Heart Failure — Practice Questions

Medicine — Heart Failure and Valvular Disease, NMC MBBS licence examination syllabus (Nepal Medical Council).

Heart failure and valvular disease — NMC-style practice questions

Practice questions written for this chapter. These are not past NMC papers.

📋 About these questions: These are practice questions written to test the reasoning in this chapter. They are NOT reproduced from any past Nepal Medical Council examination, and no verified past NMC questions were supplied for this chapter.

Level 1–2 — recall and understanding

Q1. Orthopnoea and paroxysmal nocturnal dyspnoea are features of: A. RIGHT heart failure B. LEFT heart failure C. Cor pulmonale D. Constrictive pericarditis only ANSWER: B — left heart failure. Why: a failing left ventricle backs blood up into the lungs, so lying flat worsens pulmonary congestion. Right heart failure backs blood into the systemic veins, giving a raised JVP, oedema and hepatomegaly. LEARNING POINT: the findings follow where the blood backs up.

Q2. Which murmur classically results from RHEUMATIC heart disease? A. Aortic regurgitation only B. MITRAL STENOSIS C. Pulmonary stenosis D. Tricuspid regurgitation ANSWER: B — mitral stenosis. Why: the mitral valve is the most commonly affected in rheumatic disease, giving a mid-diastolic rumble at the apex with a loud first heart sound, often with atrial fibrillation. LEARNING POINT: it presents decades after the childhood attack.

Level 3–4 — application and clinical reasoning

Q3. A 68-year-old with heart failure and REDUCED ejection fraction is discharged on a diuretic alone and feels better. This management is: A. Adequate — he is symptom-free B. INCOMPLETE — prognostic drug classes have not been started C. Correct until symptoms recur D. Correct because diuretics improve survival ANSWER: B. Why: diuretics relieve congestion but do not alter survival. ACE inhibitors or ARBs, beta-blockers and aldosterone antagonists have prognostic benefit in reduced ejection fraction. LEARNING POINT: feeling better is not the same as living longer.

Q4. A 62-year-old with COPD has raised JVP and ankle oedema but no orthopnoea and clear lung fields. The likely mechanism is: A. Left ventricular failure B. COR PULMONALE — right heart strain from lung disease C. Nephrotic syndrome D. Liver failure ANSWER: B. Why: right-sided signs WITHOUT left-sided ones point away from the left ventricle and towards the lungs. LEARNING POINT: also consider pulmonary embolism and pulmonary hypertension as causes of right-sided loading.

Q5. A 30-year-old has exertional breathlessness, atrial fibrillation, and a mid-diastolic apical rumble. She had a prolonged febrile illness with joint pains as a child. Besides echocardiography, an essential step is: A. Reassurance B. ANTICOAGULATION for atrial fibrillation C. Aspirin alone D. Exercise testing ANSWER: B — anticoagulation. Why: mitral stenosis with atrial fibrillation carries a substantial stroke risk. Aspirin is not adequate stroke prevention in atrial fibrillation. LEARNING POINT: also address secondary rheumatic prophylaxis per the national programme.

Level 5 — exception-based

Q6. In aortic stenosis, which development marks a sharp change in prognosis and warrants urgent referral? A. An increasingly loud murmur B. SYNCOPE, ANGINA or HEART FAILURE C. Atrial fibrillation alone D. A raised JVP ANSWER: B. Why: the onset of these symptoms in aortic stenosis indicates a marked deterioration in prognosis, and referral for consideration of valve intervention becomes urgent. LEARNING POINT: the murmur's loudness does not track severity reliably.

Q7. A patient with previously stable heart failure develops acute pulmonary oedema. After sitting him up, giving oxygen and a diuretic, the next priority is: A. Discharge once he improves B. IDENTIFY THE PRECIPITANT C. Increase the long-term diuretic permanently D. Restrict all fluids indefinitely ANSWER: B. Why: stable heart failure rarely decompensates without a trigger — myocardial infarction, new arrhythmia, infection, missed medication, a salt load, anaemia or a new NSAID. LEARNING POINT: treating the oedema alone guarantees a readmission.

Syllabus points

Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions

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