Heart failure — MCQs

A 55-year-old woman comes to the emergency department because of epigastric pain, sweating, and breathlessness for 45 minutes. She has hypertension treated with hydrochlorothiazide. She has smoked 1 pack of cigarettes daily for the past 30 years and drinks 1 glass of wine daily. Her pulse is 105/min and blood pressure is 100/70 mm Hg. Arterial blood gas analysis on room air shows: pH 7.49 pCO2 32 mm Hg pO2 57 mm Hg Which of the following is the most likely cause of hypoxemia in this patient?

A 34-year-old woman, gravida 2, para 2, is admitted to the hospital because of shortness of breath and fatigue 2 weeks after delivery of a full-term female newborn. She has no history of major medical illness. Cardiac examination on admission shows an S3 gallop and a grade 2/6 holosystolic murmur heard best at the apex. Treatment is initiated with intravenous furosemide and captopril. Her symptoms resolve, and 3 weeks later, cardiac examination shows no murmur. Which of the following is the most likely explanation for the initial auscultation findings?

A 25-year-old man comes to the emergency department because of a 1-week-history of progressively worsening dyspnea and intermittent chest pain that increases on inspiration. He had an upper respiratory tract infection 2 weeks ago. His pulse is 115/min and blood pressure is 100/65 mm Hg. Examination shows inspiratory crackles bilaterally. His serum troponin I is 0.21 ng/mL (N < 0.1). An x-ray of the chest shows an enlarged cardiac silhouette and prominent vascular markings in both lung fields; costophrenic angles are blunted. A rhythm strip shows inverted T waves. Which of the following additional findings is most likely in this patient's condition?

A 65-year-old man comes to the physician for a follow-up examination. He has chronic obstructive pulmonary disease and was recently discharged from the hospital for an exacerbation. His cough and chills have since improved, but his mobility is still severely limited by dyspnea and fatigue. He smoked 2 packs of cigarettes daily for 30 years, but quit 5 years ago. His medications include inhaled daily budesonide, formoterol, and tiotropium bromide plus ipratropium/albuterol as needed. Pulmonary function testing shows an FEV1 of 27% of predicted. Resting oxygen saturation ranges from 84–88%. Which of the following steps in management is most likely to increase the chance of survival in this patient?

A 60-year-old Caucasian man comes to the physician because of progressive fatigue, shortness of breath, and leg swelling for the past 4 months. He has to pause several times when climbing one flight of stairs. For the past 10 years, he has had joint pain in his hands, wrists, and knees. He has diabetes mellitus and hypertension controlled with daily insulin injections and a strict low-calorie, low-sodium diet. He takes ibuprofen as needed for his joint pain. His wife says that he snores at night. He drinks two to three beers daily. He has smoked half a pack of cigarettes daily for the past 40 years. He went camping in northern New York one week ago. His vital signs are within normal limits. Physical examination shows jugular venous distention, pitting edema around the ankles, and tanned skin. Crackles are heard at both lung bases. An S3 is heard at the apex. The liver is palpated 2 to 3 cm below the right costal margin. His skin appears dark brown. An ECG shows a left bundle branch block. Echocardiography shows left atrial and ventricular enlargement, reduced left ventricular ejection fraction, and mild mitral regurgitation. Which of the following is most likely to have prevented this patient's condition?