WorksheetsAcute Heart Failure - Case-Based MCQs
Total questions: 21
Worksheet time: 11mins
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)
A patient with decompensated HF is receiving IV furosemide 80 mg/day but remains congested and UOP 400/day. Lab : GFR 40, HCO3 15, Which next step is most reasonable?
Stop diuretics
Add HCTZ
Add acetazolamide
Furosemide 160 mg IV bolus
A 60-year-old woman with acute HF, BP 70/50 mmHg, cold extremities, and oliguria requires urgent therapy. Which of the following is most appropriate?
High-dose IV loop diuretic alone
Vasodilator infusion
Inotrope and/or vasopressor support
Oral beta-blocker up-titration
A 62-year-old man with chronic HFrEF (EF 25%) is on ARNI, beta-blocker, spironolactone, dapagliflozin and furosemide. Which of the following drugs is not part of the four pillars of GDMT for HFrEF?
ARNI (sacubitril/valsartan)
Beta-blocker (metoprolol succinate)
Mineralocorticoid receptor antagonist (spironolactone)
Loop diuretic (furosemide)
A patient hospitalized with acute decompensated HF has stabilized. You plan to initiate GDMT. Which of the following is the correct condition before starting/up-titrating GDMT?
SBP > 100 mmHg, stable for at least 6 hours without IV diuretics or vasodilators
SBP < 90 mmHg requiring vasopressors
Ongoing IV inotropes required
Persistent pulmonary edema with hypoxemia
A 70-year-old patient presents with right ventricular failure. Which clinical presentation is most likely?
Dyspnea, pulmonary congestion, orthopnea
Elevated JVP, hepatomegaly, ascites, peripheral edema
Acute pulmonary edema with pink frothy sputum
Hypotension and cardiogenic shock
A 65-year-old patient with HFrEF is optimized on ARNI, beta-blocker, and MRA. The cardiologist adds dapagliflozin. What class of medication does dapagliflozin belong to, and why is it indicated?
SGLT2 inhibitor - reduces hospitalization and mortality in HFrEF
DPP-4 inhibitor - controls blood glucose in diabetes only
Sulfonylurea - lowers HbA1c but no effect in HF
Thiazolidinedione - improves diastolic function in HFpEF
A 64-year-old man with HFrEF (EF 30%) has been optimized on GDMT for 3 months. He now presents with serum potassium 5.9 mEq/L and creatinine 2.2 mg/dL. Which of the following medications is most likely responsible for these findings?
Bisoprolol
Dapagliflozin
Spironolactone
Digoxin
A 70-year-old woman presents with fever, productive cough and dyspnea for 3 days. Vital signs: T 38.6°C, BP 122/76 mmHg, HR 108 bpm, SpO₂ 89% RA. On exam: crackles localized to right lower lung, no JVP elevation, no peripheral edema. Chest X-ray shows right lower lobe consolidation. Laboratory testing reveals NT-proBNP of 5,500 pg/mL. What diagnosis?
Pericarditis
Myocarditis
Acute heart failure
Pneumonia
A 72-year-old man with a history of ischemic cardiomyopathy (EF 30%), He reports worsening orthopnea and severe lower extremity swelling. On exam: BP 128/76 mmHg, HR 92 bpm, SpO₂ 91% on room air. JVP is 12 cm, bilateral pulmonary crepitation. Laboratory results: creatinine 1.6 mg/dL, potassium 4.3 mEq/L. Which of the following is the most appropriate initial pharmacologic therapy to relieve his symptoms?
IV norepinephrine
Oral beta-blocker
Oral diuretic
IV loop diuretic
A 68-year-old man admitted for severe pulmonary congestion. He receives IV furosemide 80 mg bolus. Over the next 6 hours, his urine output averages 120 mL/hour. Blood pressure is stable at 118/72 mmHg, creatinine remains 1.3 mg/dL, and electrolytes are within normal limits.
What is the most appropriate next step in diuretic management?
Increase furosemide dose to 160 mg IV immediately
Add a thiazide diuretic for synergy
Repeat the same furosemide dose at 12 hours if needed
Stop diuretics because urine output is adequate
What is the name of this device?
(a)
