NP Cardiac Case Mastery Test Bank exam 150
Questions, answers and rationales
(2025/2026)
1. A 65-year-old male presents with exertional chest pain that
radiates to his left arm. His ECG shows ST-segment depression
during a stress test. What is the most likely diagnosis?
Stable angina
Rationale: Exertional chest pain with ST-segment depression
during stress testing is characteristic of stable angina, caused by
myocardial ischemia due to atherosclerotic coronary artery
disease.
2. A 72-year-old female with a history of hypertension presents with
sudden shortness of breath, orthopnea, and leg swelling. Physical
exam reveals an S3 heart sound. What is the most likely
diagnosis?
Heart failure with reduced ejection fraction (HFrEF)
Rationale: S3 heart sound, dyspnea, orthopnea, and peripheral
edema indicate volume overload associated with HFrEF,
commonly due to systolic dysfunction.
3. A 58-year-old male presents with palpitations and dizziness. ECG
shows irregularly irregular QRS complexes without P waves. What
is the best initial management?
Rate control with beta-blocker or calcium channel blocker
Rationale: Irregularly irregular rhythm without P waves is
indicative of atrial fibrillation. Initial management focuses on
, rate control and anticoagulation to prevent thromboembolic
events.
4. A 70-year-old female presents with crushing chest pain at rest,
nausea, and diaphoresis. ECG shows ST-segment elevation in
leads II, III, and aVF. Which coronary artery is most likely
involved?
Right coronary artery
Rationale: ST-segment elevation in II, III, and aVF indicates an
inferior myocardial infarction, typically due to occlusion of the
right coronary artery.
5. A 60-year-old male presents with sudden severe chest pain
radiating to the back. Blood pressure is 180/100 mmHg in the
right arm and 150/90 mmHg in the left arm. What is the most
likely diagnosis?
Aortic dissection
Rationale: Severe tearing chest pain with asymmetric blood
pressures suggests an aortic dissection, commonly involving the
ascending aorta.
6. A 55-year-old female presents with fatigue and palpitations. ECG
shows a prolonged QT interval. Which medication class should be
avoided?
Class III antiarrhythmics (e.g., sotalol, dofetilide)
Rationale: Prolonged QT increases the risk of torsades de
pointes; Class III antiarrhythmics further prolong the QT interval
and should be avoided.
7. A 68-year-old male with a history of MI presents with worsening
dyspnea. Echocardiogram shows ejection fraction of 30%. Which
medication has mortality benefit in this patient?
ACE inhibitor
, Rationale: ACE inhibitors reduce morbidity and mortality in
patients with HFrEF post-myocardial infarction by decreasing
afterload and preventing remodeling.
8. A 75-year-old female presents with syncope. ECG shows a
prolonged PR interval and dropped QRS complexes intermittently.
What type of heart block is this?
Second-degree AV block, Mobitz type II
Rationale: Mobitz type II is characterized by sudden dropped
QRS complexes without prior PR interval prolongation and can
progress to complete heart block, requiring pacemaker
placement.
9. A 62-year-old male presents with leg pain while walking that
resolves with rest. Ankle-brachial index is 0.6. What is the most
likely diagnosis?
Peripheral artery disease (PAD)
Rationale: Intermittent claudication and ABI <0.9 indicate PAD,
usually due to atherosclerosis affecting the lower extremities.
10. A 70-year-old female presents with exertional dyspnea.
Echocardiogram reveals thickened ventricular walls with normal
ejection fraction. Which condition is most consistent?
Heart failure with preserved ejection fraction (HFpEF)
Rationale: Thickened ventricular walls with preserved EF indicate
diastolic dysfunction, characteristic of HFpEF, often associated
with hypertension or aging.
11. A 59-year-old male presents with chest pain and elevated
troponin levels. ECG shows ST depression in V2-V4. Which type of
myocardial infarction is this?
NSTEMI (Non-ST Elevation Myocardial Infarction)
Rationale: ST-segment depression with elevated cardiac
, biomarkers indicates NSTEMI, requiring medical management
and possible PCI depending on risk stratification.
12. A 65-year-old female presents with new-onset dyspnea and
a mid-systolic click on auscultation. What is the most likely
diagnosis?
Mitral valve prolapse
Rationale: A mid-systolic click, often followed by a late systolic
murmur, is classic for mitral valve prolapse, which may cause
mitral regurgitation in severe cases.
13. A 72-year-old male with hypertension presents with sudden
shortness of breath. Chest X-ray shows pulmonary edema. Which
drug class is first-line for acute decompensated heart failure?
Loop diuretics (e.g., furosemide)
Rationale: Loop diuretics rapidly reduce pulmonary congestion
and edema in acute decompensated heart failure.
14. A 60-year-old female presents with sudden chest pain,
hypotension, and distended neck veins. ECG shows ST elevation in
V1-V4. What is the most likely complication?
Right ventricular infarction
Rationale: Inferior MI with hypotension, JVD, and clear lungs
suggests right ventricular infarction, which requires careful fluid
management rather than nitrates.
15. A 67-year-old male presents with chest discomfort and
dyspnea. Coronary angiography shows >70% stenosis of the left
anterior descending artery. Which intervention is indicated?
Percutaneous coronary intervention (PCI) with stent placement
Rationale: Significant stenosis of a major coronary artery in a
symptomatic patient is an indication for PCI to restore perfusion
and relieve ischemia.
Questions, answers and rationales
(2025/2026)
1. A 65-year-old male presents with exertional chest pain that
radiates to his left arm. His ECG shows ST-segment depression
during a stress test. What is the most likely diagnosis?
Stable angina
Rationale: Exertional chest pain with ST-segment depression
during stress testing is characteristic of stable angina, caused by
myocardial ischemia due to atherosclerotic coronary artery
disease.
2. A 72-year-old female with a history of hypertension presents with
sudden shortness of breath, orthopnea, and leg swelling. Physical
exam reveals an S3 heart sound. What is the most likely
diagnosis?
Heart failure with reduced ejection fraction (HFrEF)
Rationale: S3 heart sound, dyspnea, orthopnea, and peripheral
edema indicate volume overload associated with HFrEF,
commonly due to systolic dysfunction.
3. A 58-year-old male presents with palpitations and dizziness. ECG
shows irregularly irregular QRS complexes without P waves. What
is the best initial management?
Rate control with beta-blocker or calcium channel blocker
Rationale: Irregularly irregular rhythm without P waves is
indicative of atrial fibrillation. Initial management focuses on
, rate control and anticoagulation to prevent thromboembolic
events.
4. A 70-year-old female presents with crushing chest pain at rest,
nausea, and diaphoresis. ECG shows ST-segment elevation in
leads II, III, and aVF. Which coronary artery is most likely
involved?
Right coronary artery
Rationale: ST-segment elevation in II, III, and aVF indicates an
inferior myocardial infarction, typically due to occlusion of the
right coronary artery.
5. A 60-year-old male presents with sudden severe chest pain
radiating to the back. Blood pressure is 180/100 mmHg in the
right arm and 150/90 mmHg in the left arm. What is the most
likely diagnosis?
Aortic dissection
Rationale: Severe tearing chest pain with asymmetric blood
pressures suggests an aortic dissection, commonly involving the
ascending aorta.
6. A 55-year-old female presents with fatigue and palpitations. ECG
shows a prolonged QT interval. Which medication class should be
avoided?
Class III antiarrhythmics (e.g., sotalol, dofetilide)
Rationale: Prolonged QT increases the risk of torsades de
pointes; Class III antiarrhythmics further prolong the QT interval
and should be avoided.
7. A 68-year-old male with a history of MI presents with worsening
dyspnea. Echocardiogram shows ejection fraction of 30%. Which
medication has mortality benefit in this patient?
ACE inhibitor
, Rationale: ACE inhibitors reduce morbidity and mortality in
patients with HFrEF post-myocardial infarction by decreasing
afterload and preventing remodeling.
8. A 75-year-old female presents with syncope. ECG shows a
prolonged PR interval and dropped QRS complexes intermittently.
What type of heart block is this?
Second-degree AV block, Mobitz type II
Rationale: Mobitz type II is characterized by sudden dropped
QRS complexes without prior PR interval prolongation and can
progress to complete heart block, requiring pacemaker
placement.
9. A 62-year-old male presents with leg pain while walking that
resolves with rest. Ankle-brachial index is 0.6. What is the most
likely diagnosis?
Peripheral artery disease (PAD)
Rationale: Intermittent claudication and ABI <0.9 indicate PAD,
usually due to atherosclerosis affecting the lower extremities.
10. A 70-year-old female presents with exertional dyspnea.
Echocardiogram reveals thickened ventricular walls with normal
ejection fraction. Which condition is most consistent?
Heart failure with preserved ejection fraction (HFpEF)
Rationale: Thickened ventricular walls with preserved EF indicate
diastolic dysfunction, characteristic of HFpEF, often associated
with hypertension or aging.
11. A 59-year-old male presents with chest pain and elevated
troponin levels. ECG shows ST depression in V2-V4. Which type of
myocardial infarction is this?
NSTEMI (Non-ST Elevation Myocardial Infarction)
Rationale: ST-segment depression with elevated cardiac
, biomarkers indicates NSTEMI, requiring medical management
and possible PCI depending on risk stratification.
12. A 65-year-old female presents with new-onset dyspnea and
a mid-systolic click on auscultation. What is the most likely
diagnosis?
Mitral valve prolapse
Rationale: A mid-systolic click, often followed by a late systolic
murmur, is classic for mitral valve prolapse, which may cause
mitral regurgitation in severe cases.
13. A 72-year-old male with hypertension presents with sudden
shortness of breath. Chest X-ray shows pulmonary edema. Which
drug class is first-line for acute decompensated heart failure?
Loop diuretics (e.g., furosemide)
Rationale: Loop diuretics rapidly reduce pulmonary congestion
and edema in acute decompensated heart failure.
14. A 60-year-old female presents with sudden chest pain,
hypotension, and distended neck veins. ECG shows ST elevation in
V1-V4. What is the most likely complication?
Right ventricular infarction
Rationale: Inferior MI with hypotension, JVD, and clear lungs
suggests right ventricular infarction, which requires careful fluid
management rather than nitrates.
15. A 67-year-old male presents with chest discomfort and
dyspnea. Coronary angiography shows >70% stenosis of the left
anterior descending artery. Which intervention is indicated?
Percutaneous coronary intervention (PCI) with stent placement
Rationale: Significant stenosis of a major coronary artery in a
symptomatic patient is an indication for PCI to restore perfusion
and relieve ischemia.
