1. T1: ACS Treatment Tutoring
By Alaina Darby

2. Which of the following can be used to differentiate NSTEMI from UA?
ST elevation
Troponin levels
Rapidity of onset
EKG
B… this is the only thing!

3. Which of the following best describes the pathophysiology of STEMI?
Plaque disruption that partially occludes the vessel and releases troponin
Plaque disruption that partially occludes the vessel and does not release troponin
Plaque disruption that totally occludes the vessel and releases troponin
Plaque disruption that totally occludes the vessel and does not release troponin C

4. Case:
AK is a 43 yo WF who presents to the ED with chest pain. She reports that she has been experiencing chest pain for 1 hour prior to arrival to the ED
PMH: diabetes, HTN, TIA
PSH: bilateral oophorectomy
SH: smokes ½ ppd, denies alcohol use, denies elicit drug use
FH: father died of MI at age 60
Vitals/Labs:
BMI: 34
HDL: 21
LDL: 100
Troponin: negative
EKG: T wave inversion, ST segment elevation, and Q wave normal

5. How many modifiable risk factors does AK have? 3 4 5 6
AK is a 43 yo WF who presents to the ED with chest pain. She reports that she has been experiencing chest pain for 1 hour prior to arrival to the ED. PMH: diabetes, HTN, TIA PSH: bilateral oophorectomy SH: smokes ½ ppd, denies alcohol use, denies elicit drug use FH: father died of MI at age 60 Vitals/Labs: BMI: 34, HDL: 21, LDL: 100, Troponin: negative, EKG: T wave inversion, ST segment elevation, and Q wave normal
How many modifiable risk factors does AK have? 3 4 5 6
C… DM, HTN, smoking, obesity, HDL

6. How many non-modifiable risk factors does AK have? 1 2 3
AK is a 43 yo WF who presents to the ED with chest pain. She reports that she has been experiencing chest pain for 1 hour prior to arrival to the ED. PMH: diabetes, HTN, TIA PSH: bilateral oophorectomy SH: smokes ½ ppd, denies alcohol use, denies elicit drug use FH: father died of MI at age 60 Vitals/Labs: BMI: 34, HDL: 21, LDL: 100, Troponin: negative, EKG: T wave inversion, ST segment elevation, and Q wave normal
How many non-modifiable risk factors does AK have? 1 2 3 A

7. AK should be diagnosed with what? NSTEMI UA STEMI Cannot be determined
AK is a 43 yo WF who presents to the ED with chest pain. She reports that she has been experiencing chest pain for 1 hour prior to arrival to the ED. PMH: diabetes, HTN, TIA PSH: bilateral oophorectomy SH: smokes ½ ppd, denies alcohol use, denies elicit drug use FH: father died of MI at age 60 Vitals/Labs: BMI: 34, HDL: 21, LDL: 100, Troponin: negative, EKG: T wave inversion, ST segment elevation, and Q wave normal
AK should be diagnosed with what?
NSTEMI UA
STEMI
Cannot be determined C

8. Which of the following occurs first on the EKG?
ST segment elevation
T wave inversion
Pathological Q waves B

9. Which is not indicative of myocardial injury?
ST segment elevation
T wave inversion
Pathological Q waves B

10. AK is a 43 yo WF who presents to the ED with chest pain
AK is a 43 yo WF who presents to the ED with chest pain. She reports that she has been experiencing chest pain for 1 hour prior to arrival to the ED. PMH: diabetes, HTN, TIA PSH: bilateral oophorectomy SH: smokes ½ ppd, denies alcohol use, denies elicit drug use FH: father died of MI at age 60 Vitals/Labs: BMI: 34, HDL: 21, LDL: 100, Troponin: negative, EKG: T wave inversion, ST segment elevation, and Q wave normal
Should her ST segment not be elevated, AK should be diagnosed with what?
NSTEMI UA
STEMI
Cannot be determined D

11. Which medications should be administered within the first 24-48 hours?
AK is a 43 yo WF who presents to the ED with chest pain. She reports that she has been experiencing chest pain for 1 hour prior to arrival to the ED. PMH: diabetes, HTN, TIA PSH: bilateral oophorectomy SH: smokes ½ ppd, denies alcohol use, denies elicit drug use FH: father died of MI at age 60 Vitals/Labs: BMI: 34, HDL: 21, LDL: 100, Troponin: negative, EKG: T wave inversion, ST segment elevation, and Q wave normal
Which medications should be administered within the first hours?
ASA 81 mg, Clopidogrel 600 mg, UFH 60 units/kg
ASA 162 mg, Clopidogrel 300 mg, UFH 60 units/kg
ASA 325 mg, Clopidogrel 300 mg, UFH 12 units/kg
ASA 325 mg, Clopidogrel 75 mg, UFH 60 units/kg B

12. Which medication regimen would be appropriate if AK will undergo PCI?
AK is a 43 yo WF who presents to the ED with chest pain. She reports that she has been experiencing chest pain for 1 hour prior to arrival to the ED. PMH: diabetes, HTN, TIA PSH: bilateral oophorectomy SH: smokes ½ ppd, denies alcohol use, denies elicit drug use FH: father died of MI at age 60 Vitals/Labs: BMI: 34, HDL: 21, LDL: 100, Troponin: negative, EKG: T wave inversion, ST segment elevation, and Q wave normal
Which medication regimen would be appropriate if AK will undergo PCI?
ASA 81 mg, Clopidogrel 600 mg, UFH 12 units/kg
ASA 162 mg, Ticagrelor 180 mg, UFH 60 units/kg
ASA 325 mg, Clopidogrel 75 mg, Bivalirudin
ASA 325 mg, Ticagrelor 90 mg, Bivalirudin B

13. ASA/ticagrelor/eptifibatide ASA/clopidogrel/heparin
AK is a 43 yo WF who presents to the ED with chest pain. She reports that she has been experiencing chest pain for 1 hour prior to arrival to the ED. PMH: diabetes, HTN, TIA PSH: bilateral oophorectomy SH: smokes ½ ppd, denies alcohol use, denies elicit drug use FH: father died of MI at age 60 Vitals/Labs: BMI: 34, HDL: 21, LDL: 100, Troponin: negative, EKG: T wave inversion, ST segment elevation, and Q wave normal
Which medication regimen would be appropriate if AK is undergoing a thrombolytic approach (in addition to tPA)?
ASA/ticagrelor/eptifibatide
ASA/clopidogrel/heparin
ASA/heparin/eptifibatide
ASA/ticagrelor/bivaliruden B

14. Clopidogrel/ Ticagrelor
ACS
Non-invasive
ASA
Clopidogrel/ Ticagrelor
UFH/ Enoxaparin
Reperfusion
Thrombolytic
Clopidogrel
Invasive (PCI)
Clopidogrel/ Ticagrelor/ Prasugrel
One of the following:
UFH/ Enoxaparin and GP IIb/IIIa
Bivalirudin

15. ASA/enoxaparin/ticagrelor ASA/heparin/prasugrel ASA/heparin/ticagrelor
AK is a 43 yo WF who presents to the ED with chest pain. She reports that she has been experiencing chest pain for 1 hour prior to arrival to the ED. PMH: diabetes, HTN, TIA PSH: bilateral oophorectomy SH: smokes ½ ppd, denies alcohol use, denies elicit drug use FH: father died of MI at age 60 Vitals/Labs: BMI: 34, HDL: 21, LDL: 100, Troponin: negative, EKG: T wave inversion, ST segment elevation, and Q wave normal
Should AK be diagnosed with NSTEMI and undergo PCI, which of the following would not be indicated for her?
ASA/enoxaparin/ticagrelor
ASA/heparin/prasugrel
ASA/heparin/ticagrelor
ASA/heparin/clopidogrel B

16. Which of the following must always be used with bivalirudin?
ASA
GP IIb/IIIa inhibitor
Enoxaparin
Heparin
A… also thienopyridine

17. Which of the following can be used as an alternate to ASA if the patient has an allergy?
Clopidogrel
Prasugrel
Ticagrelor A

18. Which of the following cannot be used in combination with ASA for a patient with UA/NSTEMI?
Clopidogrel
Prasugrel
Ticagrelor B

19. If a patient undergoes the noninvasive approach, which of the following is an acceptable regimen?
ASA continued 1 year afterward + clopidogrel continued 1 year afterward
ASA continued 1 year afterward + prasugrel continued 1 year afterward
ASA continued indefinitely + clopidogrel continued 1 month afterward
ASA continued indefinitely + prasugrel continued 1 year afterward C

20. If a GK is 65 yo and undergoes thrombolytic therapy due to STEMI, which of the following should be his regimen?
Clopidogrel 300 mg loading dose followed by 75 mg/day for 1 year
Clopidogrel 300 mg loading dose followed by 75 mg/day for 1 month
Clopidogrel 200 mg loading dose followed by 75 mg/day for 1 year
Clopidogrel 200 mg loading dose followed by 75 mg/day for 1 month A

21. Which of the following should be withheld 7 days prior to CABG?
Clopidogrel
Prasugrel
Ticagrelor B

22. For invasive therapy for UA/NSTEMI, which of the following regimens should be used in a high risk patient?
ASA, heparin, GPIIb/IIIa, and prasugrel
ASA, heparin, and prasugrel
ASA, heparin, GPIIb/IIIa, and clopidogrel
ASA, heparin, and clopidogrel
A or C
B or D
C or D C

23. For invasive therapy for UA/NSTEMI, which of the following regimens should be used in a low risk patient?
ASA, heparin, GPIIb/IIIa, and prasugrel
ASA, heparin, and prasugrel
ASA, heparin, GPIIb/IIIa, and clopidogrel
ASA, heparin, and clopidogrel
A or C
B or D
C or D F