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2025-2026 | Latest Update |
Questions with Correct Solutions |
PCCN Exam Prep | Pass
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uestion 1
Q
A patient with left-sided heart failure presents with which classic symptom cluster?
A) Peripheral edema, hepatomegaly, ascites
B) Dyspnea, orthopnea, crackles, S3 gallop
C) Jugular venous distention, weight gain, right upper quadrant pain
D) Bounding pulses, wide pulse pressure, diastolic murmur
Answer: B) Dyspnea, orthopnea, crackles, S3 gallop [CORRECT]
Rationale: Left-sided heart failure causes pulmonary congestion due to backup of blood into the
lungs. Classic symptoms include dyspnea (shortness of breath), orthopnea (dyspnea when
supine), crackles (pulmonary edema), and S3 gallop (ventricular filling sound). Options A and C
describe right-sided heart failure. Option D describes aortic regurgitation.
Question 2
Which BNP level indicates severe heart failure?
A) <100 pg/mL
B) 100-300 pg/mL
C) 300-600 pg/mL
D) >600 pg/mL
Answer: D) >600 pg/mL [CORRECT]
Rationale: B-type natriuretic peptide (BNP) correlates with heart failure severity: normal <100
pg/mL (rules out HF), mild 100-300 pg/mL, moderate 300-600 pg/mL, severe >600 pg/mL.
Values >900 pg/mL indicate very severe decompensation.
Question 3
A patient presents with acute decompensated heart failure (ADHF) with severe pulmonary
edema. Which medication should be administered first?
A) Digoxin
B) Furosemide (Lasix)
C) Warfarin
, ) Amlodipine
D
Answer: B) Furosemide (Lasix) [CORRECT]
Rationale: Furosemide is a loop diuretic that provides rapid diuresis and vasodilation, reducing
preload and improving pulmonary congestion in ADHF. It is first-line therapy along with nitrates
and oxygen. Digoxin is for chronic management, warfarin is for anticoagulation, and amlodipine
is a calcium channel blocker not used in acute HF.
Question 4
Which finding is most specific for right-sided heart failure?
A) Paroxysmal nocturnal dyspnea (PND)
B) Jugular venous distention (JVD)
C) S3 gallop
D) Pulmonary crackles
Answer: B) Jugular venous distention (JVD) [CORRECT]
Rationale: JVD is a hallmark of right-sided heart failure, indicating elevated central venous
pressure from impaired right ventricular emptying. PND, S3 gallop, and pulmonary crackles are
left-sided heart failure findings due to pulmonary congestion.
Question 5
A patient with STEMI has ST-segment elevation in leads II, III, and aVF. Which artery is likely
occluded?
A) Left anterior descending
B) Left circumflex
C) Right coronary artery
D) Posterior descending artery
Answer: C) Right coronary artery [CORRECT]
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall MI, typically caused by
occlusion of the right coronary artery (RCA) in 80% of patients (right-dominant circulation). The
left anterior descending causes anterior MIs (V1-V4), and left circumflex causes lateral MIs (I,
aVL, V5-V6).
Question 6
What is the door-to-balloon time goal for primary PCI in STEMI?
A) Within 30 minutes
B) Within 60 minutes
C) Within 90 minutes
D) Within 120 minutes
Answer: C) Within 90 minutes [CORRECT]
Rationale: The American College of Cardiology/American Heart Association guidelines
recommend door-to-balloon time of ≤90 minutes for primary PCI in STEMI to minimize
myocardial damage. Door-to-needle time for fibrinolysis should be ≤30 minutes if PCI is not
available.
Question 7
Which cardiac biomarker is most specific for myocardial injury?
A) Myoglobin
B) CK-MB
C) Troponin I/T
, ) LDH
D
Answer: C) Troponin I/T [CORRECT]
Rationale: Troponin I and T are the most specific and sensitive biomarkers for myocardial injury.
They rise within 3-6 hours, peak at 12-24 hours, and remain elevated for 7-10 days. Myoglobin
rises earliest (1-2 hours) but is not cardiac-specific. CK-MB is less specific than troponin.
Question 8
A patient with NSTEMI has persistent chest pain and dynamic ST-changes. When should
revascularization occur?
A) Immediately (within 2 hours)
B) Within 24-48 hours
C) Within 1 week
D) Only if biomarkers rise
Answer: B) Within 24-48 hours [CORRECT]
Rationale: High-risk NSTEMI patients (persistent pain, dynamic ST-changes, elevated troponin)
should undergo invasive evaluation and revascularization within 24-48 hours. Immediate
angiography is reserved for STEMI or unstable patients with life-threatening arrhythmias.
Question 9
Which component of the MONA protocol should be administered first to a patient with suspected
ACS?
A) Morphine
B) Oxygen (if SpO2 <90%)
C) Nitroglycerin
D) Aspirin
Answer: D) Aspirin [CORRECT]
Rationale: Aspirin (325 mg chewable or 325 mg PO if not chewed) should be given immediately
to all patients with suspected ACS unless contraindicated. It reduces mortality by preventing
platelet aggregation. Oxygen is only given if SpO2 <90%, and morphine/nitroglycerin follow
aspirin.
Question 10
Which post-MI complication presents with a new holosystolic murmur at the left sternal border
with a thrill?
A) Papillary muscle rupture
B) Ventricular septal rupture
C) Free wall rupture
D) Pericarditis
Answer: B) Ventricular septal rupture [CORRECT]
Rationale: Ventricular septal rupture (VSR) presents with a harsh holosystolic murmur at the left
sternal border, often with a palpable thrill, and acute heart failure/cardiogenic shock. Papillary
muscle rupture causes acute mitral regurgitation with a murmur at the apex radiating to the
axilla. Free wall rupture causes tamponade and death.
Question 11
A patient develops acute mitral regurgitation 5 days post-MI. Which physical finding is most
likely?
A) Loud S1 with opening snap
, ) Holosystolic murmur at apex radiating to axilla
B
C) Diastolic rumble at apex
D) Systolic ejection murmur at right upper sternal border
Answer: B) Holosystolic murmur at apex radiating to axilla [CORRECT]
Rationale: Acute papillary muscle rupture or dysfunction post-MI causes acute mitral
regurgitation, characterized by a holosystolic murmur at the apex radiating to the axilla. The
loud S1 with opening snap is mitral stenosis. Diastolic rumble is mitral stenosis. Systolic ejection
murmur at RUSB is aortic stenosis.
Question 12
A patient in atrial fibrillation has a heart rate of 150 bpm and BP 90/60 mmHg. What is the
priority intervention?
A) Start metoprolol PO
B) Synchronized cardioversion
C) Start heparin infusion
D) Administer digoxin
Answer: B) Synchronized cardioversion [CORRECT]
Rationale: This patient has unstable atrial fibrillation (hypotension with rapid ventricular
response). Unstable tachyarrhythmias require immediate synchronized cardioversion. Stable
patients can be rate-controlled with beta-blockers, calcium channel blockers, or digoxin.
Anticoagulation is important but not the priority in instability.
Question 13
Which ECG finding is characteristic of atrial flutter?
A) Irregularly irregular rhythm with no P waves
B) Sawtooth flutter waves (F waves) at 250-350 bpm
C) Regular narrow complex at 150-250 bpm with abrupt onset/termination
D) Chaotic baseline with no organized atrial activity
Answer: B) Sawtooth flutter waves (F waves) at 250-350 bpm [CORRECT]
Rationale: Atrial flutter is characterized by sawtooth flutter waves (F waves) at an atrial rate of
250-350 bpm, typically with a regular ventricular response due to fixed AV block (2:1 or 4:1).
Irregularly irregular with no P waves describes atrial fibrillation. Regular narrow complex
150-250 bpm describes SVT. Chaotic baseline describes ventricular fibrillation.
Question 14
A patient with SVT has a regular narrow complex rhythm at 180 bpm and BP 110/70 mmHg.
What is the first-line treatment?
A) Adenosine 6 mg rapid IV push
B) Metoprolol 5 mg IV
C) Synchronized cardioversion
D) Amiodarone 150 mg IV
Answer: A) Adenosine 6 mg rapid IV push [CORRECT]
Rationale: Adenosine 6 mg rapid IV push followed by a saline flush is first-line for stable SVT
due to its ability to transiently block the AV node and break reentrant circuits. If unsuccessful, a
second dose of 12 mg may be given. Cardioversion is for unstable patients. Metoprolol and
amiodarone are second-line options.
Question 15
2025-2026 | Latest Update |
Questions with Correct Solutions |
PCCN Exam Prep | Pass
Guaranteed - A+ Graded
uestion 1
Q
A patient with left-sided heart failure presents with which classic symptom cluster?
A) Peripheral edema, hepatomegaly, ascites
B) Dyspnea, orthopnea, crackles, S3 gallop
C) Jugular venous distention, weight gain, right upper quadrant pain
D) Bounding pulses, wide pulse pressure, diastolic murmur
Answer: B) Dyspnea, orthopnea, crackles, S3 gallop [CORRECT]
Rationale: Left-sided heart failure causes pulmonary congestion due to backup of blood into the
lungs. Classic symptoms include dyspnea (shortness of breath), orthopnea (dyspnea when
supine), crackles (pulmonary edema), and S3 gallop (ventricular filling sound). Options A and C
describe right-sided heart failure. Option D describes aortic regurgitation.
Question 2
Which BNP level indicates severe heart failure?
A) <100 pg/mL
B) 100-300 pg/mL
C) 300-600 pg/mL
D) >600 pg/mL
Answer: D) >600 pg/mL [CORRECT]
Rationale: B-type natriuretic peptide (BNP) correlates with heart failure severity: normal <100
pg/mL (rules out HF), mild 100-300 pg/mL, moderate 300-600 pg/mL, severe >600 pg/mL.
Values >900 pg/mL indicate very severe decompensation.
Question 3
A patient presents with acute decompensated heart failure (ADHF) with severe pulmonary
edema. Which medication should be administered first?
A) Digoxin
B) Furosemide (Lasix)
C) Warfarin
, ) Amlodipine
D
Answer: B) Furosemide (Lasix) [CORRECT]
Rationale: Furosemide is a loop diuretic that provides rapid diuresis and vasodilation, reducing
preload and improving pulmonary congestion in ADHF. It is first-line therapy along with nitrates
and oxygen. Digoxin is for chronic management, warfarin is for anticoagulation, and amlodipine
is a calcium channel blocker not used in acute HF.
Question 4
Which finding is most specific for right-sided heart failure?
A) Paroxysmal nocturnal dyspnea (PND)
B) Jugular venous distention (JVD)
C) S3 gallop
D) Pulmonary crackles
Answer: B) Jugular venous distention (JVD) [CORRECT]
Rationale: JVD is a hallmark of right-sided heart failure, indicating elevated central venous
pressure from impaired right ventricular emptying. PND, S3 gallop, and pulmonary crackles are
left-sided heart failure findings due to pulmonary congestion.
Question 5
A patient with STEMI has ST-segment elevation in leads II, III, and aVF. Which artery is likely
occluded?
A) Left anterior descending
B) Left circumflex
C) Right coronary artery
D) Posterior descending artery
Answer: C) Right coronary artery [CORRECT]
Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall MI, typically caused by
occlusion of the right coronary artery (RCA) in 80% of patients (right-dominant circulation). The
left anterior descending causes anterior MIs (V1-V4), and left circumflex causes lateral MIs (I,
aVL, V5-V6).
Question 6
What is the door-to-balloon time goal for primary PCI in STEMI?
A) Within 30 minutes
B) Within 60 minutes
C) Within 90 minutes
D) Within 120 minutes
Answer: C) Within 90 minutes [CORRECT]
Rationale: The American College of Cardiology/American Heart Association guidelines
recommend door-to-balloon time of ≤90 minutes for primary PCI in STEMI to minimize
myocardial damage. Door-to-needle time for fibrinolysis should be ≤30 minutes if PCI is not
available.
Question 7
Which cardiac biomarker is most specific for myocardial injury?
A) Myoglobin
B) CK-MB
C) Troponin I/T
, ) LDH
D
Answer: C) Troponin I/T [CORRECT]
Rationale: Troponin I and T are the most specific and sensitive biomarkers for myocardial injury.
They rise within 3-6 hours, peak at 12-24 hours, and remain elevated for 7-10 days. Myoglobin
rises earliest (1-2 hours) but is not cardiac-specific. CK-MB is less specific than troponin.
Question 8
A patient with NSTEMI has persistent chest pain and dynamic ST-changes. When should
revascularization occur?
A) Immediately (within 2 hours)
B) Within 24-48 hours
C) Within 1 week
D) Only if biomarkers rise
Answer: B) Within 24-48 hours [CORRECT]
Rationale: High-risk NSTEMI patients (persistent pain, dynamic ST-changes, elevated troponin)
should undergo invasive evaluation and revascularization within 24-48 hours. Immediate
angiography is reserved for STEMI or unstable patients with life-threatening arrhythmias.
Question 9
Which component of the MONA protocol should be administered first to a patient with suspected
ACS?
A) Morphine
B) Oxygen (if SpO2 <90%)
C) Nitroglycerin
D) Aspirin
Answer: D) Aspirin [CORRECT]
Rationale: Aspirin (325 mg chewable or 325 mg PO if not chewed) should be given immediately
to all patients with suspected ACS unless contraindicated. It reduces mortality by preventing
platelet aggregation. Oxygen is only given if SpO2 <90%, and morphine/nitroglycerin follow
aspirin.
Question 10
Which post-MI complication presents with a new holosystolic murmur at the left sternal border
with a thrill?
A) Papillary muscle rupture
B) Ventricular septal rupture
C) Free wall rupture
D) Pericarditis
Answer: B) Ventricular septal rupture [CORRECT]
Rationale: Ventricular septal rupture (VSR) presents with a harsh holosystolic murmur at the left
sternal border, often with a palpable thrill, and acute heart failure/cardiogenic shock. Papillary
muscle rupture causes acute mitral regurgitation with a murmur at the apex radiating to the
axilla. Free wall rupture causes tamponade and death.
Question 11
A patient develops acute mitral regurgitation 5 days post-MI. Which physical finding is most
likely?
A) Loud S1 with opening snap
, ) Holosystolic murmur at apex radiating to axilla
B
C) Diastolic rumble at apex
D) Systolic ejection murmur at right upper sternal border
Answer: B) Holosystolic murmur at apex radiating to axilla [CORRECT]
Rationale: Acute papillary muscle rupture or dysfunction post-MI causes acute mitral
regurgitation, characterized by a holosystolic murmur at the apex radiating to the axilla. The
loud S1 with opening snap is mitral stenosis. Diastolic rumble is mitral stenosis. Systolic ejection
murmur at RUSB is aortic stenosis.
Question 12
A patient in atrial fibrillation has a heart rate of 150 bpm and BP 90/60 mmHg. What is the
priority intervention?
A) Start metoprolol PO
B) Synchronized cardioversion
C) Start heparin infusion
D) Administer digoxin
Answer: B) Synchronized cardioversion [CORRECT]
Rationale: This patient has unstable atrial fibrillation (hypotension with rapid ventricular
response). Unstable tachyarrhythmias require immediate synchronized cardioversion. Stable
patients can be rate-controlled with beta-blockers, calcium channel blockers, or digoxin.
Anticoagulation is important but not the priority in instability.
Question 13
Which ECG finding is characteristic of atrial flutter?
A) Irregularly irregular rhythm with no P waves
B) Sawtooth flutter waves (F waves) at 250-350 bpm
C) Regular narrow complex at 150-250 bpm with abrupt onset/termination
D) Chaotic baseline with no organized atrial activity
Answer: B) Sawtooth flutter waves (F waves) at 250-350 bpm [CORRECT]
Rationale: Atrial flutter is characterized by sawtooth flutter waves (F waves) at an atrial rate of
250-350 bpm, typically with a regular ventricular response due to fixed AV block (2:1 or 4:1).
Irregularly irregular with no P waves describes atrial fibrillation. Regular narrow complex
150-250 bpm describes SVT. Chaotic baseline describes ventricular fibrillation.
Question 14
A patient with SVT has a regular narrow complex rhythm at 180 bpm and BP 110/70 mmHg.
What is the first-line treatment?
A) Adenosine 6 mg rapid IV push
B) Metoprolol 5 mg IV
C) Synchronized cardioversion
D) Amiodarone 150 mg IV
Answer: A) Adenosine 6 mg rapid IV push [CORRECT]
Rationale: Adenosine 6 mg rapid IV push followed by a saline flush is first-line for stable SVT
due to its ability to transiently block the AV node and break reentrant circuits. If unsuccessful, a
second dose of 12 mg may be given. Cardioversion is for unstable patients. Metoprolol and
amiodarone are second-line options.
Question 15
