繼續教育考題
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1.
(A) |
True statements
regarding to the clinical history of acute myocardial infarction
(MI) include all of the following EXCEPT: |
A | A clear precipitating factor or
prodromal symptoms can be identified in 90 percent of patients with
acute MI. |
B | Between 20 to 60 percent of
nonfatal MI are unrecognized by the patient and are identified only
by a subsequent routine ECG. |
C | One third of patients with a
prodrome have had symptoms for 1 to 4 weeks before
hospitalization. |
D | Over one half of patients with
a transmural MI have nausea and vomiting. |
E | The peak frequency of MI onset
is between 6AM and noon. |
2.
(E) |
Each of the following
statements regarding an antithrombotic therapies in the treatment of
unstable angina is correct EXCEPT: |
A | Aspirin reduces the
incidence of cardiovascular death and nonfatal MI. |
B | The combination of
aspirin and unfractionated heparin is superior to aspirin alone in
prevention of death and nonfatal MI. |
C | Glycoprotein IIb/IIIa
inhibitors decrease the incidence of death, nonfatal MI, and
recurrent ischemia at 30 days. |
D | Acute treatment with the
low-molecular-weight heparin (LMWH) enoxaparin has been shown to be
superior to unfractionated heparin in reducing the rate of death,
nonfatal MI, and recurrent ischemia. |
E | Prolonged administration of
LMWH after hospital discharge reduces the rate of recurrent ischemic
events. |
3.
(A) |
True statements
regarding to the indication of Tc-99m pyrophosphate infarct scan in
acute MI include all of the following EXCEPT: |
A | High sensitivity and low
specificity in the detection of acute MI. |
B | Not routinely use, and
suggested in the unable to differentiate acute MI or its location by
the clinical history, ECG, and serum markers. |
C | Used in 2 to 7 days after acute
MI. |
D | The sensitivity depends on the
extent of MI and duration after the event. |
4.
(A) |
All of the following
features of post-myocardial infarction pericarditis are true EXCEPT: |
A | Thrombolytic therapy increases
the incidence of early post-MI pericarditis and reduces that of
Dressler's syndrome. |
B | Post-MI pericarditis is more
common following Q wave MI. |
C | A pericardial friction rub can
be detected as early as 12 hours after the infarction. |
D | The use of heparin is not
associated with an increased risk of pericarditis. |
E | Diagnostic ECG changes include
persistently positive T waves and premature normalization of
initially inverted T waves. |
5.
(C) |
True statements about
acute MI include all of the following EXCEPT: |
A | Marked hypotension in response
to small doses of NTG in patients with inferior infarction suggests
right ventricular infarction. |
B | ST segment elevation in
lead V4R is a sensitive and specific sign of RVI. |
C | Less than half of deaths
caused by acute MI occur during hours 2 to 4 after the beginning of
the event. |
D | Most deaths among patients
hospitalized with acute MI are attributable to LV failure and shock. |
E | Careful monitoring of
cardiac rhythm and treatment of primary arrhythmias has reduced the
incidence of in-hospital death from acute MI. |
6.
(C) |
True statements
regarding thrombolytic therapy in acute MI include all of the
following EXCEPT: |
A | Thrombolytic therapy
reduces the mortality of ST-segment elevation MI by 15 to 20 percent
at 1 month. |
B | Compared with patients with
anterior ST elevation, patients who present with a bundle-branch
block have a similar risk reduction with thrombolytic therapy. |
C | Compared with patients with
anterior ST elevation, patients with inferior ST elevation have a
greater risk reduction. |
D | Clinical trial data
demonstrate no mortality benefit of thrombolysis administered more
than 12 hours after the onset of symptoms. |
E | Patients older than 75 years
experience an absolute reduction of mortality similar to that of
patients younger than 55 years. |
7.
(A) |
Which is the true
statement regarding to stent implantation? |
A | Stent implantation decreases
the restenosis rate. |
B | Stent implantation inhibits
neointimal proliferation. |
C | Stent implantation decreases
the rate of non-Q wave MI. |
D | Stent implantation
decreases the rate of Q wave MI. |
E | Stent decreases the mortality
rate when performed in the setting of acute MI. |
8.
(B) |
Which of the following
imaging techniques are capable of correctly identifying acutely
necrotic myocardial tissue? a. Tc-99m pyrophosphate
scintigraphy. b. Echocardiography. c. Monoclonal
antimyosin-specific antibody scintigraphy. d. Coronary
angiography. e. Thallium-201 single photon emission computed
tomography (SPECT). |
A | a, b |
B | a, c |
C | a, c, e |
D | d, e |
E | all of the above |
9.
(C) |
All of the following
statements regarding nuclear imaging are true EXCEPT: |
A | The size of the resting
myocardial perfusion defect after acute MI correlate with the
patients' prognosis. |
B | Increased lung uptake of
thallium-201 at rest correlates with an unfavorable prognosis. |
C | Submaximal exercise imaging
prior to discharge from the hospital is a better predictor of late
complications from the acute MI than adenosine or dipyridamole
stress myocardial perfusion imaging. |
D | Patients who cannot perform
exercise can be evaluated for coronary artery disease with
vasodilating medications (such as dipyridamole or adenosine). |
E | Dobutamine is an alternative
pharmacological stress test agent for patients with
contraindications to adenosine or dipyridamole. |
10.
(A) |
All of the following
characteristics of chest pain would be unusual for coronary artery
ischemia-induced angina EXCEPT: |
A | Pain that begins gradually and
reaches maximum intensity over a periods of minutes. |
B | Pain aggravated or
precipitated by one deep breath. |
C | Pain relieved within seconds
by lying horizontally. |
D | Pain localized to an area the
size of the tip of the finger. |
E | Pain relieved within a few
seconds by one or tow sips of
water. |