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I-Human Case Week 4 Chest Pain 69-Year-Old Male
Outpatient Clinic Actual Exam 2026/2027 – Complete
Exam-Style Questions with Detailed Rationales | 100%
Verified – Pass Guaranteed – A+ Graded
History Taking & Differential Diagnosis
Q1: You are seeing Mr. Henderson, a 69-year-old male, who presents to the outpatient clinic
complaining of chest pain. To best characterize the pain and differentiate between life-
threatening cardiac causes and less urgent etiologies, which is the most appropriate initial
question to ask?
A. Does the pain radiate down your left arm or up into your jaw?
B. Can you describe what the pain feels like and tell me exactly when it started?
C. Do you have a family history of heart disease or heart attacks?
D. Have you taken any medications like aspirin or nitroglycerin since the pain began?
Correct Answer: B
Rationale: The best answer is to ask the patient to describe the quality and onset of the pain. This
open-ended approach allows you to gather crucial details about the sensation (pressure, sharp,
tearing) and timing (acute, gradual), which are essential for forming a differential diagnosis
before narrowing down to specific associated symptoms or history.
Q2: Mr. Henderson describes the chest pain as a "heavy pressure" sitting in the center of his
chest. In the context of a 69-year-old male, which specific associated symptom would most
strongly increase your suspicion for Acute Coronary Syndrome (ACS)?
A. Pain that worsens when he takes a deep breath or coughs.
B. A recent history of a viral upper respiratory infection.
C. Diaphoresis (sweating) and shortness of breath.
D. Pain that reproducibly occurs when you press on his sternum.
Correct Answer: C
Rationale: This choice is correct because "heavy pressure" combined with diaphoresis and
dyspnea is a classic presentation of cardiac ischemia or myocardial infarction in an older adult.
,2
These systemic symptoms indicate a sympathetic nervous system response to cardiac distress,
making ACS a primary concern.
Q3: During the history of present illness, Mr. Henderson mentions the pain started about 20
minutes ago while he was walking his dog. He sat down to rest, and the pain decreased
significantly but did not go away completely. How would you best categorize this pattern of
symptoms?
A. Stable angina
B. Unstable angina
C. Variant (Prinzmetal’s) angina
D. Acute myocardial infarction
Correct Answer: B
Rationale: The best answer is unstable angina because the pain is new onset or changing in
pattern, occurring at rest (or persisting after exertion stops), and is a red flag for impending
myocardial infarction. Stable angina is typically predictable and relieved immediately by rest;
the persistence of symptoms here suggests higher risk.
Q4: You are reviewing Mr. Henderson's past medical history. Which of the following conditions
in his chart is considered the most significant risk factor for developing atherosclerosis and
coronary artery disease (CAD)?
A. History of osteoarthritis in the knees
B. Well-controlled hypertension diagnosed 10 years ago
C. Diet-controlled type 2 diabetes mellitus
D. Seasonal allergic rhinitis
Correct Answer: C
Rationale: This choice is correct because diabetes mellitus is considered a "coronary heart
disease equivalent," meaning the risk of a major cardiac event is as high as someone who already
has established heart disease. While hypertension is a risk factor, diabetes confers a significantly
higher baseline risk for mortality and complications.
, 3
Q5: When asking about medication history, Mr. Henderson hands you a list of prescriptions.
Which medication on his list requires specific caution because using it alongside nitroglycerin
for chest pain could cause severe hypotension?
A. Lisinopril
B. Sildenafil (Viagra)
C. Atorvastatin
D. Metformin
Correct Answer: B
Rationale: This choice is correct because sildenafil (and other PDE5 inhibitors used for erectile
dysfunction) potentiates the vasodilatory effects of nitrates. Combining these can lead to a life-
threatening drop in blood pressure, so you must explicitly ask about ED medication use before
prescribing nitroglycerin.
Q6: Mr. Henderson states he has had "indigestion" on and off for a few months. To differentiate
between gastrointestinal reflux (GERD) and cardiac chest pain, which historical feature is most
helpful?
A. A burning sensation that starts in the epigastrium and moves up behind the breastbone.
B. Symptoms that consistently occur after large, spicy meals and when lying down flat.
C. Symptoms that are triggered by emotional stress or physical exertion.
D. A sour taste in the mouth accompanied by frequent burping.
Correct Answer: C
Rationale: The best answer is symptoms triggered by exertion or stress, as this strongly points to
cardiac etiology (angina). While burning, post-prandial timing, and sour taste are classic for
GERD, the exertional link is the key differentiator that raises the index of suspicion for cardiac
ischemia.
Q7: As part of the differential diagnosis for chest pain in a 69-year-old male, you consider acute
aortic dissection. Which description of pain is most characteristic of this catastrophic condition?
A. Sharp, pleuritic pain that changes with position.
B. Tearing or ripping sensation radiating to the back.
C. Dull, aching pressure that lasts for hours.
I-Human Case Week 4 Chest Pain 69-Year-Old Male
Outpatient Clinic Actual Exam 2026/2027 – Complete
Exam-Style Questions with Detailed Rationales | 100%
Verified – Pass Guaranteed – A+ Graded
History Taking & Differential Diagnosis
Q1: You are seeing Mr. Henderson, a 69-year-old male, who presents to the outpatient clinic
complaining of chest pain. To best characterize the pain and differentiate between life-
threatening cardiac causes and less urgent etiologies, which is the most appropriate initial
question to ask?
A. Does the pain radiate down your left arm or up into your jaw?
B. Can you describe what the pain feels like and tell me exactly when it started?
C. Do you have a family history of heart disease or heart attacks?
D. Have you taken any medications like aspirin or nitroglycerin since the pain began?
Correct Answer: B
Rationale: The best answer is to ask the patient to describe the quality and onset of the pain. This
open-ended approach allows you to gather crucial details about the sensation (pressure, sharp,
tearing) and timing (acute, gradual), which are essential for forming a differential diagnosis
before narrowing down to specific associated symptoms or history.
Q2: Mr. Henderson describes the chest pain as a "heavy pressure" sitting in the center of his
chest. In the context of a 69-year-old male, which specific associated symptom would most
strongly increase your suspicion for Acute Coronary Syndrome (ACS)?
A. Pain that worsens when he takes a deep breath or coughs.
B. A recent history of a viral upper respiratory infection.
C. Diaphoresis (sweating) and shortness of breath.
D. Pain that reproducibly occurs when you press on his sternum.
Correct Answer: C
Rationale: This choice is correct because "heavy pressure" combined with diaphoresis and
dyspnea is a classic presentation of cardiac ischemia or myocardial infarction in an older adult.
,2
These systemic symptoms indicate a sympathetic nervous system response to cardiac distress,
making ACS a primary concern.
Q3: During the history of present illness, Mr. Henderson mentions the pain started about 20
minutes ago while he was walking his dog. He sat down to rest, and the pain decreased
significantly but did not go away completely. How would you best categorize this pattern of
symptoms?
A. Stable angina
B. Unstable angina
C. Variant (Prinzmetal’s) angina
D. Acute myocardial infarction
Correct Answer: B
Rationale: The best answer is unstable angina because the pain is new onset or changing in
pattern, occurring at rest (or persisting after exertion stops), and is a red flag for impending
myocardial infarction. Stable angina is typically predictable and relieved immediately by rest;
the persistence of symptoms here suggests higher risk.
Q4: You are reviewing Mr. Henderson's past medical history. Which of the following conditions
in his chart is considered the most significant risk factor for developing atherosclerosis and
coronary artery disease (CAD)?
A. History of osteoarthritis in the knees
B. Well-controlled hypertension diagnosed 10 years ago
C. Diet-controlled type 2 diabetes mellitus
D. Seasonal allergic rhinitis
Correct Answer: C
Rationale: This choice is correct because diabetes mellitus is considered a "coronary heart
disease equivalent," meaning the risk of a major cardiac event is as high as someone who already
has established heart disease. While hypertension is a risk factor, diabetes confers a significantly
higher baseline risk for mortality and complications.
, 3
Q5: When asking about medication history, Mr. Henderson hands you a list of prescriptions.
Which medication on his list requires specific caution because using it alongside nitroglycerin
for chest pain could cause severe hypotension?
A. Lisinopril
B. Sildenafil (Viagra)
C. Atorvastatin
D. Metformin
Correct Answer: B
Rationale: This choice is correct because sildenafil (and other PDE5 inhibitors used for erectile
dysfunction) potentiates the vasodilatory effects of nitrates. Combining these can lead to a life-
threatening drop in blood pressure, so you must explicitly ask about ED medication use before
prescribing nitroglycerin.
Q6: Mr. Henderson states he has had "indigestion" on and off for a few months. To differentiate
between gastrointestinal reflux (GERD) and cardiac chest pain, which historical feature is most
helpful?
A. A burning sensation that starts in the epigastrium and moves up behind the breastbone.
B. Symptoms that consistently occur after large, spicy meals and when lying down flat.
C. Symptoms that are triggered by emotional stress or physical exertion.
D. A sour taste in the mouth accompanied by frequent burping.
Correct Answer: C
Rationale: The best answer is symptoms triggered by exertion or stress, as this strongly points to
cardiac etiology (angina). While burning, post-prandial timing, and sour taste are classic for
GERD, the exertional link is the key differentiator that raises the index of suspicion for cardiac
ischemia.
Q7: As part of the differential diagnosis for chest pain in a 69-year-old male, you consider acute
aortic dissection. Which description of pain is most characteristic of this catastrophic condition?
A. Sharp, pleuritic pain that changes with position.
B. Tearing or ripping sensation radiating to the back.
C. Dull, aching pressure that lasts for hours.
