Cardiology: reperfusion in STEMI: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Cardiology: reperfusion in STEMI

Sample item

A 52-year-old man arrives at a district hospital without a catheterisation laboratory, 2 hours after the onset of chest pain, with ST elevation in the anterior leads. He has no contraindication to fibrinolysis. The nearest PCI-capable centre is about 3 hours away by road. What is the best strategy?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Give a fibrinolytic now, then transfer to the PCI centre for angiography

Primary PCI is preferred only when it can be done within about 120 minutes of first medical contact. When this is not achievable, prompt fibrinolysis followed by transfer to a PCI-capable centre (the pharmaco-invasive strategy) is recommended, with rescue PCI if it fails and angiography within 24 hours if it succeeds. ST elevation with typical pain is itself sufficient to act; troponin should not delay treatment.

Option by option

  • A. Give a fibrinolytic now, then transfer to the PCI centre for angiography (correct)

    A pharmaco-invasive approach saves myocardium when PCI delay is too long.

  • B. Withhold reperfusion and transfer for primary PCI regardless of delay

    A transfer taking 3 hours or more would leave the artery occluded for too long.

  • C. Give a fibrinolytic and discharge him if the pain settles

    Even after successful fibrinolysis, patients need transfer for angiography and risk stratification.

  • D. Give aspirin and heparin only, and wait for the troponin result

    STEMI is diagnosed on ECG and symptoms; waiting for troponin wastes myocardium.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Give a fibrinolytic now, then transfer to the PCI centre for angiography. Primary PCI is preferred only when it can be done within about 120 minutes of first medical contact.

Why is "Withhold reperfusion and transfer for primary PCI regardless of delay" not the answer?

A transfer taking 3 hours or more would leave the artery occluded for too long.

Why is "Give a fibrinolytic and discharge him if the pain settles" not the answer?

Even after successful fibrinolysis, patients need transfer for angiography and risk stratification.

Why is "Give aspirin and heparin only, and wait for the troponin result" not the answer?

STEMI is diagnosed on ECG and symptoms; waiting for troponin wastes myocardium.

What concept does this question test?

It tests Cardiology: reperfusion in STEMI in General Medicine. When this is not achievable, prompt fibrinolysis followed by transfer to a PCI-capable centre (the pharmaco-invasive strategy) is recommended, with rescue PCI if it fails and angiography within 24 hours if it succeeds. ST elevation with typical pain is itself sufficient to act; troponin should not delay treatment.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiology: reperfusion in STEMI?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.