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1. A 65-year-old man with a history of hypertension, diabetes, and coronary artery disease presents
to the emergency department with chest pain, dyspnea, and diaphoresis. He is diagnosed with an
acute myocardial infarction (AMI) and is given aspirin, nitroglycerin, morphine, and oxygen. He is
also scheduled for an urgent coronary angiography. Which of the following statements best
describes the pathophysiology of AMI?
a) AMI is caused by a sudden occlusion of a coronary artery by a thrombus that forms on a ruptured
atherosclerotic plaque.
b) AMI is caused by a gradual narrowing of a coronary artery by atherosclerosis that reduces blood
flow to the myocardium.
c) AMI is caused by a spasm of a coronary artery that temporarily interrupts blood flow to the
myocardium.
d) AMI is caused by an embolus that originates from the left atrium and lodges in a coronary artery.
*Answer: A. Rationale: AMI is most commonly caused by a sudden occlusion of a coronary artery by
a thrombus that forms on a ruptured atherosclerotic plaque. This leads to ischemia and necrosis of
the myocardial tissue supplied by the affected artery. The other options are less common causes of
AMI.*
2. A 50-year-old woman with a history of rheumatoid arthritis and chronic kidney disease is
admitted to the hospital with signs and symptoms of heart failure. She has bilateral crackles in her
lungs, jugular venous distension, peripheral edema, and an enlarged liver. Her blood pressure is
160/100 mmHg and her heart rate is 110 beats per minute. She is diagnosed with diastolic heart
failure and is started on diuretics, angiotensin-converting enzyme inhibitors, and beta-blockers.
Which of the following statements best explains the pathophysiology of diastolic heart failure?
a) Diastolic heart failure is caused by impaired ventricular relaxation that reduces diastolic filling
and stroke volume.
b) Diastolic heart failure is caused by increased ventricular contractility that increases systolic
ejection and afterload.
c) Diastolic heart failure is caused by reduced ventricular compliance that increases diastolic
pressure and pulmonary congestion.
d) Diastolic heart failure is caused by decreased ventricular preload that reduces cardiac output and
tissue perfusion.
*Answer: C. Rationale: Diastolic heart failure is caused by reduced ventricular compliance that
increases diastolic pressure and pulmonary congestion. This can result from conditions that cause
ventricular hypertrophy, fibrosis, or infiltration, such as hypertension, diabetes, ischemic heart
disease, rheumatic heart disease, or amyloidosis. The other options are not consistent with diastolic
heart failure.*
3. A 40-year-old man with a history of asthma and allergic rhinitis presents to his primary care
provider with wheezing, coughing, chest tightness, and shortness of breath. He reports that his
symptoms have worsened over the past week and that his albuterol inhaler does not provide muchÂ
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