Acute Heart Failure - Case-Based MCQs

A 72-year-old man with a history of hypertension and coronary artery disease presents with progressive dyspnea on exertion, orthopnea and ankle swelling over the past week. On exam, his JVP is elevated and bilateral crepitation are noted. Which of the following best defines the underlying syndrome?

• Structural heart abnormality with reduced cardiac output and elevated intracardiac pressures

• Isolated diastolic dysfunction with preserved EF

• Pulmonary disease leading to hypoxemia

• Aortic stenosis with normal cardiac output

A 68-year-old woman presents with sudden severe shortness of breath. She is found to have acute pulmonary edema. Which of the following describes the typical onset of acute pulmonary edema compared with decompensated chronic HF?

• Gradual onset over days to weeks

• Rapid onset within hours

• Always associated with arrhythmia

• Only occurs in right-sided HF

A 55-year-old man with ischemic cardiomyopathy is admitted with orthopnea, PE : SBP 85 /65 mmHg, cold extremities, altered mental status and oliguria. Which hemodynamic profile best fits his condition?

• Warm and dry

• Warm and wet

• Cold and dry

• Cold and wet

A 60-year-old woman with known HF comes to the ER with worsening dyspnea. On exam: S3 gallop, pitting edema and JVP engorgement. CXR has shown. Which stage of pulmonary edema does this represent?

• Stage 1 - Vascular redistribution

• Stage 2 - Interstitial edema

• Stage 3 - Alveolar edema

• diagnosis pneumonia > HF

A 72-year-old woman with COPD and pulmonary hypertension presents with progressive abdominal distension, ankle swelling, and early satiety. Exam: JVP 15 cm, loud P2, hepatomegaly, ascites, bilateral pedal edema. Lungs are clear, no pulmonary rales.

Which is most consistent?

• Left-sided HF due to LV dysfunction

• Right-sided HF due to pulmonary hypertension

• Biventricular HF

• Restrictive cardiomyopathy

A 70-year-old man presents with acute dyspnea. NT-proBNP is measured at 1,200 pg/mL. Which interpretation is most accurate if the patient is 68 years old?

• Rules out acute HF

• Below diagnostic cutoff

• Suggestive of acute HF

• Cannot be used in patients with renal impairment

A patient presents with chest pain and acute pulmonary edema. ECG was shows . Which is the most likely reversible cause of acute HF?

• Acute coronary syndrome

• Hypertensive emergency

• Tamponade

• Pulmonary embolism

A 72-year-old man with atrial fibrillation and RVR presents with worsening HF. Which drug may be cautiously used to control ventricular rate in this setting?

• Norepinephrine

• Digoxin

• Morphine

• Dobutamine

A 68-year-old man with known HFrEF (EF 30%) presents with progressive fatigue and ankle edema. He dyspnea on showering and walking indoors, whereas previously he was able to work normally. Which of the following NYHA functional classifications?

• Class I

• Class II

• Class III

• Class IV

A 55-year-old woman with acute HF and SBP 160 mmHg presents with acute pulmonary congestion. Which pharmacological treatment is most appropriate initially?

• Vasodilators (e.g., nitroglycerin)

• Inotropes (e.g., dobutamine)

• Vasopressors (e.g., norepinephrine)

• Diuretic + Vasodilators (e.g., nitroglycerin)