DIAGNOSIS OF AMI 28/12/23 - Exam (4 cases)

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1) Mr. Ram is a 56-year-old electrician with type 2 diabetes and hypertension. He was working on the roof of a building with his hands raised above his head for 3 hours. 2 hours back he developed an ischemic type of chest pain and was brought to you in the emergency. ECG shows nonspecific ST-T wave changes. Within 2 hours of chest pain, which marker is most specific in acute myocardial infarction?

1 point

a. Total CK-MB activity

b. Total CK-MB mass

c. Troponin

d. Myoglobin

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2) A 67-year-old woman presented with an episode of chest pain. There were no obvious ischemic changes in her ECG. Five hours later, she experienced more pain; this time the pain was accompanied with ST elevation in leads II, III, and aVF, and was diagnosed to be acute inferior wall myocardial infarction. Six days after admission, she developed hypotension with increased pressure in the jugular vein. Reinfarction was suspected. Which test is most useful in diagnosing recurrent MI developing within a week?

1 point

a. Troponins

b. CK-MB

c. Myoglobin

d. ESR

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3) A 66-year-old man with hypertension, type 2 diabetes mellitus, and chronic renal failure due to diabetic nephropathy and a history of prolonged smoking was admitted with a chief complaint of retrosternal chest pain. ECG shows nonspecific changes. Which is the preferred serum cardiac biomarker in patients with renal failure?

1 point

a. Troponins

b. CK-MB

c. Urea/Myoglobin ratio

d. Serum creatin/CK-MB ratio

e. Serum creatin/Myoglobin ratio

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4) A 49-year-old woman presents after a 30-minute episode of severe, burning central chest pain radiating to the throat. When she was sweating but is now symptom-free. Episodes of a similar but less severe pain had occurred daily for the previous 10 days, predominantly at rest but also when climbing the stairs at home. She has type II diabetes and hypertension. The initial ECG is normal. Traditional troponin I assay is also normal. High-sensitivity troponin assay result is awaited (cost=2000). What is the diagnosis?

1 point

a. Stable angina

b. Unstable angina

c. NSTEMI

d. STEMI in evolution

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