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Acute coronary syndrome with high bleeding risk — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsAcute coronary syndrome with high bleeding riskSCE Acute Medicine

A 80-year-old man is assessed on the acute medical unit. He has NSTEMI, recurrent pain despite therapy and chronic kidney disease. GRACE risk is high and haemoglobin is stable after remote gastrointestinal bleeding. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: D — Discuss early invasive strategy with cardiology

Discuss early invasive strategy with cardiology is the best answer because high-risk NSTEMI with recurrent ischaemia warrants cardiology discussion about early invasive assessment while balancing bleeding risk. Give intravenous lorazepam and protect the airway is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Bleeding risk modifies antithrombotic choices but does not erase ischaemic risk.

Reference: NICE NG185