Question 1

A 58-year-old man presents with chest pain described as squeezing and suffocating, radiating to his left arm, which is relieved by rest and nitroglycerin. Which of the following best describes the underlying pathophysiology of his condition?

Accepted Answer

Fixed atherosclerotic plaque causing reduced blood flow during exertion

Question 2

Which of the following is the most significant determinant of myocardial oxygen demand?

Accepted Answer

Heart rate

Question 3

A patient with a history of stable angina now reports chest pain at rest that is not relieved by nitroglycerin and lasts longer than 10 minutes. Which acute coronary syndrome is most likely?

Accepted Answer

Unstable angina

Question 4

Which of the following laboratory findings is most specific for diagnosing an acute myocardial infarction?

Accepted Answer

Elevated troponin I or T

Question 5

During which phase of the cardiac cycle does the majority of coronary blood flow to the left ventricle occur?

Accepted Answer

Diastole

Question 6

A patient with ST-elevated myocardial infarction (STEMI) is at risk for which of the following complications due to ventricular remodeling?

Accepted Answer

Thinning and dilation of infarcted tissue with hypertrophy of non-infarcted tissue

Question 7

Which of the following best explains why nitroglycerin relieves pain in stable angina but not in STEMI?

Accepted Answer

Nitroglycerin dilates coronary arteries, improving supply in fixed stenosis but not in complete occlusion

Question 8

Which of the following mediators is primarily responsible for coronary vasodilation during hypoxia?

Accepted Answer

Nitric oxide (NO)

Question 9

A 65-year-old woman with a sedentary lifestyle and diabetes presents with atypical chest pain and no EKG changes. Which factor may contribute to her atypical presentation of ischemic heart disease?

Accepted Answer

Neuropathy affecting pain perception

Question 10

Which of the following best describes the difference between NSTEMI and STEMI on EKG?

Accepted Answer

NSTEMI shows ST depression or T wave inversion; STEMI shows ST elevation

Question 11

A patient with a history of atherosclerosis develops a sudden, severe chest pain not relieved by rest or nitroglycerin, accompanied by diaphoresis and a sense of impending doom. Which of the following is the most likely diagnosis?

Accepted Answer

ST-elevated myocardial infarction (STEMI)

Question 12

Which of the following interventions is most appropriate for immediately improving oxygen supply in a patient with acute coronary syndrome?

Accepted Answer

Providing supplemental oxygen

Question 13

Which of the following equations best represents the relationship between cardiac output (CO), heart rate (HR), and stroke volume (SV)?

Accepted Answer

$CO = HR 	imes SV$

Question 14

A patient with STEMI is treated with tissue plasminogen activator (tPA). What is the primary mechanism of action of tPA in this context?

Accepted Answer

Lyses the thrombus occluding the coronary artery

Question 15

Which of the following is a common site of atherosclerotic plaque formation leading to myocardial infarction?

Accepted Answer

Left anterior descending coronary artery

Question 16

Which of the following best explains why heart rate is a determinant of both myocardial oxygen supply and demand?

Accepted Answer

Increased heart rate decreases diastolic filling time (reducing supply) and increases contractility (increasing demand)

Question 17

A 60-year-old man with chest pain is found to have elevated troponin levels and ST depression on EKG. Which of the following is the most likely diagnosis?

Accepted Answer

Non-ST elevated myocardial infarction (NSTEMI)

Question 18

Which of the following medications is used to decrease myocardial oxygen demand by reducing both heart rate and contractility?

Accepted Answer

Beta-blocker

Question 19

Which of the following best describes the effect of a coronary artery stent in the management of ischemic heart disease?

Accepted Answer

It mechanically opens the artery to restore blood flow

Question 20

A patient with a history of angina is prescribed a non-dihydropyridine calcium channel blocker. What is the primary therapeutic effect of this medication in ischemic heart disease?

Accepted Answer

Decreases heart rate and contractility

Disorders of Cardiac Function: Ischemic Heart Disease and Acute Coronary Syndromes

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