Unstable Angina and Non-STEMI: Risk Assessment and Management – Post Test

A 72-year-old man presents with ischaemic chest pain of three hours’ duration. He has a past history of hypertension and hypercholesterolaemia. On examination he is haemodynamically stable and his chest pain is resolving with opiate analgesia, GTN, and aspirin. His standard 12 lead ECG shows ST segment depression in the anterior chest leads. Troponin assay is awaited.

With the information given, which of the following statements is most appropriate?

A 56-year-old man presents to the Emergency Department at 3pm with a one hour history of ischaemic-sounding chest pain at rest preceded by another episode of two hours’ duration during the morning. He is an ex-smoker, has had a previous myocardial infarction, and has a history of hypertension. There is no family history of relevance. He takes aspirin, atenolol, and bendroflumethazide. On examination he is haemodynamically stable and his pain has settled. His ECG shows evidence of an old inferior infarct but no acute changes. His troponin is negative.

What is his TIMI risk score?

Which one of the following is NOT true of the GRACE risk stratification tool?

A 55-year-old man presents to the Emergency Department having had an episode of chest pain which lasted approximately one hour; it was relieved by GTN and aspirin given by the paramedic crew. He is a smoker and has a history of hypertension but has never previously had chest pain. His physiological observations are normal on arrival but his ECG reveals some anterolateral ST segment depression. His initial Troponin is negative and he has normal renal function. You perform risk stratification using the GRACE score and he has a predicted 6 month mortality of 2%.

Which one of the following statements is true?

A 72-year-old diabetic woman presents to the emergency department with retrosternal chest pain and shortness of breath of two hours’ duration. She is haemodynamically stable but has some bilateral basal crackles and an SaO2 of 93% on 6 l of inspired oxygen. Her BM is 24 mmol/l. She is given aspirin, diamorphine, an anti-emetic, and GTN. An ECG is performed and is as shown opposite.

Which one of the following is the most urgent priority for the emergency physician?

A 60-year-old woman presents to the emergency department with severe ischaemic-sounding chest pain of two hours’ duration. She is a smoker and has hypertension and diabetes. She has continuing pain despite oxygen, GTN, and opiate analgesia. On examination her pulse is 65 and her blood pressure 95/65 mmHg. Oxygen saturations are 96% on oxygen. Her ECG shows anterolateral ST segment depression. Posterior leads are normal. A troponin is awaited.

Which of the following statements regarding symptom control is most appropriate?

Which of the following statements about the various forms of heparin therapy in treating ACS is correct?

Which of the following statements regarding glycoprotein IIb/IIIa inhibitors is correct?

A 66-year-old man presents with an episode of retrosternal chest pain at rest which lasted for two hours and resolved with GTN, oxygen and aspirin administered by the paramedics. He is on treatment for hypertension, has a positive family history of ischaemic heart disease, and is a non-insulin dependent diabetic. This is his first episode of chest pain. On examination he is pain free and his observations are normal. His ECG shows some lateral T wave inversion.

Which of the following is the most appropriate next course of action?

A 66-year-old man is being treated in the ED; he presented with ischaemic chest pain of two hours’ duration, hypotension, and ST segment depression, in an anterolateral distribution. His chest pain is refractory to oxygen, opiates, and GTN. His troponin has just returned and is positive. The registrar who has been caring for him reports that he has already given clopidogrel and enoxaparin and asks you about referral for angiography and other adjuvant therapy.

Which of the following is most appropriate?