continued lifelong after ACS? A. In all patients B. If reduced left ventricular ejection fraction is present C. Only if hypertensive D. Only if diabetic

Answer 36

Beta-blockers are continued lifelong if left ventricular ejection fraction is reduced.

Question 37

Which statin regimen is recommended after ACS? A. Simvastatin 20 mg B. Atorvastatin 40 mg high intensity C. Pravastatin 10 mg D. No statin

Answer 37

High-intensity statin therapy such as atorvastatin 40 mg is recommended.

Question 38

In which ACS subtype should PCI be considered to prevent future myocardial infarction? A. STEMI only B. Unstable angina only C. NSTEMI D. Stable angina

Answer 38

PCI should be considered in NSTEMI to prevent future myocardial infarction.