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NSTEMI with previous ulcer bleed — SCE Acute Medicine MCQ

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ModerateAcute Cardiac PresentationsNSTEMI with previous ulcer bleedSCE Acute Medicine

A 34-year-old woman presents with acute chest symptoms with haemodynamic concern. Relevant history includes cardiovascular risk factors or structural heart disease. On assessment, haemodynamic findings and ECG changes are present. Investigations show rising troponin and ST depression despite remote peptic ulcer bleed. What is the most appropriate next step in management?

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Correct answer: C — Treat NSTEMI with antiplatelet therapy and gastroprotection after bleeding-risk assessment

The key discriminator is that rising troponin and ST depression despite remote peptic ulcer bleed, which makes Treat NSTEMI with antiplatelet therapy and gastroprotection after bleeding-risk assessment the single best answer. Give targeted antidote or reversal therapy is less appropriate because it does not address the dominant acute risk in the vignette; Give controlled oxygen and senior review would fit a different presentation or later stage of care. Give intravenous fluids with reassessment and Optimise chronic medication and discharge are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE NG185; BNF