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  #1  
Old 10-06-2012
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Arrow Billy Step 1 Questions #11

A 50-year-old man with a lengthy history of diabetes mellitus and hypertension has had pain in the left shoulder and
arm for the past 12 hours. He attributes the pain to arthritis and takes acetaminophen. Over the next 6 hours, he develops
shortness of breath, which persists for 2 days. On day 3, he visits the physician. On physical examination, his temperature
is 37.1C, pulse is 82/min, respirations are 18/min, and blood pressure is 160/100 mm Hg. Laboratory studies show that
the total creatine kinase (CK) activity is within reference range, but the troponin I level is elevated. The patient is admitted
to the hospital and continues to experience dyspnea for the next 3 days. On day 7 after the onset of shoulder pain, he has
a cardiac arrest. Resuscitative measures are unsuccessful. Postmortem examination shows a large transmural infarction of
the left anterior free wall with rupture and hemopericardium. Which of the following statements is best supported by these
clinical and autopsy data?


□ (A) Infarction did not develop until day 5 or day 6 after the episode of chest pain
□ (B) The normal CK level obtained on day 3 excludes the possibility of infarction within the preceding 72 hours
□ (C) He had an acute infarction occurring on the day he developed shoulder pain
□ (D) A CK-MB fraction determination would have detected acute infarction on day 3
□ (E) A second acute infarction on day 6 or day 7 caused myocardial rupture within several hours
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  #2  
Old 10-06-2012
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Default good question..

going with the autopsy results i think answer is E
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Old 10-06-2012
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c) ac MI on day he developed shoulder pain ............
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  #4  
Old 10-06-2012
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Default

C
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  #5  
Old 10-06-2012
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it's C.
He had infarction on day 1 and developed MI complication called ventricular wall rupture, which is most feared complication about 7days after MI, cause macrophages move in infarction site and eat things there and risk of rupture is highest at this time.
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? my ans is c
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  #7  
Old 10-06-2012
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Correct Answer C is correct

(C) The kinetics of creatine kinase (CK), CK-MB, and troponin I elevations after a myocardial infarction (MI) are
important. Total CK activity begins to increase 2 to 4 hours after an MI, peaks at about 24 to 48 hours, and returns to
normal within 72 hours. Troponin I levels begin to increase at about the same time as CK and CK-MB, but remain elevated
for 7 to 10 days. Total CK activity is a sensitive marker for myocardial injury in the first 24 to 48 hours. CK-MB offers more
specificity, but not more sensitivity. Myocardial rupture occurs 5 to 7 days after myocardial necrosis. This patient had an
MI on the day of the shoulder pain. When he saw the physician on day 3, the CK levels had returned to normal, but
troponin I levels remained elevated. Three days later, the infarct ruptured.
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