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Chapter 16 Test — Myocardial Ischaemia and Infarction
26 questions · 26 min · +4 / -1
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Question 1
Question 1
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A 54-year-old smoker reaches the emergency department 40 minutes after the onset of crushing central chest pain. His first 12-lead ECG shows tall, broad, peaked T waves in V2–V4 with only minimal ST-segment elevation and no Q waves. Which statement about this finding is correct?
A.
These are hyperacute T waves, the earliest change of STEMI; activate the cath lab now
B.
This is a normal variant; repeat the ECG in 6 hours before acting
C.
Tall peaked T waves are diagnostic of hyperkalaemia and exclude ischaemia
D.
Peaked T waves without Q waves indicate completed necrosis, so reperfusion would be futile
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Question 2
Question 2
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Three weeks after an untreated anterior myocardial infarction, a man's ECG shows deep, broad Q waves in V1–V4, ST segments back at the isoelectric baseline, and T waves that have almost normalised. Which phase of MI evolution does this represent?
A.
Subacute phase (1–3 days)
B.
Chronic / old MI (weeks to years)
C.
Hyperacute phase (minutes–6 hours)
D.
Acute phase (6–24 hours)
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Question 3
Question 3
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A 34-year-old man with 2 hours of chest pain has 2 mm of ST-segment elevation in leads V2 and V3 and no other ECG abnormality. What is the minimum ST-elevation threshold in V2–V3 required to call STEMI in a
man under 40 years
?
A.
≥ 1.5 mm (0.15 mV)
B.
≥ 2.5 mm (0.25 mV)
C.
≥ 2 mm (0.2 mV)
D.
≥ 1 mm (0.1 mV)
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Question 4
Question 4
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Which of the following combinations of leads, each showing 1.5 mm of ST-segment elevation, satisfies the requirement of
two contiguous leads
for a diagnosis of STEMI?
A.
Leads V2 and V3
B.
Leads III and aVL
C.
Leads II and V4
D.
Leads I and V1
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Question 5
Question 5
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A 58-year-old diabetic hypertensive man presents with crushing central chest pain radiating to the jaw for 90 minutes. The 12-lead ECG shown demonstrates marked ST elevation in leads II, III and aVF with reciprocal ST depression in leads I and aVL. Which coronary artery is
most commonly
responsible for this pattern?
A.
Left anterior descending artery (LAD)
B.
Left circumflex artery (LCx)
C.
Right coronary artery (RCA)
D.
Left main coronary artery (LMCA)
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Question 6
Question 6
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Reciprocal changes on the ECG in a patient with an acute inferior wall myocardial infarction are seen in which lead?
A.
Lead I
B.
Lead II
C.
Lead III
D.
Lead aVF
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Question 7
Question 7
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A patient with an acute inferior STEMI has ST elevation that is clearly greater in lead III than in lead II, together with marked reciprocal ST depression in aVL. Which culprit vessel does this favour?
A.
Left circumflex artery
B.
Left anterior descending artery
C.
Right coronary artery
D.
Left main coronary artery
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Question 8
Question 8
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A 58-year-old man presents with sudden-onset crushing central chest pain radiating to the jaw. His ECG shows ST-segment elevation. On examination his heart rate is 52/min and blood pressure is 98/56 mmHg. Which infarct territory best explains this haemodynamic pattern?
A.
Anterior wall MI
B.
Posterior wall MI
C.
Inferior wall MI
D.
Anteroseptal wall MI
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Question 9
Question 9
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A 69-year-old man is brought to the emergency department with severe epigastric pain and vomiting that began 30 minutes ago while gardening. Pulse 55/min, BP 90/50 mmHg. He is diaphoretic with jugular venous distension. The ECG shows P waves independent of the QRS complexes and ST-segment elevation in leads II, III and aVF. Coronary angiography is most likely to show narrowing of which vessel?
A.
Posterior interventricular (posterior descending) artery
B.
Left circumflex artery
C.
Proximal right coronary artery
D.
Left anterior descending artery
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Question 10
Question 10
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A 52-year-old diabetic man presents with retrosternal chest pain, profuse sweating and light-headedness. His ECG shows ST-segment elevation in leads I, aVL and V1–V6. What is the diagnosis?
A.
Extensive anterior wall MI
B.
Isolated anteroseptal MI
C.
Isolated lateral wall MI
D.
Inferior wall MI
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Question 11
Question 11
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A 55-year-old man presents with 2 hours of crushing chest pain and sweating. Based on the 12-lead ECG shown, which wall of the myocardium is infarcting?
A.
Inferior wall
B.
Anterior wall
C.
Posterior wall
D.
Lateral wall
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Question 12
Question 12
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A 58-year-old hypertensive smoker presents 90 minutes after the onset of crushing retrosternal chest pain with diaphoresis. The 12-lead ECG shown demonstrates ST-segment elevation in leads V1–V4 with QS complexes in V1–V3, while V5–V6 and the limb leads are relatively unaffected. Which coronary artery is most likely occluded?
A.
Posterior descending artery
B.
Left circumflex artery
C.
Left anterior descending artery
D.
Right coronary artery
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Question 13
Question 13
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A 62-year-old man presents with 3 hours of chest pain. The 12-lead ECG shown demonstrates ST-segment elevation across V2–V6. Which territory is infarcting, and which vessel is most likely responsible?
A.
Posterior wall — left circumflex artery
B.
Anterolateral wall — left anterior descending artery
C.
Inferior wall — right coronary artery
D.
Right ventricle — proximal right coronary artery
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Question 14
Question 14
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An ECG shows ST-segment elevation in leads I, aVL, V5 and V6, with reciprocal ST depression in the inferior leads (III and aVF). What is the diagnosis?
A.
Anterior wall MI
B.
Lateral wall MI
C.
Inferior wall MI
D.
Anteroseptal MI
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Question 15
Question 15
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In which leads of the standard 12-lead ECG would ST elevation be seen with an
anteroseptal
infarct?
A.
V1 and V2
B.
V3 and V4
C.
V5 and V6
D.
aVL and aVF
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Question 16
Question 16
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A 60-year-old man has 2.5 mm of ST-segment elevation in V2–V4 and 1 mm of ST depression in II, III and aVF. What is the significance of the inferior ST depression?
A.
It indicates a separate, simultaneous inferior infarct requiring a second culprit vessel to be treated
B.
It reclassifies the presentation as NSTEMI because ST depression is present
C.
It is a reciprocal change that strongly supports true STEMI and argues against pericarditis or early repolarisation
D.
Its absence would have excluded STEMI
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Question 17
Question 17
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A rhythm strip recorded during an episode of chest pain is shown; the arrows mark the ST segment. The 12-lead ECG shows no ST elevation anywhere, and troponin is raised. Which process does this ECG appearance represent?
A.
Subendocardial ischaemia
B.
Transmural (full-thickness) myocardial injury
C.
Early repolarisation
D.
Pericardial inflammation
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Question 18
Question 18
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A 64-year-old woman presents with 2 hours of chest pain; troponin is elevated. Her 12-lead ECG is shown — it demonstrates diffuse ST-segment depression, best seen in lead II and V4–V6, with no ST-segment elevation and no Q waves. What is the diagnosis?
A.
Acute pericarditis
B.
Acute anterior STEMI
C.
Unstable angina
D.
NSTEMI
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Question 19
Question 19
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What is the best way to differentiate unstable angina from NSTEMI?
A.
The 12-lead ECG
B.
Cardiac biomarkers (troponin)
C.
Transthoracic echocardiography
D.
MUGA (multi-gated acquisition) scan
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Question 20
Question 20
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A 66-year-old man with ongoing chest pain has no ST elevation on his ECG. Which finding identifies him as
high-risk NSTE-ACS
needing angiography within 24 hours?
A.
Sinus tachycardia at 105/min with an otherwise normal tracing
B.
Upsloping ST depression of 0.5 mm in lead V5 alone
C.
Isolated T-wave flattening in lead III
D.
Deep symmetrical T-wave inversion ≥3 mm in multiple leads
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Question 21
Question 21
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A 62-year-old diabetic man has had typical crushing chest pain for 3 hours. His first 12-lead ECG is entirely normal. Which statement is correct?
A.
A normal ECG excludes myocardial infarction; he can be reassured and discharged
B.
A normal ECG in ongoing chest pain means the artery must be completely occluded
C.
Troponin testing adds nothing once the initial ECG is normal
D.
20–40% of acute MIs have a normal or near-normal initial ECG
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Question 22
Question 22
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The standard 12-lead ECG is poorest at detecting ischaemia in the territory supplied by which vessel?
A.
Left anterior descending artery
B.
Left circumflex artery
C.
Left main coronary artery
D.
Right coronary artery
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Question 23
Question 23
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Which single ECG lead is the most sensitive for detecting intraoperative myocardial ischaemia?
A.
Lead I
B.
Lead II
C.
Lead V1
D.
Lead V5
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Question 24
Question 24
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Ninety minutes after primary PCI for an anterior STEMI, a patient's ST elevation has fallen by more than 50% and the monitor shows a regular wide-complex rhythm at 80/min. He is asymptomatic with a blood pressure of 120/75 mmHg. What is the correct interpretation and action?
A.
Reocclusion — perform synchronised DC cardioversion
B.
Failed reperfusion — arrange rescue PCI
C.
Ventricular tachycardia — give an IV amiodarone loading dose immediately
D.
Accelerated idioventricular rhythm indicating successful reperfusion
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Question 25
Question 25
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A 48-year-old man with chest pain has an ECG performed and the physician runs through the differential diagnosis of ST-segment elevation. Which of the following does NOT typically cause ST elevation?
A.
Prinzmetal (variant) angina
B.
Acute pericarditis
C.
Left ventricular aneurysm
D.
Unstable angina
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Question 26
Question 26
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Which of the following support a diagnosis of left ventricular aneurysm in a patient several weeks after a myocardial infarction?
I. Paradoxical (dyskinetic) impulse on the chest wall
II. Persistent ST elevation on the ECG
III. Unusual bulge in the cardiac silhouette on chest X-ray
IV. Pulsus paradoxus
A.
I and II only
B.
I and IV only
C.
I, II and III
D.
II, III and IV
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