Quiz on IHD

A 65-year-old male with a history of MI is on optimal medical therapy including a beta-blocker, ACE inhibitor, and statin. He continues to experience angina despite these medications. Which of the following medications is considered a second-line agent for symptom relief in stable angina? *

A 58-year-old female with a history of CAD presents with exertional chest pain. She is started on a high-intensity statin and aspirin. Her LDL cholesterol remains elevated at 120 mg/dL. Which of the following medications is the most appropriate addition to further lower her LDL cholesterol? *

A 65-year-old male with diabetes and hyperlipidemia is experiencing exertional angina. He is on a moderate-intensity statin and aspirin. His physician wants to add a medication to further reduce his risk of cardiovascular events. Which of the following medications, when added to statin and aspirin, has been shown to reduce cardiovascular events in patients with stable ischemic heart disease and a history of myocardial infarction or other atherosclerotic disease? *

A 70-year-old male with CAD and chronic kidney disease (CKD) stage 4 is admitted with unstable angina. He is to be treated with PCI. He is on aspirin. Which of the following P2Y12 inhibitors requires dose adjustment or is contraindicated in significant renal impairment? *

A 70-year-old male with ischemic heart disease presents with chest pain and is found to have an inferior STEMI. He undergoes successful primary PCI with placement of a drug-eluting stent. He is discharged on dual antiplatelet therapy (aspirin and ticagrelor) for 12 months. He also has a history of gout and is taking allopurinol. Which of the following is a potential drug interaction to monitor for? *

A 55-year-old male with stable angina is initiated on a beta-blocker for symptom control. He has a history of asthma. Which of the following beta-blockers would be the most appropriate choice, considering his respiratory history? *

A 55-year-old male presents with acute chest pain suggestive of an MI. His ECG shows ST-segment elevation in leads V1-V4. He is rushed to the cardiac catheterization lab for primary percutaneous coronary intervention (PCI). He is to receive dual antiplatelet therapy (DAPT). Which of the following P2Y12 inhibitors is generally preferred in the setting of primary PCI for STEMI? *

A 45-year-old male with no significant past medical history presents with sudden onset of severe, substernal chest pain radiating to his jaw, accompanied by nausea and diaphoresis. His ECG shows diffuse ST-segment elevation. He is diagnosed with a massive anterior STEMI. He is allergic to aspirin. Which of the following is the most appropriate initial antiplatelet therapy in this scenario? *

A 62-year-old male presents with new-onset shortness of breath and fatigue. He has a history of CAD and a previous myocardial infarction 5 years ago. His ejection fraction is 35%. He is currently on lisinopril, metoprolol, and furosemide. His vital signs are stable. Which of the following medications is most likely to improve his long-term prognosis and reduce hospitalizations for heart failure? *

A 75-year-old female with known ischemic heart disease develops acute chest pain at rest. Her ECG shows ST-segment depression in the anterior leads, and her troponin levels are elevated. She is diagnosed with an NSTEMI. Her blood pressure is 110/70 mmHg, and her heart rate is 70 bpm. She is allergic to penicillin. Which of the following medications should be avoided due to a potential cross-reactivity or contraindication? *

A 72-year-old male with a history of CAD and atrial fibrillation is on warfarin for stroke prevention. He presents with worsening exertional chest pain. He is prescribed sublingual nitroglycerin, which provides temporary relief. His physician is considering adding a medication to improve his exertional capacity. Which of the following medications would be most appropriate, considering his anticoagulation status and history? *

A 60-year-old male with a history of hypertension and hyperlipidemia is experiencing stable angina. His physician is considering starting a statin. Which of the following statins would be considered a high-intensity statin, indicated for primary prevention of atherosclerotic cardiovascular disease in patients with established CAD or multiple risk factors? *

A 75-year-old male with a history of ischemic heart disease develops acute shortness of breath and chest pain. He is diagnosed with acute decompensated heart failure and a concurrent myocardial infarction. He is hemodynamically unstable with hypotension. Which of the following medications should be used with extreme caution or avoided in this patient due to its negative inotropic effects and potential to worsen hypotension? *

A 65-year-old male presents to the emergency department with sudden onset of crushing chest pain radiating to his left arm, accompanied by diaphoresis and nausea. His vital signs are: BP 150/90 mmHg, HR 95 bpm, RR 20/min, SpO2 98% on room air. An ECG shows ST-segment elevation in leads II, III, and aVF. Which of the following is the most appropriate initial pharmacologic management for this patient? *

A 68-year-old male with stable angina is on optimal medical therapy, including a beta-blocker, aspirin, and a high-intensity statin. He continues to have exertional angina that limits his daily activities. His physician is considering adding a third antianginal agent. Which of the following medications is a direct vasodilator that can be used to improve anginal symptoms by reducing myocardial oxygen demand through peripheral vasodilation? *

A 70-year-old female with a history of myocardial infarction 2 years ago presents with symptoms of heart failure. She is already on an ACE inhibitor, a beta-blocker, and a loop diuretic. Her ejection fraction is 30%. Her potassium is 4.8 mEq/L. Which of the following medications would be the most appropriate addition to her regimen to improve her prognosis? *

A 68-year-old female presents with acute onset of dyspnea and chest pain that started 2 hours ago. Her ECG shows ST-segment depression in the anterior leads. Cardiac enzymes reveal elevated troponin I. She is diagnosed with a non-ST-elevation myocardial infarction (NSTEMI). Which of the following is the most appropriate initial management strategy? *

A 62-year-old male with a history of CAD and an ejection fraction of 40% presents with new-onset atrial fibrillation. He is experiencing symptoms of angina. He is currently on aspirin and metoprolol. Which of the following medications is **contraindicated** in this patient for rate control of his atrial fibrillation due to its potential to worsen myocardial ischemia? *

A 58-year-old female with a history of hypertension and hyperlipidemia presents with exertional chest pain that resolves with rest. She denies any pain at rest. Her ECG is normal at rest. She is scheduled for a stress test. Which of the following diagnostic modalities is most appropriate to assess for significant coronary artery stenosis in this patient? *

A 60-year-old male with a history of CAD is admitted with an NSTEMI. He is started on aspirin and ticagrelor, and anticoagulation with heparin. He develops a rash and pruritus after 2 days of ticagrelor. His troponin levels are still rising. Which of the following is the most appropriate management for his ticagrelor-induced rash? *

A 50-year-old male with a history of hypertension presents with sudden, severe, tearing chest pain radiating to his back. His blood pressure is 190/110 mmHg, and his pulse is 110 bpm. An aortic dissection is suspected. Which of the following medications is **contraindicated** in the initial management of suspected aortic dissection? *

A 70-year-old male with known coronary artery disease (CAD) is admitted with an acute myocardial infarction. He is treated with percutaneous coronary intervention (PCI) and receives a drug-eluting stent. He is prescribed dual antiplatelet therapy (DAPT) with aspirin and ticagrelor. He also has a history of peptic ulcer disease. Which of the following is the most significant drug interaction to consider for this patient? *