BCPS - Cardiology I Exam Questions With
Complete Answers
Difference between NSTE-ACS UA & NSTEMI - ANSWER NO myocardial injury (in UA)
vs. myocardial injury (+ biomarkers) (in NSTEMI)
TIMI risk score - ANSWER predicts 30-day & 1 yr mortality for NSTE-ACS pts
TIMI score 3 or more = moderate-high risk and need "EARLY INVASIVE APPROACH"
GRACE score - ANSWER predicts in-hospital & postdischarge mortality or MI
Fibrinolytic therapy indication - ANSWER STEMI pts in whom PCI can't be performed
within 120 mins
30 mins door-to-needle time and
within 6 hrs of chest pain/sxs
Ischemia-guided therapy indications - ANSWER 1. pts w/LOW RISK score (TIMI 0-1,
GRACE <109)
2. pts w/acute chest pain w/low likelihood of ACS, trop -
3. pt/clinician preference
*MONA + B*-blocker indications (morphine or other narcotic analgesic) - ANSWER ALL
patients presenting with ACS
ACS nitroglycerin IV dose - ANSWER 5-10 mcg/min & titrate to chest pain or 200
mcg/min max
,MONA alternative to ASA - ANSWER Clopidogrel (if ASA allergy or intolerance)
Risk factors for shock:
(Avoid *IV* B-BLOCKER for ACS initially) - ANSWER 1. >70yo
2. HR >110
3. SBP <120
4. late presentation (?)
ACE inhibitor CI's - ANSWER Hypotension
Pregnancy
Bilateral renal artery stenosis
Initial Management of ACS (after MONA) - ANSWER 1. ACE inhibitors (all w/LVEF<=40%
& ptas w/HT, DM or stable CKD)
2. Aldosterone antagonists (already have ACE & B-blocker & LVEF <= 40% & either
symptomatic HF or DM)
3. Statins (high intensity in all)
4. Nitrates (topical/oral for those without ongoing refractory ischemia (then IV))
5. CCB's (for ischemia when B-blocers not successful, CI or cause unacceptable
SE)--provide sx relief only
(Non-dihydropyridine--verapamil or diltiazem)
(Long-acting w/nitrates recommended for coronary spasm)
Aldosterone antagonist CI's - ANSWER Hyperkalemia (>5)
Crcl <30 mL/min
Creat > 2.5 male, 2.0 female
Statin CI's - ANSWER Pregnancy
, Dose restrictions on CYP3A4 interacting meds
Caution---w/fibrates
CCB's CI's - ANSWER Clinically significant L vent. dysfunction
Increased risk for cardiogenic shock
PR interval >0.24 second
2nd or 3rd degree heart block w/o pacemaker
Antiplatelet / Anticoagulation therapy indications for ACS patient - ANSWER All patients
ASA dose post-ACS - ANSWER 81 mg qd w/ or w/o PCI indefinitely
Preferred P2Y12's for ischemia-guided therapy - ANSWER Clopidogrel & Ticagrelor
(Brilinta)
Prasugrel CI's - ANSWER Stroke/TIA hx
DAPT duration w/ or w/o stent following ACS - ANSWER 12 months @ least
Post PCI + fibrinolytic P2Y12 therapy - ANSWER Clopidogrel
Clopidogrel LD for ischemia-guided therapy - ANSWER 300 mg
Prasugrel dose post-PCI - ANSWER 10 mg qd (5 mg if <60 kg) (although 5 mg dose not
studied in PCI patients)
P2Y12 DOC post-elective PCI (no ACS) - ANSWER Clopidogrel
Complete Answers
Difference between NSTE-ACS UA & NSTEMI - ANSWER NO myocardial injury (in UA)
vs. myocardial injury (+ biomarkers) (in NSTEMI)
TIMI risk score - ANSWER predicts 30-day & 1 yr mortality for NSTE-ACS pts
TIMI score 3 or more = moderate-high risk and need "EARLY INVASIVE APPROACH"
GRACE score - ANSWER predicts in-hospital & postdischarge mortality or MI
Fibrinolytic therapy indication - ANSWER STEMI pts in whom PCI can't be performed
within 120 mins
30 mins door-to-needle time and
within 6 hrs of chest pain/sxs
Ischemia-guided therapy indications - ANSWER 1. pts w/LOW RISK score (TIMI 0-1,
GRACE <109)
2. pts w/acute chest pain w/low likelihood of ACS, trop -
3. pt/clinician preference
*MONA + B*-blocker indications (morphine or other narcotic analgesic) - ANSWER ALL
patients presenting with ACS
ACS nitroglycerin IV dose - ANSWER 5-10 mcg/min & titrate to chest pain or 200
mcg/min max
,MONA alternative to ASA - ANSWER Clopidogrel (if ASA allergy or intolerance)
Risk factors for shock:
(Avoid *IV* B-BLOCKER for ACS initially) - ANSWER 1. >70yo
2. HR >110
3. SBP <120
4. late presentation (?)
ACE inhibitor CI's - ANSWER Hypotension
Pregnancy
Bilateral renal artery stenosis
Initial Management of ACS (after MONA) - ANSWER 1. ACE inhibitors (all w/LVEF<=40%
& ptas w/HT, DM or stable CKD)
2. Aldosterone antagonists (already have ACE & B-blocker & LVEF <= 40% & either
symptomatic HF or DM)
3. Statins (high intensity in all)
4. Nitrates (topical/oral for those without ongoing refractory ischemia (then IV))
5. CCB's (for ischemia when B-blocers not successful, CI or cause unacceptable
SE)--provide sx relief only
(Non-dihydropyridine--verapamil or diltiazem)
(Long-acting w/nitrates recommended for coronary spasm)
Aldosterone antagonist CI's - ANSWER Hyperkalemia (>5)
Crcl <30 mL/min
Creat > 2.5 male, 2.0 female
Statin CI's - ANSWER Pregnancy
, Dose restrictions on CYP3A4 interacting meds
Caution---w/fibrates
CCB's CI's - ANSWER Clinically significant L vent. dysfunction
Increased risk for cardiogenic shock
PR interval >0.24 second
2nd or 3rd degree heart block w/o pacemaker
Antiplatelet / Anticoagulation therapy indications for ACS patient - ANSWER All patients
ASA dose post-ACS - ANSWER 81 mg qd w/ or w/o PCI indefinitely
Preferred P2Y12's for ischemia-guided therapy - ANSWER Clopidogrel & Ticagrelor
(Brilinta)
Prasugrel CI's - ANSWER Stroke/TIA hx
DAPT duration w/ or w/o stent following ACS - ANSWER 12 months @ least
Post PCI + fibrinolytic P2Y12 therapy - ANSWER Clopidogrel
Clopidogrel LD for ischemia-guided therapy - ANSWER 300 mg
Prasugrel dose post-PCI - ANSWER 10 mg qd (5 mg if <60 kg) (although 5 mg dose not
studied in PCI patients)
P2Y12 DOC post-elective PCI (no ACS) - ANSWER Clopidogrel
