Heart Failure
A 62-year-old man with long-standing hypertension presents with exertional dyspnea. Echocardiogram shows normal ejection fraction, concentric LV hypertrophy, and elevated LV end-diastolic pressures. Which of the following best explains his condition?
A. Loss of contractile myocytes
B. Decreased ventricular compliance
C. Increased pulmonary vascular resistance
D. Impaired RV forward flow
E. Volume overload due to aortic regurgitation
A 62-year-old man with long-standing hypertension presents with exertional dyspnea. Echocardiogram shows normal ejection fraction, concentric LV hypertrophy, and elevated LV end-diastolic pressures. Which of the following best explains his condition?
A. Loss of contractile myocytes
B. Decreased ventricular compliance
C. Increased pulmonary vascular resistance
D. Impaired RV forward flow
E. Volume overload due to aortic regurgitation
Correct answer: B
A 60-year-old woman receiving chemotherapy for lymphoma develops dysuria and gross hematuria. Labs show no infection. This adverse effect is caused by which mechanism?
A. Microtubule inhibition
B. Accumulation of toxic metabolites in the bladder
C. Inhibition of thymidylate synthase
D. Binding to HER2 receptors
E. Topoisomerase II inhibition
A 60-year-old woman receiving chemotherapy for lymphoma develops dysuria and gross hematuria. Labs show no infection. This adverse effect is caused by which mechanism?
A. Microtubule inhibition
B. Accumulation of toxic metabolites in the bladder
C. Inhibition of thymidylate synthase
D. Binding to HER2 receptors
E. Topoisomerase II inhibition
Correct answer: B
A patient with decompensated HF undergoes spirometry. Which pattern is most consistent?
A. FEV1 ↓, FEV1/FVC ↓, TLC ↑
B. FEV1/FVC ↓, TLC normal
C. FEV1 ↑, FVC ↑, TLC normal
D. FEV1/FVC normal, TLC normal
E. FEV1 ↓, FEV1/FVC ↑, TLC ↓
A patient with decompensated HF undergoes spirometry. Which pattern is most consistent?
A. FEV1 ↓, FEV1/FVC ↓, TLC ↑
B. FEV1/FVC ↓, TLC normal
C. FEV1 ↑, FVC ↑, TLC normal
D. FEV1/FVC normal, TLC normal
E. FEV1 ↓, FEV1/FVC ↑, TLC ↓
Correct answer:E
(Restrictive pattern due to pulmonary edema)
A cardiologist is studying the Na+ channel binding strength differences between the class 1 anti-arrhythmic subtypes. Using a ligand binding assay, she observes the difference in binding when disopyramide, flecainide, and lidocaine are administered. Which of the following best describes the predicted difference in binding strength between these medications?
A. disopyramide > lidocaine > flecainide
B. flecainide > disopyramide > lidocaine
C. flecainide > lidocaine > disopyramide
D. lidocaine > disopyramide > flecainide
E. lidocaine > flecainide > disopyramide
A cardiologist is studying the Na+ channel binding strength differences between the class 1 anti-arrhythmic subtypes. Using a ligand binding assay, she observes the difference in binding when disopyramide, flecainide, and lidocaine are administered. Which of the following best describes the predicted difference in binding strength between these medications?
A. disopyramide > lidocaine > flecainide
B. flecainide > disopyramide > lidocaine
C. flecainide > lidocaine > disopyramide
D. lidocaine > disopyramide > flecainide
E. lidocaine > flecainide > disopyramide
Correct answer: B
A 71-year-old man with worsening systolic HF has a pulse pressure of 20 mmHg. What explains this finding?
A. Increased stroke volume
B. Decreased diastolic pressure
C. Weak left ventricular contraction
D. Increased systemic vascular resistance
E. Decreased venous return
A 71-year-old man with worsening systolic HF has a pulse pressure of 20 mmHg. What explains this finding?
A. Increased stroke volume
B. Decreased diastolic pressure
C. Weak left ventricular contraction
D. Increased systemic vascular resistance
E. Decreased venous return
Correct answer: C
A 56-year-old man with HFrEF (EF 30%) is on metoprolol succinate, lisinopril, and spironolactone. He still has exertional dyspnea and mild edema. His BP is 118/70. Which medication should be added next?
A. Verapamil
B. Sacubitril/valsartan
C. Concurrent ACEI and ARB
D. Pioglitazone
E. Hydralazine monotherapy
A 56-year-old man with HFrEF (EF 30%) is on metoprolol succinate, lisinopril, and spironolactone. He still has exertional dyspnea and mild edema. His BP is 118/70. Which medication should be added next?
A. Verapamil
B. Sacubitril/valsartan
C. Concurrent ACEI and ARB
D. Pioglitazone
E. Hydralazine monotherapy
Correct answer: B
A patient with flash pulmonary edema presents with rapid breathing and anxiety. Which ABG pattern is most expected?
A. pH ↓, CO₂ ↑
B. pH ↑, CO₂ ↓
C. pH normal, CO₂ normal
D. pH ↓, CO₂ normal
E. pH ↑, CO₂ ↑
A patient with flash pulmonary edema presents with rapid breathing and anxiety. Which ABG pattern is most expected?
A. pH ↓, CO₂ ↑
B. pH ↑, CO₂ ↓
C. pH normal, CO₂ normal
D. pH ↓, CO₂ normal
E. pH ↑, CO₂ ↑
Correct answer: B
(respiratory alkalosis from tachypnea)
An 80 year old male with an unkown past medical history is brought into the ED following a MVA where he was a restrained driver. THe patient is unresponsive on arrival but according to the police, he was hit on the driver's side of the car resulting in deployment of airbags. CT scan of the head reveals epidural hematoma and parenchymal herniation. The patient dies despite the best efforts of the medical team. Autopsy reveals thickening of the left ventricular wall resulting in a decreased ventricular cavity size. Histologic evaluation does not revela any abnormalities when stained with Congo red. Which best describes the pathogenesis of the patient's cardiac findings?
A. Chronic inflammation
B. Chronic pressure overload
C. Chronic volume overload
D. Deposition of abnormal proteins
E. Prior myocardial ischemia
An 80 year old male with an unkown past medical history is brought into the ED following a MVA where he was a restrained driver. THe patient is unresponsive on arrival but according to the police, he was hit on the driver's side of the car resulting in deployment of airbags. CT scan of the head reveals epidural hematoma and parenchymal herniation. The patient dies despite the best efforts of the medical team. Autopsy reveals thickening of the left ventricular wall resulting in a decreased ventricular cavity size. Histologic evaluation does not revela any abnormalities when stained with Congo red. Which best describes the pathogenesis of the patient's cardiac findings?
A. Chronic inflammation
B. Chronic pressure overload
C. Chronic volume overload
D. Deposition of abnormal proteins
E. Prior myocardial ischemia
Correct answer: B
A 68-year-old man with a history of myocardial infarction presents with progressive fatigue and dyspnea on exertion. Physical exam reveals an S3 gallop and bilateral basilar crackles. Echocardiogram shows a left ventricular ejection fraction of 25%. Which of the following physiologic responses is most likely occurring in this patient?
A. Decreased adrenergic tone
B. Decreased ventricular afterload
C. Increased renin release due to reduced renal perfusion
D. Increased natriuretic peptide clearance
E. Decreased aldosterone secretion
A 68-year-old man with a history of myocardial infarction presents with progressive fatigue and dyspnea on exertion. Physical exam reveals an S3 gallop and bilateral basilar crackles. Echocardiogram shows a left ventricular ejection fraction of 25%. Which of the following physiologic responses is most likely occurring in this patient?
A. Decreased adrenergic tone
B. Decreased ventricular afterload
C. Increased renin release due to reduced renal perfusion
D. Increased natriuretic peptide clearance
E. Decreased aldosterone secretion
Correct answer: C
A 60 year old female with a PMH of CHF and hyperlipidemia presents to the cardiologist for a follow up visit. She reports mild shortness of breath and fatigue which have been stable for two months. Her last echo showed an ejection fraction of 40% with left ventricular systolic dysfunction and wall motion abnormalities. Her current medications include aspirin, rosuvastatin, sacubitril-valsartan, spironolactone, and empagiflozin. Vitals: 37 C, RR 14, HR 88, BP 126/70. Physical exam is notable for jugular venous pulsations 10 cm above the the sternal angle. An extra diastolic sound is appreciated following S2. Mild bibasilar rales are noted on auscultation. There is no peripheral edema, pedal pulses are 2+ bilaterally. The patient is started on a beta blocker with proven mortality benefit in systolic heart failure. Which of the following medications was this patient prescribed?
A. Atenolol
B. Bisoprolol
C. Labetalol
D. Nadalol
E. Propranolol
A 60 year old female with a PMH of CHF and hyperlipidemia presents to the cardiologist for a follow up visit. She reports mild shortness of breath and fatigue which have been stable for two months. Her last echo showed an ejection fraction of 40% with left ventricular systolic dysfunction and wall motion abnormalities. Her current medications include aspirin, rosuvastatin, sacubitril-valsartan, spironolactone, and empagiflozin. Vitals: 37 C, RR 14, HR 88, BP 126/70. Physical exam is notable for jugular venous pulsations 10 cm above the the sternal angle. An extra diastolic sound is appreciated following S2. Mild bibasilar rales are noted on auscultation. There is no peripheral edema, pedal pulses are 2+ bilaterally. The patient is started on a beta blocker with proven mortality benefit in systolic heart failure. Which of the following medications was this patient prescribed?
A. Atenolol
B. Bisoprolol
C. Labetalol
D. Nadalol
E. Propranolol
Correct answer: B
Bisoprolol, carvedilol, and metoprolol succinate are the only ones taht have been proven to provide morality benefit in HFrEF
A 63-year-old woman with known heart failure presents with shortness of breath. PFTs show:
Which mechanism best explains these findings?
A. Airway narrowing
B. Loss of elastic recoil
C. Pulmonary interstitial fluid from elevated hydrostatic pressure
D. Increased residual volume
E. Bronchial smooth muscle contraction
A 63-year-old woman with known heart failure presents with shortness of breath. PFTs show:
Which mechanism best explains these findings?
A. Airway narrowing
B. Loss of elastic recoil
C. Pulmonary interstitial fluid from elevated hydrostatic pressure
D. Increased residual volume
E. Bronchial smooth muscle contraction
Correct answer: C
A 55 year old female with a 30 pack year cigarete smoking history presents to the ED complaining of fatigue, dyspnea, and cough productive of green sputum. Her symptoms began last night and have worsened to the point where it is painful to take a deep breath. She denies wieght loss, appetite changes, epigastric pain, or acid reflux symptoms. Vitals: temp 38.2 C, RR 19, HR 103, BP 130/85. Cardiac exam reveals tachycardia with regular S1 and S2. No rubs, murmurs, gallops. Lung sounds decreased over left lower lung. CXR shows dense opacification present over the left lower lobe. Based on this patient's presentation, which is the most likely?
A. Sarcoidosis
B. Bronchitis
C. Pneumonia
D. Small cell lung cancer
A. Sarcoidosis
B. Bronchitis
C. Pneumonia
D. Small cell lung cancer
Correct answer: C
A Swan-Ganz catheter is placed in a patient with shortness of breath. Readings show:
Which type of heart failure does this pattern most strongly support?
A. Right-sided failure
B. Left-sided failure
C. High-output heart failure
D. Combined right- and left-sided failure
E. Compensated heart failure
A Swan-Ganz catheter is placed in a patient with shortness of breath. Readings show:
Which type of heart failure does this pattern most strongly support?
A. Right-sided failure
B. Left-sided failure
C. High-output heart failure
D. Combined right- and left-sided failure
E. Compensated heart failure
Correct answer: D
A 49-year-old woman receiving trastuzumab presents with dyspnea and fatigue. Exam reveals an S3 gallop. ECG is normal. Which finding would most likely appear on echocardiogram?
A. Severe LV hypertrophy with restrictive filling
B. Systolic dysfunction with reduced EF
C. Pericardial effusion and tamponade
D. RV dilation with pulmonary hypertension
E. Hyperdynamic EF
A 49-year-old woman receiving trastuzumab presents with dyspnea and fatigue. Exam reveals an S3 gallop. ECG is normal. Which finding would most likely appear on echocardiogram?
A. Severe LV hypertrophy with restrictive filling
B. Systolic dysfunction with reduced EF
C. Pericardial effusion and tamponade
D. RV dilation with pulmonary hypertension
E. Hyperdynamic EF
Correct answer: B
A 72 year old male with a PMH of longstanding COPD presents to pulmonologist for follow up. The patient complains of a chronic cough and dyspnea which has worsened since his last visit 6 months prior. He denies fever, chills, weight loss, chest pain, or leg swelling. Vitals: temp 36.6 C, RR 18, HR 92, BP 118/72. The patient appears non distressed, taking short breaths with long exhalations. A systolic blowing murmur is noted at the left lower sternal border. End expiratory wheezes are appreciated on auscultation of the lungs. His abdomen is nontender and nondistended. His extremities are cool to the touch. Which of the following is the primary stimulus of respiratory drive in this patient?
A. Decreased PaCO2
B. Increased PaCO2
C. Decreased PaO2
D. Increased PaO2
E. Increased blood pH
A 72 year old male with a PMH of longstanding COPD presents to pulmonologist for follow up. The patient complains of a chronic cough and dyspnea which has worsened since his last visit 6 months prior. He denies fever, chills, weight loss, chest pain, or leg swelling. Vitals: temp 36.6 C, RR 18, HR 92, BP 118/72. The patient appears non distressed, taking short breaths with long exhalations. He has no conjunctival injection or scleral icterus. A systolic blowing murmur is noted at the left lower sternal border. End expiratory wheezes are appreciated on auscultation of the lungs. His abdomen is nontender and nondistended. His extremities are cool to the touch. Which of the following is the primary stimulus of respiratory drive in this patient?
A. Decreased PaCO2
B. Increased PaCO2
C. Decreased PaO2
D. Increased PaO2
E. Increased blood pH
Correct answer: C
A 69-year-old man with HFrEF (EF 28%) is started on sacubitril–valsartan. He returns 2 weeks later with dizziness and lightheadedness. BP is 86/54.
Lab values:
Which mechanism best explains the patient’s lab abnormalities?
A. Neprilysin inhibition decreasing natriuretic peptide levels
B. Excess aldosterone activity increasing K⁺ excretion
C. AT1 blockade decreasing efferent arteriole constriction
D. Reduced renin production leading to increased diuresis
E. Increased sympathetic activation causing renal vasoconstriction
A 69-year-old man with HFrEF (EF 28%) is started on sacubitril–valsartan. He returns 2 weeks later with dizziness and lightheadedness. BP is 86/54.
Lab values:
Which mechanism best explains the patient’s lab abnormalities?
A. Neprilysin inhibition decreasing natriuretic peptide levels
B. Excess aldosterone activity increasing K⁺ excretion
C. AT1 blockade decreasing efferent arteriole constriction
D. Reduced renin production leading to increased diuresis
E. Increased sympathetic activation causing renal vasoconstriction
Correct Answer: C
Reasoning:
Valsartan (ARB component) → AT1 blockade → efferent arteriole dilation → ↓GFR → ↑creatinine + hyperkalemia.
BNP increases because neprilysin inhibition prevents its breakdown, not the opposite.