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Self-Assessment Questions

Cardiology

Congestive Heart Failure: Review Questions

Beth R. Malasky, MD, FACC

Dr. Malasky is Clinical Assistant Professor at the University of Arizona Health Sciences Center, Tucson, AZ.



Choose the single best answer for each question.

Questions 1-5 refer to the following case study.

A 22-year-old firefighter presents at a cardiology clinic with dyspnea on exertion. He reports that he has trouble keeping up with his squad and can no longer carry his 40-lb pack. He reports 2 months of nocturnal cough, a 10-lb weight loss, and fatigue. He denies any history of smoking, and he drinks 2 to 3 six-packs of beer daily on weekends.
He presented 3 weeks ago to a primary care clinic, where he was told he had pneumonia and asthma. He was started on antibiotics and a ß-agonist but still does not feel well.

1. Which of the following findings is the least specific in making a diagnosis?
  1. Elevated jugular venous pulsation (JVP)
  2. Pulsus alternans
  3. Wheezing
  4. S3 gallop
  5. Cephalization on chest radiograph
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2. Physical examination reveals decreased breath sounds one third of the way up the lung field on the right side and crackles half way up on both sides. He has JVP to the angle of the jaw, hepatojugular reflux, and 2+ pitting edema to the knees. He has a grade 2-3/6 systolic murmur along the left sternal border and apex radiating to the axilla. He is diagnosed with congestive heart failure (CHF). What laboratory test would have been helpful in confirming the etiology of this patient’s symptoms?

  1. Total bilirubin
  2. C-reactive protein
  3. Troponin I
  4. Creatinine
  5. B-type natriuretic peptide (BNP)
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3. Which test would provide the most information to assess his condition?

  1. Electrocardiogram
  2. Arterial blood gas analysis
  3. Echocardiogram
  4. Chest radiograph
  5. Pulmonary function tests
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4. The patient has 4-chamber dilatation with a left ventricular ejection fraction of 15%. He has moderate mitral regurgitation and moderate tricuspid regurgitation, with an estimated pulmonary artery pressure of 70 mm Hg. He has a moderate pleural effusion, elevated liver function tests, hypokalemia, and hypomagnesemia. His blood pressure is 115/60 mm Hg, his heart rate is 110 bpm, his respiratory rate is 30 breaths/min, and his oxygen saturation on room air is 88%. You decide to admit the patient. Initial therapy should include all of the following EXCEPT:
  1. Intravenous loop diuretics
  2. Angiotensin-converting enzyme (ACE) inhibitor
  3. Digoxin
  4. ß-Blocker
  5. Electrolyte replacement
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5. All of the following statements regarding ß-blocker therapy in the treatment of heart failure are correct EXCEPT:

  1. ß-Blockers are classified based on their receptor specificity and are not uniform as a class of drugs
  2. ß-Blocker therapy results in greater improvements in ejection fractions among those with nonischemic cardiomyopathy compared to ischemic cardiomyopathy
  3. ß-Blocker therapy should be initiated only when the patient is euvolemic
  4. ß-Blocker therapy should not be initiated in patients with severe class IV CHF
  5. ß-Blocker therapy may result in improved left ventricular function without improvement in exercise tolerance
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