TRY OUT I

DOKTERPOST
dr. Muhammad Insani Ilman SpJP
CV:
• Dokter Umum FK Universitas Airlangga
• Spesialis Jantung dan Pembuluh Darah FK Univ
Airlangga
• RSUD Sumbawa, NTB
TRY OUT 1

25 SOAL
Second-degree
atrioventricular (AV) block,
Mobitz type I (AV
Wenckebach).

Note increasing PR interval

and PR interval being the
shortest after a dropped
beat. Also, note that the
patient has intraventricular
conduction delay (IVCD)
and lateral T wave
inversion. Despite IVCD, it
is less likely to be
trifascicular block as AV
Wenckebach is generally a
nodal rather than infra-
Hisian phenomenon.
Sinus rhythm with
bifascicular block. Note
right bundle branch block
(RBBB) and left axis
deviation with mean QRS
axis less than −30!
suggesting left anterior
fascicular block (LAFB).
Also note that the peak of
R wave is earliest in III,
followed by II, and then I,
indicating late activation of
left ventricular (LV) lateral
wall supplied by anterior
fascicle. Inferior wall is
supplied by posterior
fascicle and R wave peaks
early in these leads.
Sinus arrhythmia with short
PR interval suggesting
Lown–Ganong–Levine
syndrome. Note that there
is no delta wave or QRS
prolongation indicating
Wolff–Parkinson–White
(WPW) syndrome. In Lown–
Ganong–Levine syndrome,
the accessory pathway is
atrio-Hisian, shortening the
PR interval. In WPW
syndrome, AV preexcitation
of a portion of ventricular
myocardium results in delta
wave and QRS
prolongation.
Atrial fibrillation. Note
absence of P wave and
irregularly irregular
ventricular response. Also
note low QRS voltage (<5
mm in limb and<10 mm in
chest leads), which should
raise the suspicion of
chronic obstructive
pulmonary disease,
pericardial effusion, or
diffuse myocardial disease
Acute anterior ST elevation
myocardial infarction
(STEMI).

Note hyperacute,
tombstone ST elevation in
V2 and V3.
Hyperkalemia.

Note peaked, tall T waves in

V2 and V3.
Junctional tachycardia. P
waves are inverted in
inferior leads with superior
axis indicating junctional or
low atrial origin.
RVH. qR in V1 with right axis
deviation and strain pattern
in right chest leads is
suggestive of RVH.
WPW syndrome
Seven beats of
accelerated
idioventricular
rhythm, followed by
a fusion beat and
then accelerated
junctional rhythm.
This is suggestive of
digoxin toxicity.
Of the following statements regarding a patient with multiple cardiac risk factors and angina-like chest pain
lasting 30 min, which is the incorrect one?
A. A normal echocardiogram (ECG) in the emergency room (ER) rules out
B. myocardial infarction (MI)
C. Ischemia in circumflex area is more often electrically silent
D. Negative first set of cardiac markers does not rules out MI
E. ECG changes could be dynamic, and it is useful to repeat every 15 min in the first hour of chest pain or
when chest pain recurs
Of the following statements regarding a patient with multiple cardiac risk factors and angina-like chest pain
lasting 30 min, which is the incorrect one?
A. A normal echocardiogram (ECG) in the emergency room (ER) rules out
B. myocardial infarction (MI)
C. Ischemia in circumflex area is more often electrically silent
D. Negative first set of cardiac markers does not rules out MI
E. ECG changes could be dynamic, and it is useful to repeat every 15 min in the first hour of chest pain or
when chest pain recurs
The components of thrombolysis in MI (TIMI) risk score on initial patient evaluation for suspected acute
coronary syndrome (ACS) include which of the following?
A. Age >65 years
B. More than three coronary artery disease (CAD) risk factors
C. Prior CAD with >50% lesion
D. More than two anginal events in 24 h
E. Use of aspirin in last 7 days
F. ST deviation on ECG
G. Elevated cardiac markers
H. All of the above
I. Some of the above
The components of thrombolysis in MI (TIMI) risk score on initial patient evaluation for suspected acute
coronary syndrome (ACS) include which of the following?
A. Age >65 years
B. More than three coronary artery disease (CAD) risk factors
C. Prior CAD with >50% lesion
D. More than two anginal events in 24 h
E. Use of aspirin in last 7 days
F. ST deviation on ECG
G. Elevated cardiac markers
H. All of the above
I. Some of the above
Which of the following types of chest pain rule out ACS?
A. Sharp stabbing chest pain
B. Pleuritic chest pain
C. Chest pain reproduced by palpation
D. None of the above
Which of the following types of chest pain rule out ACS?
A. Sharp stabbing chest pain (22%)
B. Pleuritic chest pain (13%)
C. Chest pain reproduced by palpation (7%)
D. None of the above
STABLE vs UNSTABLE SITE
ONSET
Characteristic
Radiating
Alleviating
Time Duration
Exacerbation
Systemic signs & symptoms

Unstable:
1. Rest Angina
2. New onset angina
3. Cressendo Angina
Guideline recommendation for ECG for patients presenting with chest pain to the ER is performance of ECG
within how much time of arrival?
A. 5 min
B. 10 min
C. 30 min
D. 60 min
Guideline recommendation for ECG for patients presenting with chest pain to the ER is performance of ECG
within how much time of arrival?
A. 5 min
B. 10 min
C. 30 min
D. 60 min
The GRACE risk model predicts in hospital mortality in ACS patients and includes Killip class, systolic blood
pressure (BP), heart rate, age, and serum creatinine level. Which one of the following may be negatively
correlated with mortality?
A. Heart rate
B. Systolic BP
C. Killip class
D. None of the above
The GRACE risk model predicts in hospital mortality in ACS patients and includes Killip class, systolic blood
pressure (BP), heart rate, age, and serum creatinine level. Which one of the following may be negatively
correlated with mortality?
A. Heart rate
B. Systolic BP
C. Killip class
D. None of the above
Which of the following are contraindications for NTG in patients with ACS and continuing chest pain?
A. Systolic BP <90 mmHg
B. Inferior MI with positive Kussmaul
C. Sildenafil or vardenafil within 24 h
D. Tadalafil within 48 h
E. All of the above

F. None of the above

Which of the following are contraindications for NTG in patients with ACS and continuing chest pain?
A. Systolic BP <90 mmHg
B. Inferior MI with positive Kussmaul
C. Sildenafil or vardenafil within 24 h
D. Tadalafil within 48 h
E. All of the above

F. None of the above

Regarding use of traditional nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2)
inhibitors in the setting of ACS, which of the following statements is correct?
A. Traditional NSAIDs, but not COX-2 inhibitors can be used
B. Traditional NSAIDs should be used, but COX-2 inhibitors can be used
C. Neither traditional NSAIDs nor COX-2 inhibitors should be used

D. Either can be used with no risk of harm

Regarding use of traditional nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2)
inhibitors in the setting of ACS, which of the following statements is correct?
A. Traditional NSAIDs, but not COX-2 inhibitors can be used
B. Traditional NSAIDs should be used, but COX-2 inhibitors can be used
C. Neither traditional NSAIDs nor COX-2 inhibitors should be used

D. Either can be used with no risk of harm

Which calcium channel blockers are contraindicated in ACS?
A. Diltiazem
B. Verapamil
C. Short-acting nifedipine without a beta blocker

D. None of the above

Which calcium channel blockers are contraindicated in ACS?
A. Diltiazem
B. Verapamil
C. Short-acting nifedipine without a beta blocker

D. None of the above

The first dose and route of aspirin use in suspected ACS is which of the following?
A. 162 or 325 mg enteric coated
B. 162 or 325 mg non-enteric coated chewed
C. 81 mg orally
D. None of the above
The first dose and route of aspirin use in suspected ACS is which of the following?
A. 162 or 325 mg enteric coated
B. 162 or 325 mg non-enteric coated chewed
C. 81 mg orally
D. None of the above
Aspirin in suspected ACS is avoided in which of the following patients?
A. Aspirin allergy
B. Recent gastrointestinal bleed
C. Neither A nor B
D. Both A and B
Aspirin in suspected ACS is avoided in which of the following patients?
A. Aspirin allergy
B. Recent gastrointestinal bleed
C. Neither A nor B
D. Both A and B
For patients with ACS, what is the recommended duration of double antiplatelet therapy (DAPT)?
A. 1 month
B. 6 months
C. 1 year
D. Forever, unless at high risk of bleeding
For patients with ACS, what is the recommended duration of double antiplatelet therapy (DAPT)?
A. 1 month
B. 6 months
C. 1 year
D. Forever, unless at high risk of bleeding
After NSTEMI, in addition to ASA, Plavix, beta blocker, and high-intensity statin therapy, which other agents
are recommended for those with ejection fraction (EF) <40%?
A. Angiotensin-converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs) in those who are
ACEI intolerant
B. Aldosterone blocking agent, provided creatinine is <2 mg/dL and K is <5 meq/L
C. Diltiazem to prevent reinfarction
D. A and B
E. A and C
After NSTEMI, in addition to ASA, Plavix, beta blocker, and high-intensity statin therapy, which other agents
are recommended for those with ejection fraction (EF) <40%?
A. Angiotensin-converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs) in those who are
ACEI intolerant
B. Aldosterone blocking agent, provided creatinine is <2 mg/dL and K is <5 meq/L
C. Diltiazem to prevent reinfarction
D. A and B
E. A and C
In a patient with non-ST elevation ACS, early coronary angiography is appropriate in which of the following
situations?
A. TIMI score of 5
B. Continuing chest pain
C. EF <40%
D. Anterior wall motion abnormality
E. Dynamic mitral regurgitation (MR) murmur

F. All of the above

In a patient with non-ST elevation ACS, early coronary angiography is appropriate in which of the following
situations?
A. TIMI score of 5
B. Continuing chest pain
C. EF <40%
D. Anterior wall motion abnormality
E. Dynamic mitral regurgitation (MR) murmur

F. All of the above

Based on current data, which of the following statements are correct in the setting of ACS?
A. In the setting of ST elevation MI (STEMI), non-culprit vessels should not be stented
B. In the setting of NSTEMI, it is reasonable to perform percutaneous coronary intervention (PCI) on critically
stenosed non-culprit vessels as well
C. Both A and B are correct
D. Neither A or B are correct
Based on current data, which of the following statements are correct in the setting of ACS?
A. In the setting of ST elevation MI (STEMI), non-culprit vessels should not be stented
B. In the setting of NSTEMI, it is reasonable to perform percutaneous coronary intervention (PCI) on critically
stenosed non-culprit vessels as well
C. Both A and B are correct
D. Neither A or B are correct
Which of the following statements are correct prasugrel use?
A. It is used 10 mg once a day.
B. It reduces risk of stent thrombosis compared with clopidogrel
C. It has a higher risk of bleeding in those above 75 years of age or weigh <60 kg
D. It is contraindicated in those with prior stroke or transient ischemic attack (TIA)
E. All of the above
F. None of the above
Which of the following statements are correct prasugrel use?
A. It is used 10 mg once a day.
B. It reduces risk of stent thrombosis compared with clopidogrel
C. It has a higher risk of bleeding in those above 75 years of age or weigh <60 kg
D. It is contraindicated in those with prior stroke or transient ischemic attack (TIA)
E. All of the above
F. None of the above