Heart failure Practice Questions

Question 1

An 18-year-old man presents to a rural emergency department after being stabbed multiple times. The patient's past medical history is notable for obesity, diabetes, chronic upper respiratory infections, a 10 pack-year smoking history, and heart failure. He is protecting his airway and he is oxygenating and ventilating well. His temperature is 97.6°F (36.4°C), blood pressure is 74/34 mmHg, pulse is 180/min, respirations are 24/min, and oxygen saturation is 98% on room air. The patient is started on whole blood and the surgeon on call is contacted to take the patient to the operating room. During the secondary survey, the patient complains of shortness of breath. His blood pressure is 54/14 mmHg, pulse is 200/min, respirations are 24/min, and oxygen saturation is 90% on room air. Physical exam is notable for bilateral wheezing on lung exam. The patient goes into cardiac arrest and after 30 minutes, attempts at resuscitation are terminated. Which of the following is associated with this patient's decompensation during resuscitation?

Accepted Answer

Persistent intraabdominal bleeding

Answer

COPD

Answer

Congenital long QT syndrome

Answer

Heart failure

Answer

IgA deficiency

Question 2

A 49-year-old man presents to his physician complaining of weakness and fatigue. On exam, you note significant peripheral edema. Transthoracic echocardiogram is performed and reveals a preserved ejection fraction with impaired diastolic relaxation. A representative still image is shown in Image A. Which of the following is likely the cause of this patient's symptoms?

Accepted Answer

Hemochromatosis

Answer

Heavy, long-term alcohol consumption

Answer

History of myocardial infarction

Answer

History of a recent viral infection

Answer

Previous treatment with doxorubicin

Question 3

A 15-year-old female presents to her family physician for an annual school physical exam and check-up. She is accompanied by her mother to the visit and is present in the exam room. The patient has no complaints, and she does not have any past medical problems. She takes no medications. The patient reports that she remains active, exercising 5 times a week, and eats a healthy and varied diet. Which of the following would be the best way for the physician to obtain a more in-depth social history, including sexual history and use of alcohol, tobacco, or recreational drugs?

Accepted Answer

Ask the mother to step outside into the hall for a portion of the visit

Answer

Disallow the mother to be present in the examination room throughout the entirety of the visit

Answer

Give the patient a social history questionnaire to fill out in the exam room

Answer

Ask the patient the questions directly, with her mother still in the exam room

Answer

Speak softly to the patient so that the mother does not hear and the patient is not embarrassed

Question 4

The serum brain natriuretic peptide and N-terminal pro-BNP are elevated. A diagnosis of heart failure with preserved ejection fraction is made. In addition to supplemental oxygen therapy, which of the following is the most appropriate initial step in management?

Accepted Answer

Intravenous furosemide therapy

Answer

Intravenous dobutamine

Answer

Intravenous morphine therapy

Answer

Thoracentesis

Answer

Intermittent hemodialysis

Question 5

A 60-year-old male engineer who complains of shortness of breath when walking a few blocks undergoes a cardiac stress test because of concern for coronary artery disease. During the test he asks his cardiologist about what variables are usually used to quantify the functioning of the heart. He learns that one of these variables is stroke volume. Which of the following scenarios would be most likely to lead to a decrease in stroke volume?

Accepted Answer

Heart failure

Answer

Anxiety

Answer

Exercise

Answer

Pregnancy

Answer

Digitalis

Question 6

A 70-year-old Caucasian male visits your office regularly for treatment of New York Heart association class IV congestive heart failure. Which of the following medications would you add to this man's drug regimen in order to improve his overall survival?

Accepted Answer

Spironolactone

Answer

Furosemide

Answer

Amiloride

Answer

Acetazolamide

Answer

Hydrochlorothiazide

Question 7

A 72-year-old man presents to the outpatient clinic today. He has New York Heart Association class III heart failure. His current medications include captopril 20 mg, furosemide 40 mg, potassium chloride 10 mg twice daily, rosuvastatin 20 mg, and aspirin 81 mg. He reports that he generally feels well and has not had any recent worsening of his symptoms. His blood pressure is 132/85 mm Hg and heart rate is 84/min. Physical examination is unremarkable except for trace pitting edema of the bilateral lower extremities. What other medication should be added to his heart failure regimen?

Accepted Answer

Metoprolol succinate

Answer

Losartan

Answer

Metoprolol tartrate

Answer

Isosorbide dinitrate/hydralazine

Answer

Digoxin

Question 8

A 58-year-old man comes to the physician because of a 5-day history of progressively worsening shortness of breath and fatigue. He has smoked 1 pack of cigarettes daily for 30 years. His pulse is 96/min, respirations are 26/min, and blood pressure is 100/60 mm Hg. An x-ray of the chest is shown. Which of the following is the most likely cause of this patient's findings?

Accepted Answer

Left ventricular failure

Answer

Acute respiratory distress syndrome

Answer

Interstitial pneumonia

Answer

Tricuspid regurgitation

Answer

Pulmonary embolism

Question 9

A 78-year-old man presents to the clinic complaining of shortness of breath at rest and with exertion. He also complains of difficulty breathing while lying down. He also is concerned because he startles from sleep and feels like he is choking. These symptoms have been bothering him for the last several weeks and they are getting worse. He has been afebrile with no known sick contacts. 6 months ago, he had an acute myocardial infarction from which he recovered and until recently had felt well. He has a history of hyperlipidemia for which he takes atorvastatin. His temperature is 37.0°C (98.6°F), the pulse is 85/min, the respiratory rate is 14/min, and the blood pressure is 110/75 mm Hg. On physical examination, his heart has a regular rate and rhythm. He has bilateral crackles in both lungs. An echocardiogram is performed and shows a left ventricular ejection fraction of 33%. What medication should be started?

Accepted Answer

Captopril

Answer

Levofloxacin

Answer

Verapamil

Answer

Niacin

Answer

Nitroglycerin

Question 10

A 64-year-old man who recently immigrated to the United States from Haiti comes to the physician because of a 3-week history of progressively worsening exertional dyspnea and fatigue. For the past few days, he has also had difficulty lying flat due to trouble breathing. Over the past year, he has had intermittent fever, night sweats, and cough but he has not been seen by a physician for evaluation of these symptoms. His temperature is 37.8°C (100°F). An x-ray of the chest is shown. Further evaluation of this patient is most likely to show which of the following findings?

Accepted Answer

Jugular venous distention on inspiration

Answer

Head bobbing in synchrony with heart beat

Answer

Prominent "a" wave on jugular venous pressure tracing

Answer

Elimination of S2 heart sound splitting with inspiration

Answer

Crescendo-decrescendo systolic ejection murmur

Heart failure

Study Resources

Lessons

Questions

Flashcards

Lessons

Classification of heart failure (HFrEF vs HFpEF)

Heart failure pathophysiology

Acute decompensated heart failure

Chronic heart failure management

Guideline-directed medical therapy

Device therapy for heart failure

Cardiomyopathies

Valvular heart disease and heart failure

Right heart failure

Pulmonary hypertension

Cardio-renal syndrome

Advanced heart failure and transplantation

Quality measures in heart failure

Practice Questions

Flashcards

About Heart failure for USMLE

Lessons in Heart failure

Master Heart failure