Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map

Self-Assessment Questions


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
Click here to compare your answer.

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)
Click here to compare your answer.

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
Click here to compare your answer.

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
Click here to compare your answer.

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
Click here to compare your answer.

Self-Assessment Questions Main Page Top

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 1/04/08 • kkj