Download PrepIQ Heart Failure Program Ultimate Exam and more Exams Technology in PDF only on Docsity!
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Question 1. Which of the following best describes the primary determinant of left ventricular preload? A) Systemic vascular resistance B) Aortic valve area C) End-diastolic volume D) Myocardial contractility Answer: C Explanation: Preload is essentially the ventricular filling pressure, reflected by end-diastolic volume. Question 2. In the Frank-Starling mechanism, an increase in which parameter leads to a stronger ventricular contraction? A) Afterload B) End-diastolic stretch C) Heart rate D) Sympathetic tone Answer: B Explanation: Greater myocardial fiber stretch (higher EDV) enhances contractile force. Question 3. Which neurohormonal system is most directly responsible for sodium and water retention in chronic heart failure? A) Natriuretic peptide system B) Renin-Angiotensin-Aldosterone System (RAAS) C) Sympathetic nervous system D) Vasopressin axis Answer: B Explanation: RAAS activation stimulates aldosterone, promoting renal sodium and water reabsorption.
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Question 4. Elevated plasma levels of which peptide are most specific for myocardial stretch? A) ANP B) BNP C) Angiotensin II D) Endothelin- 1 Answer: B Explanation: BNP is released from ventricular myocytes in response to stretch and correlates with HF severity. Question 5. Which of the following is a hallmark of eccentric ventricular remodeling? A) Concentric hypertrophy B) Increased wall thickness with normal chamber size C) Chamber dilation with relative wall thinning D) Fibrotic scar formation Answer: C Explanation: Eccentric remodeling involves dilatation and thinning as myocytes add in series. Question 6. According to ACC/AHA staging, a patient with prior myocardial infarction but no symptoms of HF is classified as: A) Stage A B) Stage B C) Stage C D) Stage D Answer: B Explanation: Stage B denotes structural heart disease without current symptoms. Question 7. Which NYHA class corresponds to a patient who experiences dyspnea on ordinary exertion?
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B) Pulmonary embolism C) Elevated left-sided filling pressures D) Right-ventricular infarction Answer: C Explanation: PCWP approximates left atrial pressure, reflecting left-sided congestion when elevated. Question 11. Which laboratory finding most reliably rules out heart failure as the cause of dyspnea? A) Elevated BNP B) Low serum sodium C) Normal BNP in the setting of renal failure D) Elevated troponin I Answer: C Explanation: BNP can be falsely low in severe obesity or renal failure; a normal BNP makes HF unlikely. Question 12. The first-line ARNI for HFrEF replaces which class of drug? A) Beta-blocker B) ACE inhibitor C) Aldosterone antagonist D) Loop diuretic Answer: B Explanation: Sacubitril/valsartan (ARNI) substitutes for an ACE inhibitor or ARB to improve outcomes. Question 13. Which beta-blocker has the strongest evidence for mortality reduction in HFrEF? A) Atenolol B) Metoprolol succinate
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C) Propranolol D) Labetalol Answer: B Explanation: Metoprolol succinate, carvedilol, and bisoprolol are guideline-endorsed; metoprolol succinate is extensively studied. Question 14. Spironolactone is contraindicated in a patient with: A) Serum potassium 4.2 mmol/L B) eGFR 45 mL/min/1.73 m² C) Hyperkalemia (K⁺ > 5.5 mmol/L) D) Mild hepatic dysfunction Answer: C Explanation: MRAs can precipitate dangerous hyperkalemia; elevated K⁺ is a contraindication. Question 15. SGLT2 inhibitors improve outcomes in HF primarily by: A) Reducing afterload via arterial vasodilation B) Enhancing renal glucose reabsorption C) Promoting natriuresis and improving myocardial energetics D) Directly stimulating beta-adrenergic receptors Answer: C Explanation: SGLT2 inhibitors cause osmotic diuresis, natriuresis, and favorable metabolic effects on the myocardium. Question 16. In diuretic-resistant HF, which combination is most appropriate? A) Furosemide alone at maximal dose B) Thiazide-like diuretic added to loop diuretic C) ACEi plus ARB D) Digoxin and spironolactone
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Explanation: Milrinone inhibits PDE-3, increasing cAMP and enhancing contractility. Question 20. An ICD is indicated for primary prevention in a patient with LVEF ≤35 % who is: A) NYHA class I, asymptomatic B) NYHA class II–III, on optimal GDMT C) NYHA class IV, end-stage disease D) Post-myocardial infarction with LVEF 45 % Answer: B Explanation: Primary-prevention ICDs are recommended for symptomatic (NYHA II-III) patients with LVEF ≤35 % on GDMT. Question 21. Cardiac resynchronization therapy (CRT) is most beneficial when the QRS duration is: A) <100 ms B) 100- 119 ms with LBBB morphology C) ≥150 ms with LBBB morphology D) Any width with right-bundle branch block Answer: C Explanation: CRT improves outcomes in patients with wide (≥150 ms) LBBB QRS complexes. Question 22. Which valve lesion most often leads to secondary (type 2) mitral regurgitation in HF? A) Mitral prolapse B) Aortic stenosis C) Functional left-ventricular dilation D) Rheumatic disease Answer: C Explanation: LV dilation distorts papillary muscles, causing functional MR.
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Question 23. The primary purpose of a left ventricular assist device (LVAD) as destination therapy is to: A) Cure heart failure B) Bridge to transplant only C) Provide long-term circulatory support without transplantation D) Replace the aortic valve function Answer: C Explanation: Destination therapy LVADs are implanted permanently for patients not eligible for transplant. Question 24. A patient with HFpEF is most likely to have which hemodynamic profile? A) Low filling pressures, high contractility B) Preserved EF, elevated left-atrial pressure, normal SVR C) Reduced EF, high PCWP D) High cardiac output, low systemic vascular resistance Answer: B Explanation: HFpEF features preserved EF with diastolic dysfunction and elevated filling pressures. Question 25. CardioMEMS pulmonary artery pressure monitoring primarily aims to: A) Detect arrhythmias B) Guide diuretic titration to reduce hospitalizations C) Replace right-heart catheterization for diagnosis D) Measure coronary flow reserve Answer: B Explanation: Remote PA pressure data allow proactive diuretic adjustments, decreasing readmissions.
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A) Age 55 years B) BMI 32 kg/m² C) Active infection or malignancy D) NYHA class III symptoms Answer: C Explanation: Active systemic infection or malignancy precludes transplantation due to poor prognosis. Question 30. In pregnant women with HF, the safest diuretic class is: A) Loop diuretics B) Thiazide diuretics C) Potassium-sparing diuretics D) No diuretics; use fluid restriction only Answer: A Explanation: Loops are category C but are most studied and effective; thiazides are less potent and risk volume depletion. Question 31. The recommended daily sodium intake for HF self-care education is: A) 1 g B) 2 g C) 4 g D) 6 g Answer: B Explanation: Guidelines advise ≤2 g (≈88 mmol) sodium per day to reduce congestion. Question 32. The optimal timing for a post-discharge follow-up visit after an HF hospitalization is: A) Within 24 hours
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B) Within 7 days C) Within 30 days D) After 90 days Answer: B Explanation: Early follow-up (≤ 7 days) reduces readmission risk. Question 33. Which team member is primarily responsible for medication reconciliation at discharge? A) Nurse practitioner B) Pharmacist C) Social worker D) Dietitian Answer: B Explanation: Pharmacists specialize in reviewing and reconciling medication regimens. Question 34. A quality metric for HF programs that directly reflects adherence to evidence-based therapy is: A) Length of stay B) 30-day readmission rate C) Percentage of patients on GDMT (ACEi/ARNI, beta-blocker, MRA) at discharge D) Number of echocardiograms performed Answer: C Explanation: GDMT adherence is a core performance indicator. Question 35. When considering ICD deactivation at end-of-life, the most ethically appropriate step is: A) Immediate deactivation without discussion B) Discuss patient goals, values, and obtain informed consent C) Transfer decision to family only
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Question 39. Which of the following is a common cause of false-positive BNP elevation? A) Obesity B) Chronic atrial fibrillation C) Acute decompensated HF D) Renal failure Answer: D Explanation: Reduced clearance in renal dysfunction can raise BNP independent of HF severity. Question 40. In HF patients with reduced EF, the optimal target dose of sacubitril/valsartan is: A) 24/26 mg BID B) 49/51 mg BID C) 97/103 mg BID D) 200/210 mg BID Answer: C Explanation: 97/103 mg twice daily is the guideline-recommended target dose when tolerated. Question 41. Which of the following best characterizes “afterload” in the systemic circulation? A) Volume returning to the heart B) Pressure the ventricle must overcome to eject blood C) Rate of myocardial fiber shortening D) Venous pressure in the right atrium Answer: B Explanation: Afterload is the arterial pressure load opposing ventricular ejection.
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Question 42. The primary mechanism by which beta-blockers improve survival in HFrEF is: A) Immediate increase in heart rate B) Reduction of myocardial oxygen demand and attenuation of SNS toxicity C) Direct vasodilation of coronary arteries D) Enhancement of natriuretic peptide release Answer: B Explanation: Beta-blockers blunt chronic sympathetic activation, reducing remodeling and arrhythmias. Question 43. Which imaging finding most strongly suggests restrictive cardiomyopathy? A) Dilated LV with thin walls B) Normal wall thickness with reduced LV cavity size and bi-atrial enlargement C) Asymmetric septal hypertrophy D) Mitral valve prolapse Answer: B Explanation: Restrictive disease yields small non-dilated ventricles, thickened walls, and enlarged atria. Question 44. In a patient with HF and a serum potassium of 5.2 mmol/L, which medication should be avoided or reduced? A) Loop diuretic B) ACE inhibitor C) Spironolactone D) SGLT2 inhibitor Answer: C Explanation: MRAs can further raise potassium, risking hyperkalemia. Question 45. The most common cause of diuretic resistance in HF is:
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D) Hypervolemia Answer: B Explanation: Elevated BUN relative to creatinine suggests prerenal azotemia from neurohormonal vasoconstriction. Question 49. Which of the following agents directly antagonizes aldosterone receptors? A) Eplerenone B) Lisinopril C) Carvedilol D) Sacubitril Answer: A Explanation: Eplerenone is a selective mineralocorticoid receptor antagonist. Question 50. Which of the following best describes “ventricular interdependence”? A) Influence of right-ventricular pressure on left-ventricular filling B) Sympathetic activation of both ventricles simultaneously C) Independent function of each ventricle D) Direct electrical coupling of ventricles Answer: A Explanation: Changes in RV pressure/volume can affect LV preload due to shared septum and pericardium. Question 51. A 68-year-old man with HFrEF is started on a loop diuretic and develops symptomatic hypotension. The next step is to: A) Increase loop diuretic dose B) Add a thiazide diuretic C) Reduce diuretic dose and assess volume status D) Initiate high-dose ACEi immediately
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Answer: C Explanation: Hypotension may indicate over-diuresis; volume status should be reassessed before escalating therapy. Question 52. Which of the following statements about natriuretic peptide testing is true? A) BNP is unaffected by age B) NT-proBNP has a longer half-life than BNP, making it more stable for lab measurement C) Both are decreased in renal failure D) Levels are not influenced by obesity Answer: B Explanation: NT-proBNP is biologically inactive and remains stable, facilitating accurate assay. Question 53. In an HF patient with a QRS duration of 140 ms and LBBB, which additional criteria must be met for CRT eligibility? A) NYHA class I only B) LVEF >50 % C) NYHA class II-IV with LVEF ≤ 35 % despite optimal GDMT D) Presence of atrial flutter only Answer: C Explanation: CRT requires symptomatic HF (NYHA II-IV) and reduced EF despite GDMT. Question 54. Which of the following best explains why ACE inhibitors reduce mortality in HFrEF? A) They increase heart rate B) They block conversion of angiotensin I to II, reducing afterload and remodeling C) They directly increase contractility D) They stimulate natriuretic peptide release
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Explanation: IV diuretics rapidly reduce preload; oxygen and NIV improve oxygenation. Question 58. Which of the following best describes the mechanism of action of digoxin in HF? A) Increases intracellular calcium via Na⁺/K⁺-ATPase inhibition, augmenting contractility B) Blocks β-adrenergic receptors C) Vasodilates systemic arteries D) Inhibits RAAS Answer: A Explanation: Digoxin inhibits the Na⁺/K⁺ pump, raising intracellular Na⁺, which indirectly increases Ca²⁺ and contractility. Question 59. A 72-year-old woman with HFrEF and NYHA class III is on optimal GDMT but remains symptomatic. Which therapy is indicated to further reduce mortality? A) High-dose furosemide B) Ivabradine (if HR ≥90 bpm) C) Routine aspirin D) Nitrate-only regimen Answer: B Explanation: Ivabradine adds mortality benefit when HR remains ≥90 bpm despite beta-blockade. Question 60. Which of the following is a recognized side effect of SGLT inhibitors in HF patients? A) Hyperglycemia B) Increased risk of hypokalemia C) Genital mycotic infections D) Severe bradycardia
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Answer: C Explanation: SGLT2 inhibitors increase urinary glucose, predisposing to genital infections. Question 61. When assessing a patient with suspected HF, a “warm and dry” physical exam suggests: A) Low output, volume overloaded B) Adequate perfusion with euvolemia C) High output state with congestion D) Cardiogenic shock Answer: B Explanation: “Warm” = good perfusion; “dry” = no overt congestion. Question 62. Which of the following best defines “afterload” in the left ventricle? A) End-diastolic pressure B) Aortic systolic pressure C) Pulmonary capillary wedge pressure D) Right atrial pressure Answer: B Explanation: LV afterload is largely determined by aortic systolic pressure and systemic vascular resistance. Question 63. In the setting of acute decompensated HF, the use of ultrafiltration is most appropriate when: A) Diuretics are effective and the patient is euvolemic B) Diuretic resistance with persistent volume overload despite maximal therapy C) The patient has mild hypertension only D) There is isolated right-sided failure without congestion Answer: B Explanation: Ultrafiltration removes fluid directly when diuretics fail.
