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WorksheetsUnit 3 Study Guide
Total questions: 83
Worksheet time: 42mins
Which finding best characterizes left-sided heart failure with reduced ejection fraction?
LVEF below forty percent with impaired pumping
Normal LVEF above fifty with concentric remodeling
Fixed stroke volume with preserved forward flow
Right ventricular dilation with tricuspid regurgitation
What is the most common cause of right-sided heart failure?
Progression from left-sided heart failure
Primary pulmonary valve stenosis
Isolated congenital septal defects
Acute right coronary artery occlusion
Increased pulmonary hydrostatic pressure in left-sided failure leads to which consequence?
Bronchial smooth muscle hyperplasia occurs
Fluid moves from capillaries into alveoli
Airway resistance drops due to dilation
Protein reabsorption increases in lymphatics
Which clinical manifestation most strongly points to right-sided heart failure rather than left-sided?
Jugular venous distension with hepatomegaly
Crackles with frothy pink sputum
Pleural effusion with orthopnea
Shallow respirations near forty per minute
A patient with normal LVEF above 50%, long-standing hypertension, and concentric LV hypertrophy has dyspnea. What heart failure phenotype fits best?
Isolated right ventricular outflow failure
Heart failure with reduced ejection fraction
High-output heart failure from anemia
Heart failure with preserved ejection fraction
Which cluster is most typical of left-sided heart failure manifestations?
Dry hacking cough, pulmonary crackles, dyspnea
JVD, murmurs, generalized edema
Anasarca, ascites, RUQ pain
Anorexia, GI bloating, weight gain
You assess a patient with anxiety, depression, fatigue, and nausea. Which additional sign would most support right-sided failure?
Fine inspiratory crackles at lung bases
Shallow respirations up to forty per minute
Frothy pink-tinged sputum on coughing
Ascites with right upper quadrant tenderness
Which statement correctly contrasts left- and right-sided heart failure?
Left-sided failure is usually secondary to RV disease; right-sided never follows LV disease
Left-sided failure causes pulmonary congestion; right-sided causes systemic venous congestion
Left-sided failure causes systemic edema; right-sided causes pulmonary edema
Left-sided failure rarely raises hydrostatic pressure; right-sided always does
In the ADHF quadrant labeled Dry-Warm, which combination is expected?
PAWP increased, CO normal, orthopnea present
PAWP normal, CO normal, no symptoms
PAWP increased, CO decreased, shock signs
PAWP decreased, CO decreased, cool extremities
Which ADHF profile is most associated with altered mental status, decreased oxygen saturation, and reduced urine output?
Wet-Warm clinical state
Wet-Cold clinical state
Dry-Warm clinical state
Dry-Cold clinical state
Which ACCF/AHA stage corresponds to a person at high risk for heart failure but without structural heart disease or symptoms?
Stage A risk category
Stage B symptomatic stage
Stage D refractory stage
Stage C advanced stage
Which NYHA functional class indicates slight limitation of physical activity with ordinary activity producing symptoms, while the patient is comfortable at rest?
Class II slight limitation
Class IV symptoms at rest
Class I no limitation
Class III marked limitation
Dobutamine is listed as therapy targeting which abnormality in ADHF management within the profiles shown?
Treat decreased cardiac output
Treat elevated PAWP primarily
Treat increased systemic vascular resistance
Treat normal hemodynamics
Which statement best describes dobutamine’s primary action in acute heart failure?
Afterload reduction via arteriolar vasodilation
Negative chronotropy lowering heart rate profoundly
Positive inotropy increasing myocardial contractility
Beta-2 bronchodilation improving airway tone
A key adverse effect to monitor during dobutamine infusion is which complication?
Profound hypokalemia from renal potassium loss
Ventricular dysrhythmias and tachyarrhythmias
Cyanide toxicity with lactic acidosis
Severe bradycardia with heart block
Which physiologic effect of dobutamine can increase myocardial oxygen demand?
Suppressed beta receptors decreasing workload
Augmented contractility and cardiac output
Improved diastolic filling lowering wall stress
Enhanced venous capacitance reducing preload
What is a core mechanism by which ACE inhibitors benefit chronic heart failure?
Constrict renal vasculature to preserve GFR
Increase sodium reabsorption in Henle
Dilate venules and arterioles reducing afterload
Stimulate beta-adrenergic receptors increasing CO
Nitroprusside is first-line for acute decompensated heart failure primarily because it:
Stimulates opioid receptors reducing anxiety
Blocks sodium reabsorption at loop of Henle
Increases contractility via beta agonism
Acts as a potent vasodilator lowering preload
What serious toxicity is uniquely associated with nitroprusside infusions?
Cyanide accumulation leading metabolic acidosis
Hyperkalemia from potassium-sparing effects
Ototoxicity with sensorineural hearing loss
Digoxin toxicity causing xanthopsia
Morphine may be used in acute heart failure to achieve which effect?
Enhance renal sodium retention
Stimulate chemoreceptors to respiratory drive
Decrease anxiety and reduce dyspnea
Increase afterload by arterial constriction
A respiratory risk requiring monitoring after morphine administration in ADHF is:
Respiratory depression with hypoventilation
Bronchospasm with wheezing exacerbation
Pulmonary embolism formation risk
Hyperventilation causing respiratory alkalosis
Which statement describes the mechanism of action of loop diuretics like furosemide (Lasix) in ADHF?
Block sodium and chloride reabsorption in loop
Activate opioid receptors to reduce anxiety
Stimulate beta receptors to increase CO
Inhibit ACE to reduce systemic resistance
Therapeutic goals of Lasix in ADHF include which outcome?
Induce weight gain for volume expansion
Decrease fluid volume and pulmonary congestion
Increase preload and venous pressures
Elevate potassium to correct hypokalemia
What electrolyte should be closely monitored when administering Lasix?
Magnesium for hypermagnesemia
Calcium for hypercalcemia risk
Potassium for hypokalemia risk
Sodium for severe hypernatremia
Nesiritide (Natrecor) is used in ADHF primarily to:
Enhance sodium reabsorption at distal tubule
Increase contractility through beta agonism
Provide vasodilation lowering pulmonary wedge pressure
Treat arrhythmias by AV nodal blockade
Pulmonary edema is most commonly associated with which cardiac condition?
Right-sided heart failure predominance
Left-sided heart failure involvement
Pericardial tamponade primarily
Hypertrophic cardiomyopathy cause
Which clinical feature best suggests pulmonary edema in a decompensated patient?
Absence of crackles on lung auscultation
Bradycardia with normal oxygenation
Frothy, blood-tinged sputum expectoration
Dry cough without sputum production
A patient with pulmonary edema is most likely to exhibit which respiratory pattern?
Orthopnea and paroxysmal nocturnal dyspnea
Cheyne–Stokes breathing with apnea cycles
Bradypnea with normal accessory muscle use
Kussmaul respirations with fruity odor
Which hemodynamic sign may accompany pulmonary edema in severe cases?
Hypertension with bounding pulses
Hypotension with tachycardia
Bradycardia with narrowed pulse pressure
Normotension with low heart rate
A new S3 or S4 heart sound in a dyspneic patient suggests:
Aortic stenosis causing ejection click
Mitral valve prolapse midsystolic click
Ventricular filling abnormalities in HF
Pericardial friction from inflammation
Key patient teaching for heart failure drug therapy includes instructing patients to:
Skip doses when feeling asymptomatic
Discontinue diuretics if weight decreases
Avoid reporting dizziness or nausea
Take pulse for a full minute regularly
Which patient education point helps detect fluid retention early in heart failure?
Ignore mild orthopnea symptoms
Use remote device monitoring tools
Limit rest periods during exercise
Increase sodium intake when fatigued
For a patient starting diuretic therapy, what symptom warrants urgent reporting?
Weight loss of one kilogram weekly
Improved urine output after dosing
Muscle weakness suggesting hypokalemia
Decreased ankle swelling overnight
During ADHF management, reducing pulmonary capillary wedge pressure can be achieved by:
ACE inhibitor-mediated sodium retention
Dobutamine decreasing venous capacity markedly
Morphine increasing respiratory drive strongly
Nesiritide-induced vasodilation effects
Which statement best describes the counterpulsation principle used by an intraaortic balloon pump (IABP)?
Balloon inflates during systole to raise stroke volume
Balloon stays partially inflated throughout the entire cardiac cycle
Balloon inflates during diastole to augment coronary perfusion
Balloon deflates during diastole to lower ventricular preload
What is the primary hemodynamic benefit of IABP therapy in acute left ventricular failure?
Raises preload to enhance end-diastolic volume
Maintains constant aortic pressure throughout diastole
Increases afterload to improve arterial pressure
Decreases afterload to reduce myocardial oxygen demand
An IABP is typically inserted via which access route and positioned where?
Radial artery access, ascending aorta position
Femoral artery access, descending thoracic aorta position
Subclavian vein access, aortic root position
Femoral vein access, abdominal aorta position
A patient on IABP develops cool, painful legs and decreased urine output. Which complication is most likely?
Improper timing causing increased systolic afterload
Ischemia to periphery and renal hypoperfusion
Thrombocytopenia from platelet activation
Balloon leak leading to helium embolism risk
The monitor shows an assist ratio of 1:1. What does this setting indicate?
Balloon inflates every other heartbeat only
One inflation–deflation sequence for each heartbeat
Two assisted beats followed by one unassisted beat
Continuous inflation with intermittent deflation
Which bedside action best reduces IABP-related vascular complications in the first 24 hours?
Ambulate early to prevent deep vein thrombosis
Keep the patient immobile with head of bed under 45 degrees
Increase fluids to maintain high urine output continuously
Place patient in high Fowler position after each inflation
Which route most commonly transmits Hepatitis A?
Percutaneous exposure from needle sharing
Transfusion of unscreened blood products
Aerosol droplets from coughing patients
Fecal–oral ingestion from contaminated water
Which marker best indicates an acute Hepatitis A infection at presentation?
HBsAg detected in blood
Anti-HCV antibody screen
HAV IgM positivity in serum
HAV IgG isolated in serum
Which statement about Hepatitis B transmission is accurate?
It is mainly fecal–oral waterborne
It only spreads via undercooked shellfish
It spreads by blood and body fluids
It is airborne through respiratory droplets
Which population is listed at higher risk for Hepatitis B acquisition?
People who never had dental procedures
Children vaccinated for measles only
Adults with seasonal allergic rhinitis
Patients on chronic hemodialysis therapy
Which laboratory marker most specifically indicates current Hepatitis B infection?
HBsAg present in circulation
Anti-HBs IgG detected
Total anti-HBc IgG alone
Isolated HAV IgG positivity
A patient completed the standard three-dose series of a recombinant Hepatitis B vaccine. Which marker reflects immunity due to vaccination?
Anti-HBs IgG without anti-HBc
Anti-HCV with elevated ALT
Anti-HBc IgM with HBsAg
HBV-DNA with HBeAg
Which statement about Hepatitis D prevention is correct?
HDV spreads exclusively by fecal contamination
HBV vaccination reduces HDV infection risk
There is a licensed vaccine for HDV alone
HDV is prevented by HAV immunization
Which finding best distinguishes prior Hepatitis A exposure from acute disease during evaluation?
Presence of Anti-HCV indicating past immunity
Presence of HAV IgG indicating past immunity
Presence of HBsAg indicating past immunity
Presence of HAV IgM indicating past immunity
A patient born in 1985 reports transfusions before 1992 and now screens positive for anti-HCV. Which interpretation is most appropriate?
Anti-HCV reflects vaccine-induced antibodies
Anti-HCV indicates current or past HCV infection
Anti-HCV proves resolved infection only
Anti-HCV rules out any chronic infection
Which post-exposure measure is recommended for hepatitis A exposure?
HAV vaccine and immune globulin
HBV vaccine with HBIG injection
Pegylated interferon therapy
No prophylaxis and baseline testing
A healthcare worker sustains a needle-stick from an HBV-positive source. Which immediate strategy is appropriate?
HBV vaccine with hepatitis B immune globulin
Only baseline and follow-up testing
Direct-acting antivirals for four weeks
High-dose corticosteroids for five days
After exposure to hepatitis C, what is the recommended post-exposure approach?
Tenofovir and entecavir combination therapy
Short course of pegylated interferon
Immediate HCV vaccine and immune globulin
No prophylaxis; baseline and follow-up testing
Which is a primary goal of chronic hepatitis B therapy?
Decrease viral load and disease progression
Eradicate virus within two weeks
Induce jaundice to mark recovery
Raise liver enzymes to normal levels
Which class is first-line pharmacotherapy for chronic hepatitis B?
Ribavirin with interferon monotherapy
Broad-spectrum antibiotics and steroids
Direct-acting antiviral protease inhibitors
Nucleoside and nucleotide analogs
A patient with chronic HBV starts entecavir. Which statement best reflects its action profile?
Eradicates HCV in coinfected individuals
Replaces missing clotting factors directly
Inhibits viral DNA replication and lowers load
Stimulates autoantibodies against hepatocytes
Which adverse effect is associated with pegylated interferon therapy?
Flu-like symptoms and depression
Severe diarrhea with colitis
Hyperglycemia with pancreatitis
Nephrotoxicity and ototoxicity
Which statement about chronic hepatitis C treatment is accurate?
HBIG prophylaxis prevents acute HCV
Interferon alone is preferred in all cases
DAA therapy is effective for HCV/HIV coinfection
HCV vaccines prevent chronic infection
Which early clinical manifestation is typical in cirrhosis?
Fatigue with hepatomegaly; LFTs may be normal
Profound ascites with hepatic encephalopathy
Renal failure with severe coagulopathy
Massive variceal bleeding at diagnosis
Which skin finding is characteristic of cirrhosis?
Malar rash and oral ulcers
Target lesions with bullae
Livedo reticularis patches
Spider angiomas and palmar erythema
Which hematologic abnormality commonly occurs in cirrhosis?
Sickle cell crisis episodes
Thrombocytopenia and leukopenia
Polycythemia with eosinophilia
Hemophilia A development
Which feature best distinguishes compensated from decompensated cirrhosis?
Liver still functions despite underlying disease
Occurrence of endocrine disturbances in both sexes
Development of peripheral neuropathy symptoms
Presence of splenomegaly and collateral veins
Portal hypertension primarily refers to which pathophysiologic change?
Dilation of biliary tree due to cholestasis
Obstruction of hepatic lymphatic drainage
Increased venous pressure in portal circulation
Reduced arterial inflow to the liver parenchyma
Which complication is most immediately life‑threatening due to fragile vessels that bleed easily?
Esophageal and gastric variceal hemorrhage
Large volume ascites with tense abdomen
Hepatic encephalopathy with asterixis
Hepatorenal syndrome without structural lesions
Where are esophageal varices typically located?
Varicose veins in the mid‑esophageal submucosa
Dilated venules along the gastric fundus only
Capillary telangiectasias near the upper esophagus
Complex of tortuous enlarged veins at lower esophagus
Which finding best characterizes ascites in cirrhosis?
Accumulation of serous fluid in peritoneal cavity
Leakage of lymph into retroperitoneal space
Inflammatory exudate within pleural cavity
Chylous effusion confined to mediastinum
Ascites increases risk for which thoracic complication?
Pneumothorax from ruptured subpleural blebs
Bronchiectasis from chronic airway infection
Pulmonary embolism from lower limb thrombi
Pleural effusion due to transdiaphragmatic movement
A patient with cirrhosis shows asterixis and inappropriate behavior. What mechanism most directly explains these signs?
Neurotoxic effects of elevated ammonia
Cerebral edema from osmotic shifts
Hyponatremia producing neuronal swelling
Hypoglycemia causing cortical dysfunction
Which combination best describes hepatic encephalopathy manifestations?
Polyuria, polydipsia, and weight gain
Acute hemoptysis, chest pain, and syncope
Impaired responsiveness, sleep disturbances, and coma
Pruritus, jaundice, and xanthomas
What does fetor hepaticus most specifically refer to?
Sour, ketotic smell during fasting
Musty, sweet odor on a patient’s breath
Ammoniacal urine odor with infection
Fishy sweat odor in trimethylaminuria
Hepatorenal syndrome is best defined by which statement?
Renal failure with no structural kidney abnormalities
Autoimmune glomerulonephritis with proteinuria
Intrinsic renal disease with tubular necrosis
Postrenal obstruction from ureteral compression
Which clinical triad most strongly suggests progression to decompensated cirrhosis from portal hypertension?
Splenomegaly, collateral veins, and ascites
Hyperaldosteronism, gynecomastia, and infertility
Peripheral neuropathy, ataxia, and paresthesias
Coagulopathy, easy bruising, and epistaxis
A cirrhotic patient presents with oliguria and intractable ascites, but imaging shows normal‑appearing kidneys. What is the most likely diagnosis?
Pre‑renal azotemia due to hemorrhage and shock
Acute tubular necrosis from ischemic injury
Obstructive uropathy from enlarged prostate
Hepatorenal syndrome causing functional renal failure
Which mechanism best explains how lactulose treats hepatic encephalopathy?
Inhibits hepatic urea cycle to limit ammonia formation
Stimulates renal clearance of ammonia via diuresis
Acidifies colonic contents to trap ammonia as ammonium
Neutralizes gastric acid to reduce ammonia production
A patient with esophageal varices is started on a nonselective beta blocker. What is the primary therapeutic goal?
Raise systemic blood pressure to prevent syncope
Constrict varices to induce thrombosis formation
Decrease portal pressure to reduce bleeding risk
Increase cardiac output to improve liver perfusion
Which medication pairing lists two common nonselective beta blockers used for variceal prophylaxis?
Esmolol and bisoprolol
Atenolol and metoprolol
Nadolol and propranolol
Carvedilol and nebivolol
In cirrhosis, albumin infusion primarily helps manage which complication and how?
Hepatic encephalopathy by reducing ammonia load
Varices by lowering portal pressure and wall tension
Coagulopathy by increasing fibrinogen and clot strength
Ascites by enhancing intravascular volume and urine output
Which description best characterizes the TIPS procedure?
Endovascular shunt between portal and systemic venous flow
Open surgery connecting portal vein to IVC directly
Percutaneous drainage catheter for refractory ascites only
Laparoscopic banding of bleeding esophageal varices
Which is a key indication for TIPS rather than continued diuretics?
Stable compensated cirrhosis without varices
Refractory ascites not responding to diuretics
Mild pedal edema responsive to salt restriction
Acute hepatic encephalopathy without bleeding
Which statement about TIPS and liver transplantation is most accurate?
TIPS requires removal before any transplantation attempt
TIPS precludes future liver transplantation permanently
TIPS improves graft availability by lowering MELD score
TIPS does not interfere with future liver transplantation
Which statement best differentiates a portocaval shunt from TIPS?
Portocaval shunt is nonsurgical and reversible easily
Portocaval shunt connects portal vein directly to IVC surgically
Portocaval shunt is preferred first-line due to low complications
Portocaval shunt is placed via jugular access with stent graft
Balloon tamponade is used for what purpose in variceal hemorrhage?
Endoscopic clipping of bleeding vessels
Mechanical compression to control bleeding
Electrocautery coagulation of bleeding points
Chemical sclerotherapy to obliterate varices
Which statement best defines paracentesis in the context of ascites management?
Intravenous infusion to expand plasma volume
Oral diuretic therapy to reduce fluid
Insertion of a needle to drain peritoneal fluid
Abdominal massage to mobilize ascitic fluid
Surgical removal of the entire peritoneum
A patient with tense ascites has symptomatic relief after paracentesis but returns with fluid reaccumulation one week later. What is the most plausible explanation?
Ascites cannot recur after adequate drainage
Paracentesis provides temporary relief of ascites
Paracentesis increases long-term ascites production
The needle permanently seals lymphatic leaks
Paracentesis cures portal hypertension completely
