• Question: Coronary artery disease (CAD) is mainly the result of:
• Question: Which of the following statements correctly describes the flow of blood between the heart and lungs:
• Question: Which of the following is a non-modifiable risk factor for Coronary Artery Disease?
• Question: Which of the following is a modifiable risk factor for Coronary Artery Disease (CAD)?
• Question: In Coronary Artery Disease (CAD), pumping ability of the heart can be impaired due to the deprivation of oxygen.
• Question: Identify whether each risk factor of coronary artery disease is modifiable or non-modifiable.
• Question: The most common cause of right-sided heart failure is:
• Question: In the healthy heart, the response to an increase in preload is for the stroke volume to increase.
• Question: Which of the following conditions can decrease preload?
• Question: Cor Pulmonale is:
• Question: Hypertension has its most immediate effect on:
• Question: Determine if the list of issues are associated with right-sided or left-sided heart failure and select the appropriate type of heart failure.
• Question: Correctly match each class of heart failure to their proper description
• Question: Correctly match each stage of heart failure to their proper description.
• Question: The patient with aortic regurgitation would most likely present with:
• Question: The patient with aortic stenosis would most likely present with:
• Question: A patient with mitral regurgitation would most likely present with
• Question: A patient with mitral stenosis would most likely present with:

Review each patient scenario below for the presenting signs and symptoms to determine the type of heart valve disease prevalent for that patient.

Question 1 / 4

A 64-year old female reports to the primary care office with a complaint of “fainting”. She reported that the episode occurred while she was engaged in her usual low impact aerobics class. She also noticed, for the first time, during exercise that her heart “hurt”. The NP conducts a symptom analysis of the chest pain and determined that the patient describes it as chest pressure. The patient reports no dyspnea with exercise and denies orthopnea or paroxysmal nocturnal dyspnea. On examination, the NP notes that all vital signs are normal, lungs are clear to auscultation; There is a laterally displaced, sustained apical impulse and a grade 4/6 mid-systolic crescendo- decrescendo murmur, heard loudest at the base and radiating to the neck.

There is also an S4 gallop. no peripheral edema noted. There is a laterally displaced, sustained apical impulse and a grade 4/6 mid-systolic crescendo- decrescendo murmur, heard loudest at the base and radiating to the neck.

There is also an S4 gallop. The NP performs an ECG in the office and discovers left ventricular hypertrophy.

Question 2 / 4

A 60-year old male reports to the primary care office with “shortness of breath” that started a few days after being released from the hospital following angioplasty and stent placement. Upon exam, the NP observes that

the patient does have dyspnea and jugular vein distention. Crackles are also noted in lung bases bilaterally. A blowing holosystolic murmur is also heard at the heart’s apex with radiation into the axilla.

Question 3 / 4

A woman brings her 67-year old father to see the NP at the primary care clinic. The patient reports that he has experienced shortness of breath for the last two months that has continued to get progressively worse. He expresses great concern that this development has kept him from participating in his Silver Sneaker’s program that he enjoys with his friends. He reports that he can barely walk a city block or walk up the stairs in his home without becoming short of breath. Upon exam, the NP notes a blood pressure of 180/58 mmHg and peripheral pulses are palpable at 4+. The cardiac exam reveals several murmurs: an early diastolic murmur that is high-pitched located loudest at the left lower sternal border; a diastolic rumbling sound heard at the heart’s apex and a systolic crescendo-decrescendo murmur heard at the left upper sternal border. A chest x-ray is performed at the office and shows pulmonary edema and cardiomegaly.

Question 4 / 4

A 40-year old male reports to the primary care office with a chief complaint of dyspnea, especially with activity, over the last 5 days. He also notices that several times during the last two days that he could feel his heart “pounding and racing”. On collecting the medical history, the patient indicates that he had rheumatic heart disease as a young child but remembers little about it. On exam, the NP determines that he is tachycardic with a heart rate of 120 beats/minute that is irregularly irregular. A low-pitched murmur is also auscultated and is heard most prominently at the apex. The NP also notes jugular vein distention (JVD) and bilateral crackles in the lung bases. The NP performs an ECG in the office that reveals atrial fibrillation and left atrial hypertrophy.