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Sample questions

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Inside one explanation

Every question is built this way. Here is one, opened up.

The question

A 55-year-old man with STEMI presents to a regional hospital where the nearest PCI centre is 90 minutes away by road. Per the Australasian (ANZCOR) STEMI guidelines, the most appropriate decision is:

The options

  • A Thrombolyse immediately in all cases, regardless of PCI availability
  • B Transfer for primary PCI regardless of the time delay involved
  • C Primary PCI if achievable within 120 minutes; otherwise thrombolyse, then transfer · the key
  • D Anticoagulation and medical therapy without any reperfusion

Why it's right

Primary PCI is preferred when it can be delivered within 120 minutes of first medical contact. If that is not achievable, give fibrinolysis within 30 minutes (door-to-needle) and transfer for early angiography — the pharmacoinvasive strategy.

Why the rest are wrong

A
thrombolysis is reserved for when timely PCI is not possible.
B
transferring despite an excessive delay forfeits myocardium.
D
every STEMI needs reperfusion unless contraindicated.

Bottom line

PCI within 120 minutes wins; otherwise thrombolyse within 30 minutes and transfer (pharmacoinvasive).

One step further

Tenecteplase is the usual Australian agent — a single weight-adjusted bolus — and clopidogrel (not ticagrelor) is the preferred P2Y12 inhibitor with fibrinolysis.

Cited to local practice

ANZCOR Guidelines; LITFL – STEMI Reperfusion

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