Galen College of Nursing NSG 3850 / NSG3850 Pathophysiology II Exam 2 (V2) | Complete Questions & Answers | 100% Updated .

Galen College of Nursing NSG 3850 / NSG3850 Pathophysiology II Exam 2 (V2) | Complete Questions & Answers | 100% Updated . ### 1. A patient with end-stage Chronic Obstructive Pulmonary Disease (COPD) has an arterial blood gas (ABG) drawn showing pH 7.28 and PaCO₂ 54 mm Hg. Which acid-base imbalance does the nurse identify? A. Metabolic Alkalosis B. Respiratory Alkalosis C. Respiratory Acidosis D. Metabolic Acidosis ### 2. Which pathophysiological mechanism defines hypoventilation? A. Excessive clearance of alveolar carbon dioxide causing hypocapnia B. Delivery of air to alveoli is insufficient to provide O₂ and remove CO₂ C. Impaired systemic tissue utilization of oxygen despite normal arterial PaO₂ D. Primary loss of alveolar elastic recoil leading to air trapping ### 3. A patient receiving IV morphine post-op exhibits a respiratory rate of 8 breaths/min. Which blood gas alteration is expected? A. Increased PaCO₂ (hypercapnia) and hypoxemia B. Decreased PaCO₂ (hypocapnia) and respiratory alkalosis C. Increased PaO₂ and decreased arterial bicarbonate D. Normal PaCO₂ with histotoxic cellular hypoxia ### 4. Hyperventilation leads to which specific arterial blood gas change? A. Hypercapnia (PaCO₂ 45 mm Hg) B. Hypocapnia (PaCO₂ 35 mm Hg) C. Increased serum lactic acid D. Decreased arterial pH with normal PaCO₂ ### 5. A patient presenting with rapid, deep respirations at 28 breaths/min following brainstem trauma is demonstrating central neurogenic hyperventilation. What etiology triggers this response? A. Activation of peripheral alveolar stretch receptors B. Direct injury to central respiratory control centers in the brainstem C. Severe elevation of oxygen-carrying hemoglobin capacity D. Inhibition of carbonic anhydrase in renal tubules ### 6. Which type of hypoxia is characterized by a decrease in arterial PaO₂ despite a normal oxygen-carrying capacity of the blood? A. Anemic hypoxia B. Circulatory hypoxia C. Hypoxic hypoxia D. Histotoxic hypoxia ### 7. A patient diagnosed with severe iron deficiency anemia displays pale mucosa and fatigue. Which type of hypoxia is present? A. Anemic hypoxia B. Histotoxic hypoxia C. Hypoxic hypoxia D. Circulatory hypoxia ### 8. A patient in cardiogenic shock has a severely decreased cardiac output. Normal hemoglobin levels are noted, but peripheral tissue perfusion is poor. Which form of hypoxia does this represent? A. Histotoxic hypoxia B. Anemic hypoxia C. Hypoxic hypoxia D. Circulatory hypoxia ### 9. Cyanide poisoning causes tissue hypoxia through which mechanism? A. Rupture of alveolar septa preventing diffusion B. Interference of a toxic substance preventing cellular utilization of available oxygen C. Severe destruction of hemoglobin molecules D. Massive pulmonary artery vasoconstriction ### 10. What is the hallmark diagnostic clinical manifestation of acute bronchitis? A. Inspiration friction rub B. Recent onset of cough C. Pertaining purulent sputum for 2 years D. Apical lung cavitation on radiograph ### 11. Which diagnostic test definitively distinguishes acute bronchitis from pneumonia? A. Sputum Gram stain B. Arterial blood gas C. Chest radiograph D. Pulmonary function test ### 12. Which criteria formally establish a clinical diagnosis of Chronic Bronchitis (Type B COPD)? A. Exertional dyspnea accompanied by bullae on CT scan B. Chronic or recurrent productive cough for 3 months per year for ≥ 2 consecutive years C. FEV1 improvement of 20% following bronchodilator administration D. Non-productive morning cough with bilateral hilar adenopathy ### 13. Why do patients with chronic bronchitis develop secondary polycythemia? A. Direct stimulation of bone marrow by excessive sputum ingestion B. Compensatory erythropoiesis triggered by persistent chronic hypoxemia C. Loss of plasma volume secondary to excessive fluid restrictions D. Inactivation of alpha-1 antitrypsin by hepatic macrophages ### 14. In advanced chronic bronchitis, pulmonary arterial hypertension develops primarily due to which factor? A. Loss of bronchial smooth muscle tone B. Alveolar hyperinflation compressing pulmonary veins C. Chronic pulmonary arterial vasoconstriction induced by persistent alveolar hypoxia D. Left ventricular failure causing systemic fluid backing ### 15. Which clinical presentation is typical of a patient with Emphysema (Type A COPD / “Pink Puffer”)? A. Obese appearance, severe peripheral edema, profuse purulent sputum B. Thin/underweight appearance, barrel chest, pursed-lip breathing, hunched posture C. Normal body mass index, acute inspiratory stridor, high fever D. Marked hemoptysis, night sweats, erythema nodosum ### 16. What is the primary pathophysiological mechanism underlying alveolar destruction in emphysema? A. Formation of immune-complex epithelioid granulomas B. Release of proteolytic enzymes (elastase) from neutrophils/macrophages damaging alveolar walls C. Bacterial infiltration leading to dense parenchymal consolidation D. Autoimmune destruction of von Willebrand factor in capillaries ### 17. Why is pursed-lip breathing beneficial for patients with emphysema? A. Increases respiratory rate to clear carbon dioxide rapidly B. Maintains positive airway pressure during exhalation, preventing premature small airway collapse C. Decreases diaphragmatic excursion and residual volume D. Suppresses cough reflex by humidifying room air ### 18. When managing oxygen therapy for a severe COPD patient whose baseline SpO₂ is 89%, what is the key safety guideline? A. Maintain oxygen flow at high rates to achieve SpO₂ 98% B. Avoid excessive O₂ administration because high PaO₂ can suppress their hypoxic respiratory drive C. Administer 100% O₂ via non-rebreather mask immediately D. Withhold all supplemental oxygen regardless of cyanosis ### 19. Which immunological cell type is characteristically prominent in sarcoidosis granulomas? A. CD8+ Cytotoxic T cells B. CD4+ T helper cells C. IgE-sensitized mast cells D. Neutrophils with Auer rods ### 20. Which histological finding from a transbronchial lung biopsy provides a definitive diagnosis of Sarcoidosis? A. Caseating necrosis with acid-fast bacilli B. Noncaseating epithelioid granulomas C. Diffuse hyaline membrane formation D. Alveolar purulent exudative consolidation ### 21. Which ocular manifestation affects approximately 65% of patients diagnosed with sarcoidosis? A. Cataracts B. Uveitis C. Glaucoma D. Retinal detachment ### 22. What is the primary medical treatment for symptomatic pulmonary sarcoidosis? A. Broad-spectrum oral cephalosporins B. Oral corticosteroids (Prednisone) tapered over 12 months C. Inhaled short-acting beta-2 agonists only D. High-dose IV loop diuretics ### 23. Which patient population accounts for 80% to 95% of cases of Hypersensitivity Pneumonitis (Extrinsic Allergic Alveolitis)? A. Active cigarette smokers B. Nonsmokers C. Patients with prior TB infections D. Elderly nursing home residents ### 24. What pathognomonic structural change occurs in chronic Hypersensitivity Pneumonitis? A. Bullous panacinar emphysema B. Diffuse pulmonary fibrosis in the upper lobes C. Subpleural apical bleb formation D. Bronchial smooth muscle hypertrophy ### 25. Spontaneous Primary Pneumothorax occurs most frequently in which demographic group? A. Elderly women with osteoporosis B. Tall, thin men aged 20 to 40 years C. Overweight men over 60 years D. Young children under 10 years ### 26. A patient with a penetrating chest injury develops severe dyspnea, hypotension, tachycardia, jugular vein distention, and tracheal deviation to the left. Which life-threatening condition is present? A. Left-sided primary spontaneous pneumothorax B. Right-sided tension pneumothorax C. Bilateral pleural effusion D. Acute pulmonary embolism ### 27. Which physical examination finding is associated with subcutaneous emphysema following a tension pneumothorax? A. Dullness on chest percussion B. Crackling “rice krispies” sensation upon palpation of skin C. Increased tactile fremitus over chest wall D. Systolic murmur heard at apex ### 28. During physical examination of a patient with a large pleural effusion, which percussion and fremitus findings are expected over the affected lung region? A. Hyperresonance to percussion and increased tactile fremitus B. Dullness to percussion and decreased tactile fremitus C. Tympanitic percussion and normal tactile fremitus D. Resonant percussion and absent vocal resonance ### 29. Which etiology is characteristically associated with transudative pleural effusion? A. Severe congestive heart failure or cirrhosis B. Bacterial empyema infection C. Bronchogenic carcinoma D. Pulmonary tuberculosis infection ### 30. Why is early screening for kyphoscoliosis conducted in school-aged children? A. Prevent early onset of coronary artery disease B. Identify and correct spinal deformity before severe chest wall compression and restrictive pulmonary impairment occur C. Prevent hypercalcemia and uveitis D. Reduce risk of developing spontaneous apices blebs ### 31. Ninety percent (90%) of patients diagnosed with Ankylosing Spondylitis test positive for which genetic marker? A. BRCA1 gene B. HLA-B27 antigen C. Alpha-1 antitrypsin allele D. Factor V Leiden mutation ### 32. What is a characteristic clinical feature of back pain in Ankylosing Spondylitis? A. Pain is worst during physical exercise and relieved by bed rest B. Pain and stiffness worsen with rest/immobility and improve with exercise C. Pain is strictly localized to the cervical spine D. Pain radiates along the sciatic nerve down to the toes ### 33. Obesity Hypoventilation Syndrome (Pickwickian Syndrome) is characterized by which cluster of manifestations? A. BMI 30, daytime somnolence, severe hypoxemia, hypercapnia, and secondary polycythemia B. BMI 18.5, morning purulent cough, hyperresonance, and leukopenia C. Severe alkalosis, hypercalcemia, and acute hemoptysis D. Loss of elastic recoil, barrel chest, and normal PaCO₂ ### 34. How is Legionnaires' disease (Legionella pneumonia) typically transmitted? A. Direct person-to-person respiratory droplet contact B. Inhalation of mist from contaminated potable water systems, air conditioning cooling towers, or condensers C. Inhalation of fungal spores from old building demolition D. Aspiration of gastric juices during anesthesia ### 35. Which diagnostic test provides the definitive confirmation of active Pulmonary Tuberculosis? A. Mantoux PPD skin test B. Acid-fast bacilli (AFB) sputum culture (3 consecutive morning specimens) C. Chest radiograph showing hilar adenopathy D. Elevated white blood cell count ### 36. A patient complains of cramping pain in the right calf that occurs during walking and is relieved within minutes of sitting down. What clinical sign does the nurse document? A. Homan sign B. Reactive hyperemia C. Intermittent claudication D. Trousseau sign ### 37. A thromboembolism originating from a deep vein in the lower extremity travels through the venous system and lodges in which vascular bed? A. Middle cerebral artery causing ischemic stroke B. Pulmonary arterial circulation causing Pulmonary Embolism (PE) C. Renal artery causing acute kidney injury D. Coronary artery causing acute myocardial infarction ### 38. A thromboembolism dislodging from the left ventricle exits the aorta and most commonly lodges in which artery? A. Pulmonary artery B. Cerebral artery causing a stroke C. Hepatic portal vein D. Great saphenous vein ### 39. How does cigarette smoking directly predispose patients to arterial thrombus formation? A. Destroys bone marrow megakaryocytes B. Nicotine causes vasoconstriction, endothelial lining damage, and elevates cholesterol/triglycerides C. Inhibits liver synthesis of Factor VIII and IX D. Causes direct fluid volume overload in systemic veins ### 40. A patient with a peripheral IV site has a reddened, warm, tender streak along the vein path. Which condition is present? A. Arteriovenous fistula B. Phlebitis C. Raynaud's syndrome D. Lymphedema ### 41. Which pathogenetic feature distinguishes Atherosclerosis from general Arteriosclerosis? A. Arteriosclerosis affects veins, whereas atherosclerosis affects lymphatics B. Atherosclerosis involves plaque accumulation (fatty substances, cholesterol, calcium, cellular waste, fibrin) inside medium and large arteries C. Arteriosclerosis is caused solely by viral streptococcal infections D. Atherosclerosis involves acute loss of venous valve competence ### 42. Which lipid profile result represents a major risk factor for coronary heart disease and atherosclerosis? A. HDL cholesterol 40 mg/dL B. Total cholesterol 150 mg/dL C. LDL cholesterol 100 mg/dL D. Triglycerides 100 mg/dL ### 43. An Ankle-Brachial Index (ABI) value of less than 1.0 ( 1.0) indicates which underlying problem? A. Venous valve incompetence B. Peripheral arterial occlusive disease / arterial narrowing C. Lymphatic fluid obstruction D. Normal resting peripheral blood flow ### 44. What is the most common underlying cause of abdominal aortic aneurysms (AAA)? A. Deep vein thrombosis B. Atherosclerosis and chronic hypertension C. Acute viral phlebitis D. Group A streptococcal endocarditis ### 45. What is the most dangerous potential complication of a cerebral Arteriovenous Malformation (AVM)? A. Venous stasis ulceration B. Intracranial hemorrhage / rupture C. Pulmonary empyema D. Hemosiderin skin staining ### 46. Which criteria differentiate a Hypertensive Emergency from Hypertensive Urgency? A. Emergency occurs only in pregnant patients B. Emergency features severe BP elevation (DBP 120 / SBP 180) WITH evidence of acute end-organ damage C. Urgency requires immediate ICU admission and continuous IV Nitroprusside D. Urgency has DBP 90 mm Hg ### 47. Orthostatic Hypotension is clinically defined by which BP drop within 3 minutes of standing? A. Drop in systolic BP 20 mm Hg or diastolic BP 10 mm Hg B. Drop in systolic BP 5 mm Hg and HR drop 30 bpm C. Increase in diastolic BP 15 mm Hg D. Drop in mean arterial pressure of exactly 5 mm Hg ### 48. Which sequence correctly describes the triphasic color changes in Raynaud's syndrome attacks? A. Red to Blue to White B. White (vasoconstriction) to Blue (cyanosis/desaturation) to Red (reactive hyperemia) C. Blue to Red to Yellow D. White to Red to Brown ### 49. Which class of medications is prescribed to manage vasospasms in Raynaud's syndrome by promoting arterial vasodilation? A. Non-selective Beta Blockers B. Calcium Channel Blockers C. Loop Diuretics D. Alpha-1 Agonists ### 50. Buerger's Disease (Thromboangiitis Obliterans) is strongly associated with which essential etiology? A. Heavy cigarette smoking B. High dietary calcium intake C. Chronic alcohol abuse D. Prior streptococcal pharyngitis ### 51. A patient with Acute Peripheral Arterial Occlusion presents with cold, pale, pulseless right leg and severe pain. How should the nurse position the affected extremity? A. Elevated 15–20 degrees above heart level B. Dependent (lowered below heart level) C. Wrapped tightly in ice packs D. Rigidly immobilized in a knee splint ### 52. Once therapeutic anticoagulation is initiated for a patient with Deep Vein Thrombosis (DVT), what activity modification is educated? A. Strict bed rest without moving for 14 days B. Walk every 1 to 2 hours for 10 minutes C. Vigorous leg massages twice daily D. Apply sequential compression devices (SCDs) directly over the affected leg clot ### 53. Which lab test is monitored during continuous IV Heparin therapy, and what is its specific reversal antidote? A. INR; Antidote: Vitamin K B. aPTT; Antidote: Protamine Sulfate C. Platelet count; Antidote: Desmopressin D. Bleeding time; Antidote: Aminocaproic acid ### 54. What is the therapeutic INR target range for a patient on Warfarin (Coumadin), and what is the reversal antidote? A. INR 2.0 to 3.0; Antidote: Vitamin K B. INR 4.5 to 6.0; Antidote: Protamine Sulfate C. INR 0.5 to 1.0; Antidote: Factor VIII D. INR 1.2 to 1.5; Antidote: Deferoxamine ### 55. A patient with Chronic Venous Insufficiency displays dark brown skin discoloration around the lower medial malleolus. What causes this characteristic hemosiderin staining? A. Arterial plaque embolization to dermal capillaries B. Breakdown of RBCs leaking into subcutaneous tissues due to chronic high venous pressure C. Deposition of noncaseating epithelioid granulomas D. Deficiency of circulating plasma fibronectin ### 56. How does leg elevation affect lower extremity pain in Chronic Venous Insufficiency (CVI)? A. Significantly worsens pain B. Decreases pain and relieves aching/heaviness C. Causes immediate numbness and cyanosis D. Triggers vasospasms in fingers and toes ### 57. Spontaneous, unprovoked bleeding (epistaxis, GI bleeding, CNS hemorrhages) becomes a major clinical concern when the platelet count drops below which threshold? A. Below 150,000 / mcL B. Below 50,000 / mcL C. Below 300,000 / mcL D. Below 100,000 / mcL ### 58. Which pathogenetic mechanism drives Autoimmune Immune Thrombocytopenic Purpura (ITP)? A. Inherited deficiency of clotting Factor IX B. Production of antiplatelet autoantibodies that cause premature destruction of platelets C. Excessive megakaryocyte hyperplasia in bone marrow D. Inability of vascular endothelial cells to synthesize prostacyclin ### 59. Which nursing interventions are strictly contraindicated for a patient with severe Immune Thrombocytopenic Purpura (ITP)? A. Use of electric razors and soft-bristled toothbrushes B. Rectal temperature measurements, IM injections, and NSAID administration C. Oral fluid hydration and daily weights D. Fall precautions and gentle ambulation ### 60. Hemophilia A and Hemophilia B share which genetic inheritance pattern? A. Autosomal dominant disorder affecting males and females equally B. X-linked recessive disorder transmitted from carrier mothers to sons C. Autosomal recessive trait limited to elderly adults D. Mitochondrial gene mutation inherited strictly from fathers ### 61. Which lab test profile is characteristic of Hemophilia? A. Prolonged aPTT with a normal platelet count B. Severely reduced platelet count ( 20,000) with normal aPTT C. Shortened PT/INR with elevated fibrinogen D. Normal aPTT with prolonged bleeding time ### 62. Seventy-five percent (75%) of spontaneous bleeding episodes in hemophilia occur in which body anatomical location? A. Pleural space B. Joint cavities (hemarthrosis) C. Subcutaneous forearm tissue D. Sublingual oral mucosa ### 63. Von Willebrand Disease interferes with normal blood clotting through which dual mechanism? A. Reduces bone marrow megakaryocytes and causes aplastic anemia B. Deficiency of von Willebrand factor inhibits platelet adhesion to injured tissue and causes Factor VIII dysfunction C. Causes massive systemic destruction of erythrocyte membranes D. Accelerates conversion of prothrombin to thrombin ### 64. Which medication is administered to patients with mild Von Willebrand Disease prior to minor procedures to boost endogenous Factor VIII and vWF levels? A. Protamine Sulfate B. Desmopressin (DDAVP) C. Warfarin D. Heparin ### 65. Secondary Lymphedema in a upper extremity most commonly develops following which medical etiology? A. Viral phlebitis of the cephalic vein B. Removal of or damage to axillary lymph nodes during breast cancer surgery C. High dietary salt ingestion D. Congenital absence of the thoracic duct ### 66. Which classic cluster of symptoms alerts the nurse to an acute Pulmonary Embolism (PE)? A. Sudden onset of dyspnea, tachypnea, chest pain, and anxiety B. Gradual weight gain, severe ascites, and dark brown leg staining C. Slow bounding pulse, hypocalcemia, and painless petechiae D. Productive morning cough with rust-colored sputum for 3 years ### 67. Secondary Varicose Veins develop frequently in individuals in occupations characterized by which physical stressor? A. Repetitive upper extremity lifting B. Prolonged periods of standing (e.g., nurses, teachers, hair dressers) C. Frequent deep sea scuba diving D. Strict prolonged bed rest ### 68. What is the key pathophysiological driver of intermittent claudication in peripheral artery disease? A. Excessive accumulation of lymphatic fluid in interstitial spaces B. Inadequate arterial blood supply to meet metabolic demands of active exercising muscle tissue C. Autoimmune immune-complex deposition in peripheral venules D. Sudden reduction in venous valve hydrostatic pressure ### 69. How is the Homan sign assessed during physical examination of the lower extremities? A. Palpating the popliteal artery while the leg is elevated B. Dorsiflexing the foot upward toward the shin while observing for calf pain C. Compressing the calf muscle laterally to check for pitting edema D. Measuring thigh circumference before and after exercise ### 70. Which essential self-care instruction is reinforced for a patient placed on bleeding precautions? A. Use a soft-bristled toothbrush and an electric razor B. Floss vigorously twice daily with waxed dental string C. Take over-the-counter aspirin for mild headaches D. Engage in contact sports to maintain muscle mass ### 71. On an EKG tracing, which wave represents ventricular depolarization? A. P wave B. QRS complex C. T wave D. U wave ### 72. Which clinical feature distinguishes Stable Angina Pectoris from Unstable Angina? A. Pain occurs unpredictably at rest and lasts 30 minutes B. Anginal pain onset is predictable with exertion and is RELIEVED BY REST AND NITROGLYCERIN C. Causes permanent focal transmural myocardial necrosis D. Responds exclusively to high-dose IV loop diuretics ### 73. Prinzmetal or Variant Angina is characterized by which underlying pathophysiological mechanism? A. Fixed 99% calcified stenosis of the left anterior descending artery B. Unpredictable attacks of anginal pain caused by coronary artery vasospasm at rest C. Inflammatory vegetation formation on aortic cusps D. Rupture of chordae tendineae during exercise ### 74. Which drug class is particularly effective in preventing and treating coronary vasospasms in Prinzmetal (variant) angina? A. Calcium Channel Blockers B. Loop Diuretics C. Cardiac Glycosides (Digoxin) D. Beta-2 Agonists ### 75. What medical management protocol is represented by the acronym MONA for emergency Acute Coronary Syndrome (ACS)? A. Metoprolol, Oxygen, Nifedipine, Aspirin B. Morphine, Oxygen, Nitroglycerin, Aspirin C. Milrinone, Overload, Nitroprusside, Acetaminophen D. Morphine, Omeprazole, Nitrates, Anticoagulants ### 76. A patient experiencing acute chest pain is instructed to take sublingual Nitroglycerin. What instructions are taught regarding dosage and calling EMS? A. Swallow 1 tablet every 15 minutes up to 5 doses while walking B. Take 1 tablet sublingually sitting down every 5 minutes up to 3 doses; if pain is not relieved after 1 dose (or 3 doses), call EMS immediately C. Chew 3 tablets simultaneously at the onset of pain D. Dissolve 1 tablet under tongue only after drinking 500 mL of water ### 77. Mitral Valve Stenosis impairs blood flow between which two heart chambers? A. Right Atrium and Right Ventricle B. Left Atrium and Left Ventricle C. Left Ventricle and Aorta D. Right Ventricle and Pulmonary Artery ### 78. Which characteristic murmur is auscultated in Mitral Valve Stenosis? A. Harsh crescendo-decrescendo systolic murmur at 2nd right intercostal space B. Low-pitched rumbling diastolic murmur heard best at the cardiac apex C. High-pitched blowing diastolic murmur at left sternal border D. Pansystolic blowing murmur radiating to left axilla ### 79. What auscultatory sound is pathognomonic for Mitral Valve Prolapse (MVP)? A. Prominent S4 Tennessee gallop B. Midsystolic click C. Pericardial friction rub D. Continuous machinery murmur ### 80. Mitral Valve Regurgitation produces which distinct murmur upon cardiac auscultation? A. Low-pitched diastolic rumble B. Loud, high-pitched pansystolic (holosystolic) blowing murmur heard at the apex radiating to the left axilla C. Soft diastolic blowing murmur radiating to carotids D. Inspiratory friction rub at 4th intercostal space ### 81. What is the primary etiology of Aortic Valve Stenosis in elderly patients aged 70 to 90 years? A. Autoimmune destruction of von Willebrand factor B. Age-related calcification and calcium accumulation on aortic valve cusps C. Congenital Marfan syndrome connective tissue laxity D. Group A streptococcal pharyngitis ### 82. Which clinical symptom triad is classic for advanced Aortic Valve Stenosis? A. JVD, Hepatomegaly, Ascites B. Syncope, Angina, Exertional Dyspnea (SAD) C. Fever, Night sweats, Hemoptysis D. Petechiae, Purpura, Ecchymosis ### 83. Aortic Valve Stenosis characteristically produces which type of cardiac murmur? A. Loud, harsh crescendo-decrescendo systolic murmur radiating to the neck/carotids with a prominent S4 B. Low-pitched diastolic rumble at apex C. High-pitched pansystolic blowing murmur at axilla D. Soft friction rub at sternal border ### 84. Which physical examination finding is associated with severe Aortic Valve Regurgitation? A. Narrow pulse pressure of 10 mm Hg B. Widened pulse pressure with bounding/throbbing pulses and head bobbing C. Marked cyanosis around lips and facial edema D. Absence of peripheral pulses in lower legs ### 85. Rheumatic Heart Disease develops secondary to an untreated pharyngeal infection caused by which microorganism? A. Staphylococcus aureus B. Group A beta-hemolytic Streptococcus C. Mycobacterium tuberculosis D. Legionella pneumophila ### 86. What pathogenetic mechanism damages heart valves in Rheumatic Endocarditis? A. Direct bacterial toxins digesting collagen B. Cross-reactive antibodies against streptococcal antigens attacking the host's own connective tissue in heart valves C. High lipid plaque rupture inside coronary arteries D. Excessive accumulation of pericardial transudate ### 87. Intravenous (IV) drug users are particularly susceptible to which life-threatening cardiac valvular infection? A. Rheumatic endocarditis B. Infective Endocarditis C. Prinzmetal vasospastic angina D. Constrictive pericarditis ### 88. What key chest pain positional characteristic helps distinguish Acute Pericarditis from myocardial infarction? A. Pain is relieved by physical exertion B. Sharp pleuritic pain worsens when lying flat and is relieved by sitting upright and leaning forward C. Pain radiates exclusively down both legs D. Pain is unaffected by body position changes or deep breathing ### 89. Which auscultatory finding is pathognomonic for Acute Pericarditis? A. Pericardial friction rub (scratchy/squeaky sandpaper sound) B. Loud S3 gallop at apex C. Midsystolic click D. Crescendo diastolic rumble ### 90. Beck's Triad for life-threatening Cardiac Tamponade consists of which three clinical signs (“3 Ds”)? A. Dyspnea, Diarrhea, Dysphagia B. Decreased BP (Hypotension), Distended neck veins (JVD), and Decreased/Muffled heart sounds C. Dizziness, Dry cough, Digital clubbing D. Dull percussion, Decreased fremitus, Deep vein swelling ### 91. What is the immediate emergency medical procedure required to treat Cardiac Tamponade? A. Thoracentesis B. Pericardiocentesis C. Chemical pleurodesis D. Hemodialysis ### 92. Left-Sided Heart Failure produces BACKWARD failure manifestations primarily in which organ system? A. Hepatic portal system B. Pulmonary circulation / Lungs C. Systemic peripheral veins D. Renal tubular system ### 93. Which symptom cluster represents BACKWARD failure symptoms of Left-Sided Heart Failure? A. JVD, peripheral edema, ascites, hepatomegaly B. Dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, basilar crackles, frothy pink-tinged sputum C. Daytime somnolence, enuresis, polycythemia D. Intermittent claudication, cyanotic cool toes, absent pulses ### 94. Which symptoms reflect FORWARD failure (decreased cardiac output) in Left-Sided Heart Failure? A. Fatigue, oliguria, faint pulses, confusion, restlessness, and increased heart rate B. Hepatomegaly, splenomegaly, and ascites C. Subcutaneous emphysema and hyperresonance D. Uveitis, hypercalcemia, and erythema nodosum ### 95. What is the number one (#1) primary cause of Right-Sided Heart Failure? A. Cyanide poisoning B. Left-Sided Heart Failure C. Primary spontaneous pneumothorax D. Ankylosing spondylitis ### 96. Right-Sided Heart Failure causes BACKWARD failure manifestations primarily in which areas of the body? A. Pulmonary alveoli causing basilar crackles B. Systemic venous circulation (JVD, peripheral pedal edema, hepatomegaly, splenomegaly, ascites) C. Cerebral arteries causing hemorrhagic stroke D. Upper lobe pulmonary parenchyma causing fibrosis ### 97. What is Cor Pulmonale? A. Left ventricular failure secondary to systemic arterial hypertension B. Right ventricular hypertrophy and dilation resulting from high pulmonary vascular resistance caused by chronic lung disease C. Infection of the mitral valve leaflets by staphylococcus bacteria D. Congenital communication between the pulmonary artery and aorta ### 98. The acronym FACES is used to help patients recognize worsening symptoms of Heart Failure. What does FACES stand for? A. Fever, Anxiety, Cyanosis, Empyema, Stridor B. Fatigue, Activity limitation, Congestion, Edema, Shortness of breath C. Faint pulse, Anorexia, Confusion, Erythema, Syncope D. Friction rub, Angina, Claudication, Ecchymosis, Somnolence ### 99. Which laboratory blood test is elevated in heart failure due to increased ventricular wall stretch and pressure? A. Alpha-fetoprotein (AFP) B. B-type Natriuretic Peptide (BNP) C. Blood Urea Nitrogen (BUN) only D. Amylase ### 100. What does an S3 heart sound indicate when auscultated in an adult patient with dyspnea? A. Normal physiological variant in elderly adults B. High atrial pressure causing rapid early diastolic blood flow into a volume-overloaded, dilated ventricle (characteristic of CHF) C. Stiff non-compliant ventricle contracting during atrial systole D. Acute pericardial layer friction during systole