CMN 574 EXAM 1 STUDY GUIDE 2025/2026
COMPLETE QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES ||
100% GUARANTEED PASS LATEST VERSION
SECTION 1: CARDIAC ASSESSMENT
1. A 55-year-old male presents with substernal chest pain that is burning in nature,
associated with nocturnal cough, flatus, and belching. The pain is worsened when
lying flat and relieved by sitting up. What is the most likely diagnosis?
A) Acute coronary syndrome
B) Gastroesophageal reflux disease
C) Pericarditis
D) Aortic dissection
Correct Answer: B
Rationale: GI-origin chest pain presents with substernal burning, associated with
nocturnal cough, flatus, belching, and dysphagia. It is typically recurrent and worsened
by meals or supine position. Unlike cardiac pain, it is not associated with exertion.
Pericarditis pain is relieved by sitting forward, not sitting up generally. Aortic dissection
presents with tearing pain.
,2. A 62-year-old female with hypertension and smoking history presents with
abrupt onset of severe, tearing chest pain radiating to the back. BP is 160/90 in
right arm and 110/70 in left arm. What is the most appropriate next step?
A) Administer sublingual nitroglycerin
B) Order serial cardiac enzymes
C) Obtain emergent chest CT and echocardiography
D) Discharge with NSAIDs and follow-up
Correct Answer: C
Rationale: This presentation is classic for aortic dissection, a life-threatening emergency.
Key features include abrupt onset of tearing/ripping pain radiating to back, with
differential blood pressures between arms. Emergent chest CT and echocardiography
are required for diagnosis, followed by surgical intervention. Nitroglycerin and cardiac
enzymes would be appropriate for ACS, not dissection.
3. A 45-year-old male presents with sharp, stabbing chest pain that is worse when
lying flat and with deep inspiration. Pain is relieved when he sits up and leans
forward. He reports recent URI symptoms. What is the most likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
C) Pericarditis
D) Musculoskeletal chest pain
Correct Answer: C
Rationale: Pericarditis is characterized by pleuritic, sharp chest pain that worsens in the
supine position and with deep inspiration, and improves when sitting up and leaning
forward. Recent viral illness is a common trigger. Musculoskeletal pain is typically
reproducible on palpation. MI pain is not positional.
4. A 28-year-old healthy female presents with chest pain that is localized and
reproducible on palpation. She reports the pain worsens with deep inspiration and
movement. What is the most likely etiology?
,A) Pericarditis
B) Musculoskeletal chest pain
C) Mitral valve prolapse
D) Panic disorder
Correct Answer: B
Rationale: Musculoskeletal chest pain is the most common cause of non-cardiac chest
pain in primary care. Characteristics include localized pain, reproducible on palpation,
worsened with movement or deep inspiration. This is most common in active young
individuals.
5. A patient with chest pain reports the pain is unrelated to meals or activity and
describes it as a constant heaviness. Screening questions reveal sudden feelings of
anxiety and heart racing in the past 6 months. What is the most likely diagnosis?
A) Esophageal spasm
B) Stable angina
C) Panic disorder
D) Costochondritis
Correct Answer: C
Rationale: Panic disorder chest pain is characterized by constant or intermittent
heaviness unrelated to meals or activity. A positive screen (yes to anxiety/fear spells or
sudden palpitations/dyspnea) makes panic disorder likely. The pain is classified as
psychogenic or precordial chest pain.
6. A 70-year-old male with history of hypertension presents with substernal chest
pressure that occurs with exertion and is relieved by rest. What is the most likely
diagnosis?
A) Unstable angina
B) Stable angina
C) Gastroesophageal reflux
D) Aortic dissection
, Correct Answer: B
Rationale: Stable angina is characterized by substernal chest pressure/discomfort that
occurs predictably with exertion, emotional stress, or cold weather and is relieved within
minutes by rest or sublingual nitroglycerin. The pain is typically described as pressure,
squeezing, or heaviness.
7. Which of the following is a risk factor for aortic dissection?
A) Hypotension
B) Bradycardia
C) Cocaine use
D) Hypothyroidism
Correct Answer: C
Rationale: Risk factors for aortic dissection include hypertension, tobacco abuse,
congenital aortic valvular or ascending aortic disease, atherosclerotic disease,
pregnancy, and cocaine use. Cocaine use increases risk due to catecholamine surge and
increased shear forces on the aortic wall.
8. A patient with pericarditis would most likely have which ECG finding?
A) ST-segment depression
B) Diffuse ST-segment elevation
C) Pathologic Q waves
D) T-wave inversion
Correct Answer: B
Rationale: Pericarditis typically shows diffuse ST-segment elevation in multiple leads,
often with PR-segment depression. This is due to inflammation of the epicardial surface.
Unlike MI, the ST elevation is usually concave upward and not associated with reciprocal
changes.
COMPLETE QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES ||
100% GUARANTEED PASS LATEST VERSION
SECTION 1: CARDIAC ASSESSMENT
1. A 55-year-old male presents with substernal chest pain that is burning in nature,
associated with nocturnal cough, flatus, and belching. The pain is worsened when
lying flat and relieved by sitting up. What is the most likely diagnosis?
A) Acute coronary syndrome
B) Gastroesophageal reflux disease
C) Pericarditis
D) Aortic dissection
Correct Answer: B
Rationale: GI-origin chest pain presents with substernal burning, associated with
nocturnal cough, flatus, belching, and dysphagia. It is typically recurrent and worsened
by meals or supine position. Unlike cardiac pain, it is not associated with exertion.
Pericarditis pain is relieved by sitting forward, not sitting up generally. Aortic dissection
presents with tearing pain.
,2. A 62-year-old female with hypertension and smoking history presents with
abrupt onset of severe, tearing chest pain radiating to the back. BP is 160/90 in
right arm and 110/70 in left arm. What is the most appropriate next step?
A) Administer sublingual nitroglycerin
B) Order serial cardiac enzymes
C) Obtain emergent chest CT and echocardiography
D) Discharge with NSAIDs and follow-up
Correct Answer: C
Rationale: This presentation is classic for aortic dissection, a life-threatening emergency.
Key features include abrupt onset of tearing/ripping pain radiating to back, with
differential blood pressures between arms. Emergent chest CT and echocardiography
are required for diagnosis, followed by surgical intervention. Nitroglycerin and cardiac
enzymes would be appropriate for ACS, not dissection.
3. A 45-year-old male presents with sharp, stabbing chest pain that is worse when
lying flat and with deep inspiration. Pain is relieved when he sits up and leans
forward. He reports recent URI symptoms. What is the most likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
C) Pericarditis
D) Musculoskeletal chest pain
Correct Answer: C
Rationale: Pericarditis is characterized by pleuritic, sharp chest pain that worsens in the
supine position and with deep inspiration, and improves when sitting up and leaning
forward. Recent viral illness is a common trigger. Musculoskeletal pain is typically
reproducible on palpation. MI pain is not positional.
4. A 28-year-old healthy female presents with chest pain that is localized and
reproducible on palpation. She reports the pain worsens with deep inspiration and
movement. What is the most likely etiology?
,A) Pericarditis
B) Musculoskeletal chest pain
C) Mitral valve prolapse
D) Panic disorder
Correct Answer: B
Rationale: Musculoskeletal chest pain is the most common cause of non-cardiac chest
pain in primary care. Characteristics include localized pain, reproducible on palpation,
worsened with movement or deep inspiration. This is most common in active young
individuals.
5. A patient with chest pain reports the pain is unrelated to meals or activity and
describes it as a constant heaviness. Screening questions reveal sudden feelings of
anxiety and heart racing in the past 6 months. What is the most likely diagnosis?
A) Esophageal spasm
B) Stable angina
C) Panic disorder
D) Costochondritis
Correct Answer: C
Rationale: Panic disorder chest pain is characterized by constant or intermittent
heaviness unrelated to meals or activity. A positive screen (yes to anxiety/fear spells or
sudden palpitations/dyspnea) makes panic disorder likely. The pain is classified as
psychogenic or precordial chest pain.
6. A 70-year-old male with history of hypertension presents with substernal chest
pressure that occurs with exertion and is relieved by rest. What is the most likely
diagnosis?
A) Unstable angina
B) Stable angina
C) Gastroesophageal reflux
D) Aortic dissection
, Correct Answer: B
Rationale: Stable angina is characterized by substernal chest pressure/discomfort that
occurs predictably with exertion, emotional stress, or cold weather and is relieved within
minutes by rest or sublingual nitroglycerin. The pain is typically described as pressure,
squeezing, or heaviness.
7. Which of the following is a risk factor for aortic dissection?
A) Hypotension
B) Bradycardia
C) Cocaine use
D) Hypothyroidism
Correct Answer: C
Rationale: Risk factors for aortic dissection include hypertension, tobacco abuse,
congenital aortic valvular or ascending aortic disease, atherosclerotic disease,
pregnancy, and cocaine use. Cocaine use increases risk due to catecholamine surge and
increased shear forces on the aortic wall.
8. A patient with pericarditis would most likely have which ECG finding?
A) ST-segment depression
B) Diffuse ST-segment elevation
C) Pathologic Q waves
D) T-wave inversion
Correct Answer: B
Rationale: Pericarditis typically shows diffuse ST-segment elevation in multiple leads,
often with PR-segment depression. This is due to inflammation of the epicardial surface.
Unlike MI, the ST elevation is usually concave upward and not associated with reciprocal
changes.
