AACN CMC Exam New Latest Version with Best
Questions, Correct Answers and Rationale
Graded A+
,Acute Coronary Syndromes (Questions 1-25)
1. A patient presents to the ED with chest pain. The 12-lead ECG shows ST-segment elevation in leads II, III,
and aVF. Which coronary artery is most likely occluded?
A) Left Anterior Descending (LAD)
B) Left Circumflex (LCx)
C) Right Coronary Artery (RCA)
D) Left Main
Answer: C
Rationale: Leads II, III, and aVF represent the inferior wall of the left ventricle. The RCA supplies the inferior wall
in the majority of the population (right-dominant circulation).
2. Which biomarker is the most specific and sensitive for myocardial necrosis?
A) Myoglobin
B) CK-MB
C) Troponin I
D) LDH
Answer: C
,Rationale: Troponin I and T are highly specific to cardiac muscle. Myoglobin rises early but is non-specific, while
CK-MB is less sensitive than troponin for minor myocardial damage.
3. A patient with an acute inferior wall MI develops sudden hypotension, JVD, and clear lung sounds. What is the
most likely diagnosis?
A) Acute mitral regurgitation
B) Left ventricular free wall rupture
C) Right ventricular infarction
D) Cardiac tamponade
Answer: C
Rationale: Inferior MIs may involve the RV. The classic triad of hypotension, clear lungs, and elevated JVP
suggests RV failure; treatment involves volume resuscitation, not diuretics or nitrates.
4. What is the recommended door-to-balloon time for a patient presenting with a STEMI to a PCI-capable
facility?
A) 30 minutes
B) 60 minutes
C) 90 minutes
D) 120 minutes
, Answer: C
Rationale: The ACC/AHA guidelines recommend a door-to-balloon time of 90 minutes or less for STEMI patients
undergoing primary PCI.
5. Absolute contraindications to fibrinolytic therapy include all of the following EXCEPT:
A) Prior hemorrhagic stroke
B) Suspected aortic dissection
C) Recent major surgery (within 3 weeks)
D) Age > 75 years
Answer: D
Rationale: Advanced age is a relative contraindication due to higher bleeding risk, but it is not absolute.
Hemorrhagic stroke, aortic dissection, and recent major surgery are absolute contraindications.
6. A patient is 24 hours post-STEMI. They develop a new harsh, loud systolic murmur at the left sternal border
with a palpable thrill. Hemodynamics show a step-up in oxygen saturation in the right ventricle. What is the
diagnosis?
A) Papillary muscle rupture
B) Ventricular septal rupture
C) Aortic stenosis
Questions, Correct Answers and Rationale
Graded A+
,Acute Coronary Syndromes (Questions 1-25)
1. A patient presents to the ED with chest pain. The 12-lead ECG shows ST-segment elevation in leads II, III,
and aVF. Which coronary artery is most likely occluded?
A) Left Anterior Descending (LAD)
B) Left Circumflex (LCx)
C) Right Coronary Artery (RCA)
D) Left Main
Answer: C
Rationale: Leads II, III, and aVF represent the inferior wall of the left ventricle. The RCA supplies the inferior wall
in the majority of the population (right-dominant circulation).
2. Which biomarker is the most specific and sensitive for myocardial necrosis?
A) Myoglobin
B) CK-MB
C) Troponin I
D) LDH
Answer: C
,Rationale: Troponin I and T are highly specific to cardiac muscle. Myoglobin rises early but is non-specific, while
CK-MB is less sensitive than troponin for minor myocardial damage.
3. A patient with an acute inferior wall MI develops sudden hypotension, JVD, and clear lung sounds. What is the
most likely diagnosis?
A) Acute mitral regurgitation
B) Left ventricular free wall rupture
C) Right ventricular infarction
D) Cardiac tamponade
Answer: C
Rationale: Inferior MIs may involve the RV. The classic triad of hypotension, clear lungs, and elevated JVP
suggests RV failure; treatment involves volume resuscitation, not diuretics or nitrates.
4. What is the recommended door-to-balloon time for a patient presenting with a STEMI to a PCI-capable
facility?
A) 30 minutes
B) 60 minutes
C) 90 minutes
D) 120 minutes
, Answer: C
Rationale: The ACC/AHA guidelines recommend a door-to-balloon time of 90 minutes or less for STEMI patients
undergoing primary PCI.
5. Absolute contraindications to fibrinolytic therapy include all of the following EXCEPT:
A) Prior hemorrhagic stroke
B) Suspected aortic dissection
C) Recent major surgery (within 3 weeks)
D) Age > 75 years
Answer: D
Rationale: Advanced age is a relative contraindication due to higher bleeding risk, but it is not absolute.
Hemorrhagic stroke, aortic dissection, and recent major surgery are absolute contraindications.
6. A patient is 24 hours post-STEMI. They develop a new harsh, loud systolic murmur at the left sternal border
with a palpable thrill. Hemodynamics show a step-up in oxygen saturation in the right ventricle. What is the
diagnosis?
A) Papillary muscle rupture
B) Ventricular septal rupture
C) Aortic stenosis
