front 1 levosimendan MOA? A. Inhibits Na/K ATPase | back 1 B. Increases Ca2+ sensitivity |
front 2 A ventricular myocyte is exposed to strong β-adrenergic stimulation with high cAMP and active protein kinase A. Which phospholamban-SERCA state is expected? A. Dephosphorylated; SERCA activated | back 2 D. Phosphorylated; SERCA activated PKA phosphorylates phospholamban, which activates SERCA. |
front 3 In a failing cardiomyocyte, phospholamban remains dephosphorylated. What is the most immediate consequence? A. Inhibited SERCA reuptake | back 3 A. Inhibited SERCA reuptake |
front 4 During diastole, the sodium-calcium exchanger helps extrude calcium from cardiac myocytes. What is its ion stoichiometry? A. 2 Na in, 1 Ca out | back 4 C. 3 Na in, 1 Ca out |
front 5 Digoxin MOA: A. Inhibits Na/K ATPase | back 5 A. Inhibits Na/K ATPase |
front 6 Which form of cardiac dysfunction responds most optimally to inotropic drugs? A. Constrictive pericarditis | back 6 D. Systolic heart failure Systolic failure responds best because the primary defect is inotropy. |
front 7 Which direct effect best describes digitalis on cardiac muscle? A. Negative inotropy | back 7 B. Positive inotropy |
front 8 Digoxin toxicity: A. Constipation, bloating, cramps | back 8 C. Vomiting, nausea, diarrhea |
front 9 A patient on digoxin is found to have elevated serum potassium. How does hyperkalemia affect digitalis-induced arrhythmia risk? A. Protective against arrhythmia | back 9 A. Protective against arrhythmia Hyperkalemia is protective against digitalis-induced arrhythmia. |
front 10 A digoxin-treated patient also has hypercalcemia. What effect does the calcium abnormality have? A. Stabilizes cardiac membranes | back 10 D. Conducive to arrhythmia Hypercalcemia is conducive to digitalis-induced arrhythmia. |
front 11 In the setting of digoxin use and hypercalcemia, increased magnesium would most likely: A. Raise intracellular sodium | back 11 B. Blunt calcium’s toxic effect |
front 12 A patient in acute systolic failure receives milrinone. What is its mechanism? A. PDE-3 inhibition | back 12 A. PDE-3 inhibition |
front 13 Milrinone belongs to which drug class? A. Cardiac glycoside | back 13 C. Bipyridine |
front 14 Besides improving inotropy, milrinone can reduce afterload through which additional action? A. α1-mediated vasoconstriction | back 14 D. Vasodilation via MLCK inhibition |
front 15 A patient with severe low-output heart failure is started on dobutamine. What is its primary mechanism? A. PDE-3 inhibition | back 15 C. β1 agonism |
front 16 A stable outpatient with chronic heart failure is discharged on guideline-type long-term therapy. Which class is explicitly listed as first-line in your material? A. Organic nitrates | back 16 B. ACE inhibitors |
front 17 A patient with chronic heart failure needs additional neurohormonal blockade. Which class is also listed as first-line? A. Direct renin inhibitors | back 17 D. Aldosterone antagonists |
front 18 A patient with chronic heart failure cannot tolerate one RAAS-blocking strategy and is switched to another listed first-line class. Which is it? A. Central α2 agonists | back 18 B. Angiotensin receptor antagonists |
front 19 A volume-overloaded patient with heart failure needs a preferred diuretic class for symptomatic control. Which is favored? A. Thiazides | back 19 C. Loop diuretics |
front 20 Which sympathetic-modulating class is listed among first-line chronic heart failure therapies? A. β-blockers | back 20 A. β-blockers |
front 21 A patient with chronic HFrEF is started on an aldosterone antagonist proven useful in heart failure. Which drug is indicated? A. Eplerenone | back 21 C. Spironolactone |
front 22 A patient with chronic systolic heart failure is started on enalapril. Which pathologic process does this therapy help reduce over time? A. Cardiac remodeling | back 22 A. Cardiac remodeling |
front 23 A patient with congestive heart failure is given enalapril. What is its hemodynamic effect on preload and afterload? A. ↑ preload, ↓ afterload | back 23 D. ↓ preload, ↓ afterload |
front 24 A patient with acute decompensated heart failure receives nesiritide. What is its mechanism of action? A. PDE-3 inhibitor | back 24 B. BNP analog |
front 25 A patient with acute heart failure is treated with a drug that mimics BNP but has limited overall benefit in practice. Which drug is this? A. Nesiritide | back 25 A. Nesiritide |
front 26 Nesiritide most common adverse effect? A. Hyperkalemia | back 26 C. Excessive hypotension |
front 27 A patient with heart failure is taking digoxin and a loop diuretic. Which complication is the greatest concern? A. Hypernatremic seizures | back 27 B. Hypokalemic arrhythmia |
front 28 Why does loop diuretic therapy increase arrhythmia risk in a patient taking digoxin? A. Raises digoxin metabolism | back 28 D. Low potassium enhances pump binding |
front 29 A patient with both HFrEF and atrial fibrillation needs a drug that can aid rate control while also supporting inotropy. Which drug fits? A. Digoxin | back 29 A. Digoxin |
front 30 In which setting is digoxin classically contraindicated because it may worsen conduction down an accessory pathway? A. Ebstein anomaly | back 30 C. Wolff-Parkinson-White syndrome |
front 31 Which β-blocker is noted here to be effective in both systolic and diastolic heart failure? A. Metoprolol | back 31 D. Nebivolol |
front 32 The additional vasodilatory property of nebivolol is primarily attributed to activity at which receptor? A. β1 receptor | back 32 B. β3 receptor |
front 33 A patient arrives with acute pulmonary edema from acute heart failure. Which diuretic is preferably given intravenously? A. Furosemide | back 33 A. Furosemide |
front 34 Which drug is first-line and indicated in both acute HFrEF and acute HFpEF for symptomatic volume overload? A. Digoxin | back 34 C. Furosemide |
front 35 In heart failure, preload is usually increased primarily because of: A. Increased blood volume and reduced venous tone | back 35 B. Increased blood volume and venous tone |
front 36 Increased preload in heart failure most directly increases myocardial oxygen demand by increasing: A. Fiber length at filling | back 36 A. Fiber length at filling |
front 37 Which electrolyte abnormality most facilitates the toxic actions of cardiac glycosides? A. Hypocalcemia | back 37 C. Increased calcium levels Cardiac glycosides (like digoxin) work by inhibiting the Na+/K+-ATPase pump, which leads to a secondary increase in intracellular calcium levels to enhance cardiac contractility. |
front 38 A 58-year-old man has long-standing hypertension and diabetes but no structural heart disease and no heart-failure symptoms. Which stage best fits? A. Stage C | back 38 B. Stage A |
front 39 An asymptomatic patient is found to have reduced ejection fraction after a prior silent myocardial infarction. Which heart-failure stage is this? A. Stage D | back 39 C. Stage B |
front 40 A patient has known dilated cardiomyopathy and dyspnea that improves with standard heart-failure therapy. Which stage applies? A. Stage C | back 40 A. Stage C |
front 41 A patient with end-stage heart failure remains symptomatic despite ordinary therapy and is being evaluated for transplant. Which stage is this? A. Stage A | back 41 D. Stage D |
front 42 A patient with heart failure also has atrial fibrillation with rapid ventricular response. Which drug from your material is specifically indicated in this setting? A. Digoxin | back 42 A. Digoxin |
front 43 In chronic heart failure, digoxin is usually added only after which therapies fail to adequately control symptoms? A. β-blockers and nitrates | back 43 B. Diuretics and ACE inhibitors |
front 44 A patient in cardiogenic shock has severe hypotension and needs a rapidly acting positive inotrope. Which pair is especially useful? A. Digoxin and nesiritide | back 44 C. Dopamine and dobutamine |
front 45 A patient has left-ventricular dysfunction but no edema. According to your material, which drug class should be used first? A. ACE inhibitors | back 45 A. ACE inhibitors |
front 46 An African American patient remains symptomatic from heart failure despite ACE-inhibitor therapy. Which add-on combination is specifically recommended? A. Verapamil and nitrate | back 46 C. Isosorbide dinitrate and hydralazine |