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Megacode Scenario 7

Instructions: Evaluate the case and use your knowledge of ACLS algorithms to answer each question. You will receive a score at the end of the test. You may repeat this simulation as often as you like, until you are confident in your ability to intervene effectively in similar situations. There are 20 questions in this simulation.

1. You are working in the emergency room when a man, aged 55 years, arrives accompanied by his wife. He complains of left-sided chest pain that radiates to his left shoulder and arm. His wife states that the patient vomited once and has been sweating since then. Based on these symptoms, you should suspect:
a. Stroke.
b. Acute coronary syndrome.
c. Gastritis.
d. Musculoskeletal chest pain.
 
2. For a patient with ACS you would initiate all of the following measures within the first 10 minutes except:
a. Administer oxygen to the patient to maintain SpO2 at ≥ 94%.
b. Administer Aspirin 180 to 325 mg, chewed (if the patient has not already taken)
c. Perform a 12-lead ECG.
d. Administer thrombolytics.
 
3. The ECG has been completed and has been handed to you. What is your interpretation based on this ECG?
inferior-stemi-due-to-circumflex-occlusion.jpg
a. STEMI
b. NSTEMI
c. Hyperkalemia.
d. Hypokalaemia.
 
4. What is the recommended time frame within which the ECG should be read and analysed when a patient presents with chest pain?
a. 5 minutes.
b. 10 minutes.
c. 15 minutes.
d. 20 minutes.
 
5. Why is the time frame for diagnosis kept to within 10 minutes?
a. To initiate early transfer to the ICU for ongoing close observation and care.
b. To encourage early administration of beta blockers, which offer a protective factor against another MI.
c. To initiate early surgical intervention for patients requiring bypass surgery.
d. To promote early reperfusion and minimize damage in patients with STEMI.
 
6. A patient with chest pain has been in the ED for 15 minutes. Which of the following interventions need not be completed in this time frame?
a. ED assessment.
b. Portable chest x ray.
c. 12 lead ECG.
d. None of the above.
 
7. All of the following are a possible modes of reperfusion therapy in patients with ACS except:
a. Low molecular weight heparin.
b. Fibrinolytic therapy.
c. Percutaneous intervention (PCI).
d. All of the above.
e. None of the above.
 
8. Which of the following groups of drugs play an important role in managing a patient with ACS in the emergency setting?
a. Nitroprusside, Aspirin, and Clopidogrel.
b. Nitroglycerine, Aspirin, Clopidogrel.
c. Nitroglycerine, Aspirin, Morphine.
d. Metoprolol, Aspirin, Morphine.
 
9. Which of the following ECG abnormalities helps to further streamline the management of the patient suffering from ACS?
a. ST segment abnormality.
b. Morphology of T waves.
c. Duration of PR interval.
d. Duration of QRS complex.
 
10. Your patient has an ST segment elevation MI. What is the longest acceptable ‘door to needle’ (fibrinolysis) time?
a. 10 minutes.
b. 30 minutes.
c. 45 minutes.
d. 60 minutes.
 
11. What is the target door-to-balloon inflation time in patients with ACS?
a. 30 minutes.
b. 60 minutes.
c. 90 minutes.
d. 120 minutes.
 
12. Patients who have suffered an acute coronary event often suffer sudden cardiac death (SCD). What is the most common underlying cause of SCD?
a. Massive pulmonary thromboembolism.
b. Severe acute hyperkalemia leading to asystole.
c. Cardiogenic shock.
d. Ventricular fibrillation and pulseless ventricular tachycardia.
 
13. Given that ECG findings are diagnostic and PCI is not available within 90 minutes of first medical contact, what is the preferred time frame within which fibrinolytic therapy should be administered in a patient suffering from STEMI?
a. Within one hour of the onset of symptoms.
b. Within 6 hours from the onset of symptoms.
c. Within 12 hours from the onset of symptoms.
d. There is no time frame- fibrinolytic therapy can be performed at any stage.
 
14. All the following are indications to perform an invasive strategy (i.e. PCI) to achieve reperfusion rather than fibrinolytic therapy except:
a. Early presentation of within three hours or less from onset of symptoms.
b. Door to balloon time of less than 90 minutes.
c. Contraindication(s) to fibrinolysis.
d. Diagnosis of STEMI is in doubt.
 
15. Which of the following are relative contraindications for using nitroglycerine in patients suffering from ACS?
a. Systolic blood pressure less than 90 mm of Hg.
b. Heart rate of less than 50 beats per minute.
c. Tachycardia (heart rate greater than 100 beats per minute) in the absence of heart failure.
d. All of the above.
 
16. All the following are absolute contraindication to the fibrinolytic except?
a. Pregnancy
b. History of previous intracranial hemorrhage.
c. Malignant intracranial neoplasm.
d. Suspected aortic dissection.
 
17. Which of the following is the most common arrhythmia seen during the first four hours after myocardial infarction?
a. Ventricular tachycardia.
b. Ventricular fibrillation.
c. Pulseless electrical activity.
d. Sinus bradycardia.
 
18. The most commonly used analgesic in patients suffering from ACS is:
a. Fentanyl.
b. Aspirin.
c. Morphine.
d. Acetaminophen.
 
19. In patients suffering from ACS, the minimum target SpO2 should be:
a. 92%
b. 94%
c. 96%
d. 95%
 
20. What is the recommended dose of aspirin administered to a patient with probable ACS?
a. 160 to 325 mg.
b. 200 to 325 mg.
c. 80 to 160 mg.
d. 100 to 300 mg.
 
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