Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Cardiovascular Disorders--->Heart Failure
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Question 1# Print Question

An 82-year-old obese male with a long-standing history of diabetes mellitus presents to the emergency department with dyspnea, cough, mild fever, and tachycardia (heart rate 105 bpm). The patient’s blood pressure is 93/58 mm Hg. The patient reports having had a cold for the past few days and noticed a sudden-onset shortness of breath yesterday. A chest x-ray reveals diffuse opacification of the right lung. Heart and lung sounds are difficult to auscultate. Empiric antibiotics for community-acquired pneumonia are started, and supplemental O2 via nasal cannula is given. His respiratory rate is 18 breaths/min and oxygen saturation is 97% while receiving 4 L/min of O2 supplementation.

Which of the following actions is most appropriate?

A. Initiate biphasic positive airway pressure (BIPAP) to improve pulmonary edema
B. Start high-flow nasal cannula to decrease work of breathing and eliminate CO2
C. Obtain CT scan of the chest to further evaluate the right lung process
D. Obtain transthoracic echocardiogram
E. Start phenylephrine to increase blood pressure and improve coronary blood flow

Question 2# Print Question

An 81-year-old woman with a body mass index of 36 kg/m2 and longstanding congestive heart failure, hypertension, atrial fibrillation, and chronic obstructive pulmonary disease is admitted to the intensive care unit with exacerbation of heart failure. The patient presented with severe shortness of breath, diffuse bilateral pulmonary edema on chest x-ray, elevated brain natriuretic peptide levels of 13 187 pg/mL, and an elevated creatinine of 2.13 mg/dL. Echocardiogram reveals a left ventricular ejection fraction of 55%.

Which statement with regards to this patient is most accurate?

A. Beta-blocker therapy yields equal reduction in mortality in diastolic heart failure versus systolic heart failure patients
B. Ischemic heart disease is the major mechanism leading to diastolic heart failure
C. Diastolic heart failure is characterized by eccentric ventricular hypertrophy
D. Diastolic pulmonary gradient is a poor predictor of mortality in patients with pulmonary hypertension due to left heart disease
E. Patients with diastolic heart failure have a lower 5-year survival than patients with systolic heart failure

Question 3# Print Question

A 79-year-old male with acutely decompensated systolic heart failure is admitted from the emergency department with respiratory failure and acute anuric renal failure. The patient is bradycardic and hypotensive. At home, the patient has been taking atenolol, digoxin, hydrochlorothiazide, and lisinopril. A milrinone infusion is started for inotropic support. The patient’s renal function did not improve over the following days ultimately requiring renal continuous venovenous hemofiltration (CVVH).

Which of the statements regarding the medical therapy is CORRECT?

A. Milrinone metabolism is highly dependent on hepatic function
B. Milrinone’s terminal elimination halflife is approximately 2 hours in patients with normal renal function
C. Milrinone can safely be used in patients requiring CVVH
D. CVVH clears digoxin from the patient’s plasma
E. Atenolol metabolism is independent of renal function

Question 4# Print Question

A 72-year-old male with coronary artery disease presents 5 days after experiencing chest pain complaining of dyspnea. He is in the emergency department with heart rate 87 beats/min and blood pressure 86/42 mm Hg, oxygen saturation 91% on 50% oxygen via facemask. You do a bedside echocardiogram and find that he has a depressed ejection fraction and severe mitral regurgitation. A formal echocardiogram was performed and a ruptured papillary muscle identified. His other lab values are significant for lactate 5.6 mmol/L and creatinine 2.01 mg/dL. You place him on BIPAP to improve oxygenation and inotropes to augment perfusion. Despite these measures, he continues to have worsening metabolic acidosis and now LFTs are rising. An intra-aortic balloon pump (IABP) is placed and the patient is being prepared to go to the operating room.

Which of the following is NOT true regarding IABP?

A. IABP is the most commonly used mechanical support device
B. It has been shown to improve mortality in patients with cardiogenic shock
C. It has been indicated for patients with mechanical complications from myocardial infarction such as a ventricular septal defect and mitral regurgitation
D. It is contraindicated in a patient with aortic insufficiency
E. Helium is used to inflate the balloon

Question 5# Print Question

A 64-year-old female with longstanding hypertension and mild aortic stenosis and subsequent left ventricular hypertrophy is in septic shock requiring vasopressors. You do a bedside echocardiogram, and left ventricular function is within normal limits. You decide to continue volume resuscitation, and she becomes more hypoxic requiring supplemental oxygen. You suspect heart failure with preserved ejection fraction (HFpEF).

Which of the following is NOT true regarding diastolic function?

A. Atrial fibrillation is tolerated poorly
B. End-stage renal disease is associated with diastolic dysfunction
C. Lusitropy is a determinant of the effectiveness of early diastole
D. Diastolic dysfunction can be a component of septic cardiomyopathy
E. Ventricular relaxation is only a passive process

Category: Critical Care Medicine-Cardiovascular Disorders--->Heart Failure
Page: 1 of 1