NR 571 MIDTERM PAPER 2026 DETAILED
CONTENT REVIEW WITH ACCURATE
SOLUTIONS
◉ What is CKMB.
Answer: CK isoenzyme specific to cardiac muscle tissue (MI)
◉ When should CKMB be used?.
Answer: for suspicion of secondary ischemia after an initial infarct
◉ normal level for Troponin I.
Answer: <0.04
◉ normal level for CKMB.
Answer: 3-5% of total CK
◉ What is BNP.
Answer: B-type natriuretic peptide
◉ Normal BNP levels.
Answer: <100 pg/mL
,◉ Differential for chest pain.
Answer: Consider:
Myocardium- angina, MI, myocarditis, heart failure
Pericardium- pericarditis
Aorta- dissecting aortic aneurysm
Trachea and bronchi- bronchitis
Parietal pleura- pericarditis, pneumonia, pneumothorax, pleural
effusion, pulmonary embolus
Chest wall- costochondritis, herpes zoster
Esophagus- reflux, esophageal spasm, esophageal tear
Referred pain from elsewhere- cervical arthritis, biliary colic,
gastritis
Psych: anxiety attacks
◉ Revascularization in under ____ minutes.
Answer: 90
◉ Initial diagnostics for chest pain.
Answer: 12-lead EKG
Troponin q3h x3 at least
BNP - HF
,CBC - baseline H&H and Plts
PTT, PT/INR - baseline coagulation status
BMP - renal function and lytes
TSH, Mg, and Phos
ECHO
Cath
◉ Requirements for STEMI dx.
Answer: new ST elevation in 2 contiguous leads of >0.1 mV except
V2&V3
elevated troponin
◉ STEMI findings in V2-V3.
Answer: >0.2mV in >40yo M
>0.25 mV in <40 yo M
>0.15 mV in women
◉ Difference between NSTEMI and unstable angina.
Answer: NSTEMI involves Elevated Cardiac Bio markers (cell death)
◉ NSTEMI & unstable angina tx.
Answer: Dual antiplatelet therapy
, Full-dose AC
High-intensity statin
BB
Nitrates
oxygen
pain medication
◉ Dual antiplatelet therapy.
Answer: DAPT
Aspirin (325 x1 = daily 81mg)
AND
P2Y2 inhibitor
clopidogrel or ticagrelor
◉ full dose AC.
Answer: SQ lovenox 1mg/kg BID
if PCI planned of low GFR use heparin gtt
50-70 units/kg bolus plus 12units/kg/hr titrated to PTT 1.5-2.5 x
baseline
◉ High-intensity statin.
Answer: atorvastatin 40-80 mg or rosuvastatin 20-40 mg
CONTENT REVIEW WITH ACCURATE
SOLUTIONS
◉ What is CKMB.
Answer: CK isoenzyme specific to cardiac muscle tissue (MI)
◉ When should CKMB be used?.
Answer: for suspicion of secondary ischemia after an initial infarct
◉ normal level for Troponin I.
Answer: <0.04
◉ normal level for CKMB.
Answer: 3-5% of total CK
◉ What is BNP.
Answer: B-type natriuretic peptide
◉ Normal BNP levels.
Answer: <100 pg/mL
,◉ Differential for chest pain.
Answer: Consider:
Myocardium- angina, MI, myocarditis, heart failure
Pericardium- pericarditis
Aorta- dissecting aortic aneurysm
Trachea and bronchi- bronchitis
Parietal pleura- pericarditis, pneumonia, pneumothorax, pleural
effusion, pulmonary embolus
Chest wall- costochondritis, herpes zoster
Esophagus- reflux, esophageal spasm, esophageal tear
Referred pain from elsewhere- cervical arthritis, biliary colic,
gastritis
Psych: anxiety attacks
◉ Revascularization in under ____ minutes.
Answer: 90
◉ Initial diagnostics for chest pain.
Answer: 12-lead EKG
Troponin q3h x3 at least
BNP - HF
,CBC - baseline H&H and Plts
PTT, PT/INR - baseline coagulation status
BMP - renal function and lytes
TSH, Mg, and Phos
ECHO
Cath
◉ Requirements for STEMI dx.
Answer: new ST elevation in 2 contiguous leads of >0.1 mV except
V2&V3
elevated troponin
◉ STEMI findings in V2-V3.
Answer: >0.2mV in >40yo M
>0.25 mV in <40 yo M
>0.15 mV in women
◉ Difference between NSTEMI and unstable angina.
Answer: NSTEMI involves Elevated Cardiac Bio markers (cell death)
◉ NSTEMI & unstable angina tx.
Answer: Dual antiplatelet therapy
, Full-dose AC
High-intensity statin
BB
Nitrates
oxygen
pain medication
◉ Dual antiplatelet therapy.
Answer: DAPT
Aspirin (325 x1 = daily 81mg)
AND
P2Y2 inhibitor
clopidogrel or ticagrelor
◉ full dose AC.
Answer: SQ lovenox 1mg/kg BID
if PCI planned of low GFR use heparin gtt
50-70 units/kg bolus plus 12units/kg/hr titrated to PTT 1.5-2.5 x
baseline
◉ High-intensity statin.
Answer: atorvastatin 40-80 mg or rosuvastatin 20-40 mg
