Exams, Answer Key, and Complete Study
Guide for Success
Q1: A 55-year-old male presents with substernal chest
pressure radiating to the left arm, precipitated by
exertion and relieved by rest. Which pathophysiologic
mechanism best explains his symptoms?
A. Fixed coronary artery obstruction with inadequate
blood flow during increased demand
B. Transient coronary artery vasospasm
C. Rupture of an atherosclerotic plaque with thrombus
formation
D. Microvascular dysfunction without epicardial
obstruction
Answer: A
Rationale: Stable angina is caused by fixed coronary
artery obstruction (atherosclerosis) that limits blood flow
during increased myocardial oxygen demand (exertion,
stress). The pain is relieved by rest when demand
decreases. Option B describes Prinzmetal/variant angina,
,C describes acute coronary syndrome/MI, and D describes
cardiac syndrome X .
Q2: A patient with heart failure has an ejection fraction
of 25%. Which medication class has been shown to
reduce mortality in this population?
A. Calcium channel blockers
B. Beta-blockers (carvedilol, metoprolol succinate,
bisoprolol)
C. Digoxin
D. Hydralazine monotherapy
Answer: B
Rationale: Beta-blockers (carvedilol, metoprolol
succinate, bisoprolol) have mortality benefit in HFrEF.
Calcium channel blockers do not have mortality benefit in
HFrEF. Digoxin improves symptoms but does not reduce
mortality. Hydralazine/nitrates reduce mortality in
African Americans but not as monotherapy .
, Q3: A patient presents with sudden onset of severe,
tearing chest pain radiating to the back. Blood pressure
is 180/100 mmHg. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Acute pericarditis
C. Aortic dissection
D. Pulmonary embolism
Answer: C
Rationale: Aortic dissection presents with sudden onset of
severe, tearing chest pain radiating to the back.
Hypertension is a major risk factor. Immediate CT
angiography is needed for diagnosis. MI pain is
substernal pressure, pericarditis is pleuritic and relieved
by sitting forward, and PE presents with dyspnea .
Q4: Where should the stethoscope be placed to
auscultate heart sounds arising from the aortic valve in
an adult patient?
A. Near the apex, 5th-6th intercostal space, mid-
clavicular line
B. Between the 2nd and 3rd intercostal spaces at the