, Question 1
A patient with chronic heart failure has an echocardiogram showing a
restrictive filling pattern, elevated left atrial pressure, and preserved left
ventricular ejection fraction. Which pathophysiologic mechanism best explains
these findings?
A. Impaired myocardial relaxation and increased ventricular stiffness
B. Reduced myocardial contractility with eccentric hypertrophy
C. Increased afterload due to systemic vasoconstriction
D. Pericardial constriction limiting diastolic filling
Correct Answer: A - Impaired myocardial relaxation and
increased ventricular stiffness
RATIONALE
A restrictive filling pattern with preserved ejection fraction and
elevated left atrial pressure indicates diastolic dysfunction, primarily
due to impaired relaxation and increased ventricular stiffness
(HFpEF). Reduced contractility (B) would decrease ejection fraction;
increased afterload (C) is a contributor but not the primary
mechanism; pericardial constriction (D) would show different
hemodynamic features (e.g., ventricular interdependence).
Question 2
In a patient with suspected disseminated intravascular coagulation (DIC),
which laboratory pattern is most characteristic?
A. Prolonged PT and aPTT, elevated D-dimer, low platelet count
B. Shortened PT and aPTT, elevated fibrinogen, normal platelet count
C. Prolonged bleeding time, normal PT/aPTT, increased factor VIII
D. Isolated prolonged aPTT, normal PT, decreased von Willebrand factor
Correct Answer: A - Prolonged PT and aPTT, elevated D-dimer,
low platelet count
Page 2
, RATIONALE
DIC involves widespread activation of coagulation, leading to
consumption of clotting factors and platelets, resulting in prolonged
PT/aPTT, elevated D-dimer (from fibrinolysis), and
thrombocytopenia. Option B describes a hypercoagulable state; C is
more consistent with a platelet function defect; D suggests von
Willebrand disease or isolated intrinsic pathway defect.
Question 3
Which lymphatic structure primarily drains lymph from the lower extremities
and abdominopelvic cavity into the venous system?
A. Right lymphatic duct
B. Thoracic duct
C. Cisterna chyli
D. Subclavian vein directly
Correct Answer: B - Thoracic duct
RATIONALE
The thoracic duct drains lymph from the lower body, abdomen, and
left upper body into the left subclavian vein. The right lymphatic duct
(A) drains the right upper body; the cisterna chyli (C) is a sac that
receives lymph from the lower body but drains into the thoracic duct;
the subclavian vein (D) is the entry point, not the duct itself.
Question 4
A patient with a mechanical mitral valve has an INR of 4.5. Which
management decision is most appropriate according to current guidelines?
A. Continue current warfarin dose and recheck INR in 1 week
B. Hold warfarin and administer vitamin K 10 mg IV
C. Hold warfarin, monitor, and consider low-dose vitamin K if bleeding
D. Administer fresh frozen plasma immediately
Correct Answer: C - Hold warfarin, monitor, and consider
Page 3
, low-dose vitamin K if bleeding
RATIONALE
For an INR of 4.5 without bleeding, guidelines recommend holding
warfarin and monitoring, with low-dose oral vitamin K considered if
there is a high risk of bleeding. Option A ignores the elevated INR; B
uses excessive vitamin K that may cause warfarin resistance; D is
reserved for major bleeding or urgent surgery.
Question 5
Which compensatory mechanism initially maintains cardiac output in acute
heart failure but eventually contributes to worsening heart failure?
A. Increased parasympathetic tone
B. Activation of the renin-angiotensin-aldosterone system
C. Decreased antidiuretic hormone release
D. Peripheral vasodilation
Correct Answer: B - Activation of the
renin-angiotensin-aldosterone system
RATIONALE
RAAS activation increases preload and afterload to maintain cardiac
output acutely, but chronic activation leads to fluid retention,
vasoconstriction, and adverse remodeling. Increased parasympathetic
tone (A) would lower heart rate and is not a primary compensatory
mechanism; decreased ADH (C) would reduce fluid retention;
vasodilation (D) would decrease preload and afterload, not
compensate.
Question 6
A patient with a history of venous thromboembolism is found to have a factor
V Leiden mutation. Which statement best explains the pathophysiologic
consequence?
A. Enhanced fibrinolysis due to increased plasminogen activator
Page 4
A patient with chronic heart failure has an echocardiogram showing a
restrictive filling pattern, elevated left atrial pressure, and preserved left
ventricular ejection fraction. Which pathophysiologic mechanism best explains
these findings?
A. Impaired myocardial relaxation and increased ventricular stiffness
B. Reduced myocardial contractility with eccentric hypertrophy
C. Increased afterload due to systemic vasoconstriction
D. Pericardial constriction limiting diastolic filling
Correct Answer: A - Impaired myocardial relaxation and
increased ventricular stiffness
RATIONALE
A restrictive filling pattern with preserved ejection fraction and
elevated left atrial pressure indicates diastolic dysfunction, primarily
due to impaired relaxation and increased ventricular stiffness
(HFpEF). Reduced contractility (B) would decrease ejection fraction;
increased afterload (C) is a contributor but not the primary
mechanism; pericardial constriction (D) would show different
hemodynamic features (e.g., ventricular interdependence).
Question 2
In a patient with suspected disseminated intravascular coagulation (DIC),
which laboratory pattern is most characteristic?
A. Prolonged PT and aPTT, elevated D-dimer, low platelet count
B. Shortened PT and aPTT, elevated fibrinogen, normal platelet count
C. Prolonged bleeding time, normal PT/aPTT, increased factor VIII
D. Isolated prolonged aPTT, normal PT, decreased von Willebrand factor
Correct Answer: A - Prolonged PT and aPTT, elevated D-dimer,
low platelet count
Page 2
, RATIONALE
DIC involves widespread activation of coagulation, leading to
consumption of clotting factors and platelets, resulting in prolonged
PT/aPTT, elevated D-dimer (from fibrinolysis), and
thrombocytopenia. Option B describes a hypercoagulable state; C is
more consistent with a platelet function defect; D suggests von
Willebrand disease or isolated intrinsic pathway defect.
Question 3
Which lymphatic structure primarily drains lymph from the lower extremities
and abdominopelvic cavity into the venous system?
A. Right lymphatic duct
B. Thoracic duct
C. Cisterna chyli
D. Subclavian vein directly
Correct Answer: B - Thoracic duct
RATIONALE
The thoracic duct drains lymph from the lower body, abdomen, and
left upper body into the left subclavian vein. The right lymphatic duct
(A) drains the right upper body; the cisterna chyli (C) is a sac that
receives lymph from the lower body but drains into the thoracic duct;
the subclavian vein (D) is the entry point, not the duct itself.
Question 4
A patient with a mechanical mitral valve has an INR of 4.5. Which
management decision is most appropriate according to current guidelines?
A. Continue current warfarin dose and recheck INR in 1 week
B. Hold warfarin and administer vitamin K 10 mg IV
C. Hold warfarin, monitor, and consider low-dose vitamin K if bleeding
D. Administer fresh frozen plasma immediately
Correct Answer: C - Hold warfarin, monitor, and consider
Page 3
, low-dose vitamin K if bleeding
RATIONALE
For an INR of 4.5 without bleeding, guidelines recommend holding
warfarin and monitoring, with low-dose oral vitamin K considered if
there is a high risk of bleeding. Option A ignores the elevated INR; B
uses excessive vitamin K that may cause warfarin resistance; D is
reserved for major bleeding or urgent surgery.
Question 5
Which compensatory mechanism initially maintains cardiac output in acute
heart failure but eventually contributes to worsening heart failure?
A. Increased parasympathetic tone
B. Activation of the renin-angiotensin-aldosterone system
C. Decreased antidiuretic hormone release
D. Peripheral vasodilation
Correct Answer: B - Activation of the
renin-angiotensin-aldosterone system
RATIONALE
RAAS activation increases preload and afterload to maintain cardiac
output acutely, but chronic activation leads to fluid retention,
vasoconstriction, and adverse remodeling. Increased parasympathetic
tone (A) would lower heart rate and is not a primary compensatory
mechanism; decreased ADH (C) would reduce fluid retention;
vasodilation (D) would decrease preload and afterload, not
compensate.
Question 6
A patient with a history of venous thromboembolism is found to have a factor
V Leiden mutation. Which statement best explains the pathophysiologic
consequence?
A. Enhanced fibrinolysis due to increased plasminogen activator
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