Scenarios of myocardial infarction with answers

Question 1: Classic MI Presentation

A 58-year-old male smoker presents with severe chest pain radiating to the left arm, sweating, and nausea. ECG shows ST-segment elevation in leads II, III, and aVF. What is the most likely diagnosis?

A. Anterior wall MI
B. Inferior wall MI
C. Lateral wall MI
D. Non-ST elevation MI (NSTEMI)

✅ Correct Answer: B. Inferior wall MI

Question 2: Silent MI in a Diabetic

A 65-year-old diabetic female complains of fatigue and shortness of breath for 2 days without chest pain. ECG shows Q waves in anterior leads. Troponin is elevated. What is the most likely diagnosis?

A. Stable angina
B. Silent myocardial infarction
C. Panic attack
D. Congestive heart failure

✅ Correct Answer: B. Silent myocardial infarction

Question 3: Drug-Induced MI

A 29-year-old man with a history of cocaine use presents with chest pain and palpitations. ECG shows ST elevation. Which of the following drugs should be avoided in his treatment?

A. Nitroglycerin
B. Aspirin
C. Benzodiazepines
D. Beta-blockers

✅ Correct Answer: D. Beta-blockers

Question 4: Recurrent Ischemia

A 62-year-old man with a past history of MI presents with chest pain after climbing stairs. ECG shows ST depression in leads V5 and V6. What is the most likely diagnosis?

A. Stable angina
B. Prinzmetal angina
C. Unstable angina or NSTEMI
D. Pericarditis

✅ Correct Answer: C. Unstable angina or NSTEMI

Question 5: Postoperative MI

A 70-year-old woman recovering from hip replacement complains of chest discomfort and shortness of breath. ECG shows non-specific ST changes, and troponin is elevated. What is the likely diagnosis?

A. Pulmonary embolism
B. Myocardial infarction (perioperative)
C. Pneumonia
D. Deep vein thrombosis

✅ Correct Answer: B. Myocardial infarction (perioperative)

Question 6: Atypical MI Symptoms

A 55-year-old female presents with indigestion, jaw pain, and fatigue. ECG shows ST elevation in anterior leads. What is the best next step in management?

A. Order abdominal ultrasound
B. Reassure and discharge
C. Initiate myocardial infarction protocol
D. Refer to dentist for jaw pain

✅ Correct Answer: C. Initiate myocardial infarction protocol

Question 7: Cardiogenic Shock

A 60-year-old man presents with chest pain, confusion, and cold extremities. His BP is 70/40 mmHg. ECG shows anterior ST elevation. What is the most probable complication?

A. Pulmonary embolism
B. Cardiogenic shock
C. Septic shock
D. Neurogenic shock

✅ Correct Answer: B. Cardiogenic shock

Question 8: Elderly with Delirium

A 78-year-old male in a nursing home is found confused and febrile. ECG reveals Q waves and ST changes. Troponin is elevated. What is the most likely cause?

A. Delirium due to infection
B. Alzheimer's disease
C. Atypical myocardial infarction
D. Stroke

✅ Correct Answer: C. Atypical myocardial infarction

Question 9: MI with VT

A 61-year-old male collapses and is resuscitated. Post-resuscitation ECG shows ST elevation, and ventricular tachycardia was documented during the event. What is the best next step?

A. Start antibiotics
B. Immediate coronary angiography
C. Give IV fluids only
D. Send home with medications

✅ Correct Answer: B. Immediate coronary angiography

Question 10: MI in Renal Failure

A 67-year-old dialysis patient presents with chest discomfort and mild dizziness. ECG shows T-wave inversion, and troponin is mildly elevated. What is the likely diagnosis?

A. Stable angina
B. Myocardial infarction (NSTEMI)
C. Uremic pericarditis
D. Electrolyte imbalance only

✅ Correct Answer: B. Myocardial infarction (NSTEMI)


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