General Medicine

20 learning units • 100 chapter sections • 200 explained questions. Assess the patient, choose investigations and build a monitored management plan across adult medical specialties.

Original RAHBAR study material for the Year 4 learning pathway. Clinical cases support supervised undergraduate learning. Treatment choices, doses and procedures must follow current local protocols and the responsible clinical team. References & further reading ↓

MODULE 02 / 20

Chest Pain & Acute Coronary Syndromes

Distinguish immediately dangerous chest pain and interpret ECGs and troponin within a time-sensitive clinical pathway.

Answer all 10 questions, then submit to see your score and explanations. This is a self-study exercise; results are not saved.

Question 01. A patient has ongoing chest pain and diagnostic ST elevation. What is the priority? A. Wait for a fasting lipid resultB. Arrange routine review next monthC. Activate the urgent reperfusion pathwayD. Exclude every non-cardiac diagnosis before escalation

Question 02. What does an elevated troponin establish by itself? A. Plaque rupture in every patientB. Coronary anatomyC. A need for thrombolysis in every caseD. Myocardial injury

Question 03. How should a normal first ECG in suspected ACS be interpreted? A. It proves the pain is refluxB. It does not reliably exclude ACSC. It excludes all coronary diseaseD. It removes the need for reassessment

Question 04. Which chest-pain feature particularly raises concern for aortic dissection? A. Pain only when pressing one ribB. Months of unchanged meal-related burningC. Abrupt severe pain with pulse asymmetryD. Brief discomfort only with twisting

Question 05. Why are serial troponins used in validated pathways? A. Timing and change help identify acute injuryB. They directly show the coronary arteriesC. They replace all symptom assessmentD. Every assay uses identical timing

Question 06. Which patient with chest pain particularly needs supplemental oxygen? A. Every patient regardless of saturationB. Only patients with a raised cholesterolC. Every patient discharged from clinicD. A patient with significant hypoxaemia

Question 07. What can cause troponin elevation without a type 1 infarction? A. An isolated healed skin scarB. Correct spectacle prescriptionC. Sepsis-related myocardial injuryD. A normal resting pulse alone

Question 08. Which discharge intervention supports recovery after myocardial infarction? A. Stopping all follow-up when pain resolvesB. Avoiding all activity indefinitelyC. Omitting medication counsellingD. Cardiac rehabilitation and secondary prevention

Question 09. Why assess bleeding risk before antithrombotic therapy? A. Benefit must be balanced against bleeding and contraindicationsB. Bleeding risk predicts the exact infarct sizeC. It makes ECG interpretation unnecessaryD. It always forbids treatment

Question 10. A diabetic adult presents with sweating and unexplained dyspnoea without classic pain. What is appropriate? A. Consider ACS alongside other urgent causesB. Exclude ACS because pain is absentC. Diagnose anxiety without assessmentD. Delay ECG until chest pain develops

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References & Further Reading

Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.

Reference review: 27 September 2026. Consult current local protocols for prescribing, procedures and escalation.