CME questions: update in the approach to and management of heart failure.1. Stage A heart failure (HF) describes which of the following patient groups? a. Patients with structural heart disease who have past or current HF symptoms. b. Patients at risk for developing HF but without evidence of structural heart disease. c. Patients with evidence of structural heart disease, such as left ventricular hypertrophy left ventricular hypertrophy Cardiology Enlargement of the left ventricle often linked to the prolonged hemodynamic stress of CHF, characterized by myocardial cell hypertrophy, ↑ left ventricular wall thickness, ↓ ventricular compliance, ↑ , but without symptoms of heart failure. d. Patients with medically refractory end-stage HF. 2. The majority of HF patients present with signs and symptoms consistent with which bedside hemodynamic he·mo·dy·nam·ics n. (used with a sing. verb) The study of the forces involved in the circulation of blood. he profile? a. Profile A: Warm and dry hemodynamic profile. b. Profile L: Cold and dry hemodynamic profile. c. Profile C: Cold and wet hemodynamic profile. d. Profile B: Warm and wet hemodynamic profile. 3. BNP BNP B-type natriuretic peptide, brain natriuretic peptide Physiology A 32-residue peptide hormone produced predominantly in the ventricles, secreted in response to fluid overload–eg, CHF. See Atrial natriuretic peptide. is best used as a test in which of the following clinical scenarios? a. Exclusion of HF in patients presenting to the emergency room with acute shortness of breath Shortness of Breath Definition Shortness of breath, or dyspnea, is a feeling of difficult or labored breathing that is out of proportion to the patient's level of physical activity. . b. A screening test in asymptomatic populations. c. A prognostic indicator in patients with chronic heart failure. d. All of the above 4. Each of the following are first line therapies in the treatment of HF except? a. Beta blocker b. ACE inhibitor c. Spironolactone spironolactone /spir·o·no·lac·tone/ (spi?rah-no-lak´ton) one of the spirolactones, an aldosterone inhibitor that blocks the aldosterone-dependent exchange of sodium and potassium in the distal tubule, thus increasing excretion of sodium d. Digoxin digoxin: see digitalis. e. All of the above 5. Aldosterone antagonists should be avoided in all of the following patients except? a. NYHA NYHA New York Heart Association class II HF. b. Post-MI patients with EF <40%. c. Serum creatinine >2.5 mg/dL. d. Patients with inadequate outpatient follow up. e. All of the above 6. True or False: The benefits of beta-blocker therapy in chronic heart failure are dependent on baseline heart rate, change in heart rate and final heart rate. a. True b. False 7. Which beta blocker did not lower mortality among chronic HF patients in a randomized ran·dom·ize tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es To make random in arrangement, especially in order to control the variables in an experiment. placebo-controlled trial? a. Metoprolol succinate (Toprol XL[R]) b. Bisoprolol c. Carvedilol d. Bucindolol 8. What are the only two beta blockers to be compared in a head to head trial? a. Bucindolol and bisoprolol b. Carvedilol and bisoprolol c. Metoprolol tartrate and carvedilol d. Metoprolol succinate (Toprol XL) and carvedilol 9. All of the following statements regarding digoxin therapy for chronic heart failure are true except? a. Digoxin improves mortality in patients with chronic heart failure. b. Digoxin reduces hospitalizations for heart failure in patients with chronic heart failure. c. Digoxin levels should primarily be used to confirm clinically suspected drug toxicity rather than for dose titration for therapeutic efficacy. d. There is an increased risk of death among women with chronic heart failure treated with digoxin. 10. Which of the following statements regarding the patients included in the A-Heft trial is false? a. They were African American. b. All patients had NYHA class III or IV heart failure. c. Patients were already treated with an ACEI ACEI Angiotensin Converting Enzyme Inhibitor ACEI Association for Childhood Education International ACEI Association of Consulting Engineers of Ireland , ARB and aldosterone antagonist. d. All patients had suffered a MI in the prior 3 to 14 days. 11. Successful outpatient management of chronic HF requires a comprehensive management strategy that includes which of the following? a. Evidence-based pharmacologic therapies. b. Treatment of comorbidities including atrial fibrillation, sleep apnea, and thromboembolic thromboembolic pertaining to or emanating from thromboembolism. thromboembolic meningoencephalitis see hemophilosis. thromboembolic parasitism see thromboembolic colic. complications. c. Medication compliance. d. Daily weight monitoring. e. All of the above Answers to CME CME See: Chicago Mercantile Exchange CME See Chicago Mercantile Exchange (CME). Questions 1. B, 2. D, 3. A, 4. D, 5. B, 6. B, 7. D, 8. C, 9. A, 10. D 11. E |
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