Academic Year 2026–2027 HCR 240 | 190+
Practice Questions & Verified Answers | Latest
Study Guide, Test Bank, Healthcare Concepts,
Clinical Practice, Patient Care & Exam Prep
Question 1: A 68-year-old male presents with a 3-week history of progressive
lower extremity edema and dyspnea on exertion. He has a history of
hypertension and type 2 diabetes. On examination, jugular venous pressure is
elevated at 14 cm H₂O, and he has a third heart sound. Which of the following
hemodynamic profiles is most consistent with his presentation?
A. Elevated pulmonary capillary wedge pressure (PCWP) with normal cardiac output
B. Normal PCWP with reduced cardiac output
C. Elevated PCWP with reduced cardiac output
D. Normal PCWP with elevated cardiac output
CORRECT ANSWER: C. Elevated PCWP with reduced cardiac output
Rationale: The patient presents with signs of left-sided heart failure, including dyspnea,
elevated JVP, and an S3 gallop. This indicates elevated filling pressures (PCWP) and
reduced forward flow (cardiac output) due to systolic or diastolic dysfunction. Option A
describes isolated volume overload without low output, while B and D do not match the
clinical picture of heart failure.
Question 2: A 45-year-old woman with systemic lupus erythematosus develops
acute pleuritic chest pain and a pericardial friction rub. An echocardiogram
shows a moderate pericardial effusion. Which of the following is the most
appropriate next step in management?
A. High-dose oral corticosteroids
B. Pericardiocentesis
C. Colchicine in addition to NSAIDs
D. Heparin anticoagulation
CORRECT ANSWER: C. Colchicine in addition to NSAIDs
Rationale: In acute pericarditis, especially with an underlying autoimmune condition,
colchicine combined with NSAIDs is first-line therapy to reduce recurrence risk.
Pericardiocentesis is reserved for cardiac tamponade or diagnostic uncertainty. High-
dose steroids may be used in refractory cases but are not first-line due to increased
recurrence risk.
Question 3: A 72-year-old patient with chronic kidney disease stage 4 is
started on lisinopril for hypertension. One week later, he presents with
confusion, nausea, and muscle twitching. Laboratory results show serum
potassium 6.8 mEq/L, BUN 89 mg/dL, and creatinine 4.2 mg/dL. Which of the
following ECG findings is most likely to be seen in this patient?
A. Peaked T waves and widened QRS complex
B. Flattened T waves and U waves
,C. Prolonged PR interval and delta waves
D. ST-segment elevations in leads V1-V4
CORRECT ANSWER: A. Peaked T waves and widened QRS complex
Rationale: Severe hyperkalemia (K > 6.5 mEq/L) causes peaked, narrow-based T waves,
followed by QRS widening and ultimately a sine-wave pattern. Flattened T waves and U
waves are seen in hypokalemia. PR prolongation and delta waves are features of WPW
syndrome.
Question 4: Which of the following physiologic changes in the cardiovascular
system is most characteristic of normal aging?
A. Decreased left ventricular wall thickness
B. Increased arterial compliance
C. Decreased baroreceptor sensitivity
D. Increased maximal heart rate response to exercise
CORRECT ANSWER: C. Decreased baroreceptor sensitivity
Rationale: Aging is associated with decreased baroreceptor sensitivity, leading to
impaired reflex tachycardia in response to hypotension. Left ventricular wall thickness
increases (not decreases), arterial compliance decreases (stiffens), and maximal heart
rate declines with age.
Question 5: A 56-year-old man with a history of smoking and hyperlipidemia
presents with unstable angina. Cardiac catheterization reveals a 90% stenosis
in the left anterior descending artery. A drug-eluting stent is placed. Which of
the following dual antiplatelet therapy regimens is most appropriate for the
first 12 months post-procedure?
A. Aspirin and clopidogrel
B. Aspirin and ticagrelor
C. Aspirin and warfarin
D. Clopidogrel and ticagrelor
CORRECT ANSWER: B. Aspirin and ticagrelor
Rationale: Current guidelines recommend aspirin plus a P2Y12 inhibitor (ticagrelor or
prasugrel) for patients with acute coronary syndrome undergoing PCI, with ticagrelor
preferred due to faster onset and greater efficacy. Warfarin is not part of standard dual
antiplatelet therapy.
Question 6: A 34-year-old woman presents with palpitations, sweating, and
weight loss despite increased appetite. She has a fine tremor and lid lag.
Thyroid function tests show undetectable TSH and elevated free T4. Which of
the following is the most likely underlying diagnosis?
A. Graves' disease
B. Toxic multinodular goiter
,C. Subacute thyroiditis
D. Pituitary TSH-secreting adenoma
CORRECT ANSWER: A. Graves' disease
Rationale: The classic presentation of hyperthyroidism with diffuse goiter,
ophthalmopathy (lid lag), and autoimmune features in a young woman is most consistent
with Graves' disease. Toxic multinodular goiter is more common in older adults, and
subacute thyroiditis typically presents with a painful thyroid.
Question 7: A 28-year-old male with a known history of Marfan syndrome
presents with sudden-onset severe tearing chest pain radiating to the back.
Blood pressure is 160/90 mmHg in the right arm and 110/70 mmHg in the left.
Which of the following imaging studies is most appropriate for immediate
diagnosis?
A. Chest X-ray
B. Transesophageal echocardiography
C. CT angiography of the chest
D. Magnetic resonance angiography
CORRECT ANSWER: C. CT angiography of the chest
Rationale: CT angiography is rapid, widely available, and highly sensitive for diagnosing
aortic dissection. Transesophageal echocardiography is useful but operator-dependent
and may delay diagnosis in unstable patients. MRI is not preferred in acute settings due
to longer acquisition time.
Question 8: A 65-year-old woman with osteoporosis is started on alendronate.
She is counseled to remain upright for at least 30 minutes after taking the
medication. Which of the following adverse effects is this precaution intended
to prevent?
A. Esophageal ulceration
B. Hypocalcemia
C. Osteonecrosis of the jaw
D. Atrial fibrillation
CORRECT ANSWER: A. Esophageal ulceration
Rationale: Oral bisphosphonates like alendronate can cause severe esophageal irritation
and ulceration if not taken with a full glass of water and if the patient does not remain
upright to ensure rapid passage to the stomach.
Question 9: A 52-year-old patient with long-standing type 2 diabetes and
hypertension is found to have a urine albumin-to-creatinine ratio of 300 mg/g.
His eGFR is 55 mL/min/1.73m². Which of the following is the most
appropriate medication to slow progression of his kidney disease?
, A. Hydrochlorothiazide
B. Amlodipine
C. Lisinopril
D. Metformin
CORRECT ANSWER: C. Lisinopril
Rationale: ACE inhibitors (e.g., lisinopril) are the preferred agents in diabetic kidney
disease due to their renoprotective effects independent of blood pressure lowering,
especially in patients with microalbuminuria and reduced eGFR.
Question 10: A 22-year-old woman with no significant medical history presents
with acute onset of shortness of breath and pleuritic chest pain. She is taking
oral contraceptives. Her oxygen saturation is 88% on room air. A D-dimer is
elevated, and CT pulmonary angiography reveals a central pulmonary
embolism. Which of the following is the most appropriate immediate
management?
A. Unfractionated heparin bolus and infusion
B. Low-molecular-weight heparin subcutaneous
C. Alteplase thrombolysis
D. Warfarin loading dose
CORRECT ANSWER: C. Alteplase thrombolysis
Rationale: This patient has a massive pulmonary embolism (central location,
hemodynamic instability indicated by hypoxia) and should receive thrombolytic therapy
(alteplase) to reduce mortality. Heparin alone is insufficient for massive PE.
Question 11: A 70-year-old patient with heart failure with reduced ejection
fraction (HFrEF) is on maximal medical therapy including beta-blocker, ACE
inhibitor, and spironolactone. He remains in NYHA class III. His QRS duration
is 150 ms with a left bundle branch block morphology. Which of the following
treatments is most likely to improve his survival?
A. Cardiac resynchronization therapy (CRT)
B. Implantable cardioverter-defibrillator (ICD) alone
C. Digoxin
D. Hydralazine and isosorbide dinitrate
CORRECT ANSWER: A. Cardiac resynchronization therapy (CRT)
Rationale: CRT is indicated for patients with HFrEF, NYHA class II-IV symptoms, and
wide QRS (>130-150 ms) with LBBB to improve survival and symptoms. ICD alone
addresses arrhythmic death but not dyssynchrony.
Question 12: A 48-year-old man with a history of alcohol use disorder presents
with confusion, ataxia, and ophthalmoplegia. Which of the following vitamin
deficiencies is most likely responsible for this classic triad?
Practice Questions & Verified Answers | Latest
Study Guide, Test Bank, Healthcare Concepts,
Clinical Practice, Patient Care & Exam Prep
Question 1: A 68-year-old male presents with a 3-week history of progressive
lower extremity edema and dyspnea on exertion. He has a history of
hypertension and type 2 diabetes. On examination, jugular venous pressure is
elevated at 14 cm H₂O, and he has a third heart sound. Which of the following
hemodynamic profiles is most consistent with his presentation?
A. Elevated pulmonary capillary wedge pressure (PCWP) with normal cardiac output
B. Normal PCWP with reduced cardiac output
C. Elevated PCWP with reduced cardiac output
D. Normal PCWP with elevated cardiac output
CORRECT ANSWER: C. Elevated PCWP with reduced cardiac output
Rationale: The patient presents with signs of left-sided heart failure, including dyspnea,
elevated JVP, and an S3 gallop. This indicates elevated filling pressures (PCWP) and
reduced forward flow (cardiac output) due to systolic or diastolic dysfunction. Option A
describes isolated volume overload without low output, while B and D do not match the
clinical picture of heart failure.
Question 2: A 45-year-old woman with systemic lupus erythematosus develops
acute pleuritic chest pain and a pericardial friction rub. An echocardiogram
shows a moderate pericardial effusion. Which of the following is the most
appropriate next step in management?
A. High-dose oral corticosteroids
B. Pericardiocentesis
C. Colchicine in addition to NSAIDs
D. Heparin anticoagulation
CORRECT ANSWER: C. Colchicine in addition to NSAIDs
Rationale: In acute pericarditis, especially with an underlying autoimmune condition,
colchicine combined with NSAIDs is first-line therapy to reduce recurrence risk.
Pericardiocentesis is reserved for cardiac tamponade or diagnostic uncertainty. High-
dose steroids may be used in refractory cases but are not first-line due to increased
recurrence risk.
Question 3: A 72-year-old patient with chronic kidney disease stage 4 is
started on lisinopril for hypertension. One week later, he presents with
confusion, nausea, and muscle twitching. Laboratory results show serum
potassium 6.8 mEq/L, BUN 89 mg/dL, and creatinine 4.2 mg/dL. Which of the
following ECG findings is most likely to be seen in this patient?
A. Peaked T waves and widened QRS complex
B. Flattened T waves and U waves
,C. Prolonged PR interval and delta waves
D. ST-segment elevations in leads V1-V4
CORRECT ANSWER: A. Peaked T waves and widened QRS complex
Rationale: Severe hyperkalemia (K > 6.5 mEq/L) causes peaked, narrow-based T waves,
followed by QRS widening and ultimately a sine-wave pattern. Flattened T waves and U
waves are seen in hypokalemia. PR prolongation and delta waves are features of WPW
syndrome.
Question 4: Which of the following physiologic changes in the cardiovascular
system is most characteristic of normal aging?
A. Decreased left ventricular wall thickness
B. Increased arterial compliance
C. Decreased baroreceptor sensitivity
D. Increased maximal heart rate response to exercise
CORRECT ANSWER: C. Decreased baroreceptor sensitivity
Rationale: Aging is associated with decreased baroreceptor sensitivity, leading to
impaired reflex tachycardia in response to hypotension. Left ventricular wall thickness
increases (not decreases), arterial compliance decreases (stiffens), and maximal heart
rate declines with age.
Question 5: A 56-year-old man with a history of smoking and hyperlipidemia
presents with unstable angina. Cardiac catheterization reveals a 90% stenosis
in the left anterior descending artery. A drug-eluting stent is placed. Which of
the following dual antiplatelet therapy regimens is most appropriate for the
first 12 months post-procedure?
A. Aspirin and clopidogrel
B. Aspirin and ticagrelor
C. Aspirin and warfarin
D. Clopidogrel and ticagrelor
CORRECT ANSWER: B. Aspirin and ticagrelor
Rationale: Current guidelines recommend aspirin plus a P2Y12 inhibitor (ticagrelor or
prasugrel) for patients with acute coronary syndrome undergoing PCI, with ticagrelor
preferred due to faster onset and greater efficacy. Warfarin is not part of standard dual
antiplatelet therapy.
Question 6: A 34-year-old woman presents with palpitations, sweating, and
weight loss despite increased appetite. She has a fine tremor and lid lag.
Thyroid function tests show undetectable TSH and elevated free T4. Which of
the following is the most likely underlying diagnosis?
A. Graves' disease
B. Toxic multinodular goiter
,C. Subacute thyroiditis
D. Pituitary TSH-secreting adenoma
CORRECT ANSWER: A. Graves' disease
Rationale: The classic presentation of hyperthyroidism with diffuse goiter,
ophthalmopathy (lid lag), and autoimmune features in a young woman is most consistent
with Graves' disease. Toxic multinodular goiter is more common in older adults, and
subacute thyroiditis typically presents with a painful thyroid.
Question 7: A 28-year-old male with a known history of Marfan syndrome
presents with sudden-onset severe tearing chest pain radiating to the back.
Blood pressure is 160/90 mmHg in the right arm and 110/70 mmHg in the left.
Which of the following imaging studies is most appropriate for immediate
diagnosis?
A. Chest X-ray
B. Transesophageal echocardiography
C. CT angiography of the chest
D. Magnetic resonance angiography
CORRECT ANSWER: C. CT angiography of the chest
Rationale: CT angiography is rapid, widely available, and highly sensitive for diagnosing
aortic dissection. Transesophageal echocardiography is useful but operator-dependent
and may delay diagnosis in unstable patients. MRI is not preferred in acute settings due
to longer acquisition time.
Question 8: A 65-year-old woman with osteoporosis is started on alendronate.
She is counseled to remain upright for at least 30 minutes after taking the
medication. Which of the following adverse effects is this precaution intended
to prevent?
A. Esophageal ulceration
B. Hypocalcemia
C. Osteonecrosis of the jaw
D. Atrial fibrillation
CORRECT ANSWER: A. Esophageal ulceration
Rationale: Oral bisphosphonates like alendronate can cause severe esophageal irritation
and ulceration if not taken with a full glass of water and if the patient does not remain
upright to ensure rapid passage to the stomach.
Question 9: A 52-year-old patient with long-standing type 2 diabetes and
hypertension is found to have a urine albumin-to-creatinine ratio of 300 mg/g.
His eGFR is 55 mL/min/1.73m². Which of the following is the most
appropriate medication to slow progression of his kidney disease?
, A. Hydrochlorothiazide
B. Amlodipine
C. Lisinopril
D. Metformin
CORRECT ANSWER: C. Lisinopril
Rationale: ACE inhibitors (e.g., lisinopril) are the preferred agents in diabetic kidney
disease due to their renoprotective effects independent of blood pressure lowering,
especially in patients with microalbuminuria and reduced eGFR.
Question 10: A 22-year-old woman with no significant medical history presents
with acute onset of shortness of breath and pleuritic chest pain. She is taking
oral contraceptives. Her oxygen saturation is 88% on room air. A D-dimer is
elevated, and CT pulmonary angiography reveals a central pulmonary
embolism. Which of the following is the most appropriate immediate
management?
A. Unfractionated heparin bolus and infusion
B. Low-molecular-weight heparin subcutaneous
C. Alteplase thrombolysis
D. Warfarin loading dose
CORRECT ANSWER: C. Alteplase thrombolysis
Rationale: This patient has a massive pulmonary embolism (central location,
hemodynamic instability indicated by hypoxia) and should receive thrombolytic therapy
(alteplase) to reduce mortality. Heparin alone is insufficient for massive PE.
Question 11: A 70-year-old patient with heart failure with reduced ejection
fraction (HFrEF) is on maximal medical therapy including beta-blocker, ACE
inhibitor, and spironolactone. He remains in NYHA class III. His QRS duration
is 150 ms with a left bundle branch block morphology. Which of the following
treatments is most likely to improve his survival?
A. Cardiac resynchronization therapy (CRT)
B. Implantable cardioverter-defibrillator (ICD) alone
C. Digoxin
D. Hydralazine and isosorbide dinitrate
CORRECT ANSWER: A. Cardiac resynchronization therapy (CRT)
Rationale: CRT is indicated for patients with HFrEF, NYHA class II-IV symptoms, and
wide QRS (>130-150 ms) with LBBB to improve survival and symptoms. ICD alone
addresses arrhythmic death but not dyssynchrony.
Question 12: A 48-year-old man with a history of alcohol use disorder presents
with confusion, ataxia, and ophthalmoplegia. Which of the following vitamin
deficiencies is most likely responsible for this classic triad?
