4th quarterly exam

Question 1

The amount of alcohol drinking considered to be considered an alcoholic is:
More than 60 g/day for 3 years or more
More than 100 g/day for 6 years or more
More than 120 g/day for 8 years or more
More than 90 g/day for 5 years or more

Answer 1

More than 90 g/day for 5 years or more

Question 2

The most common cardiac arrhythmia associated with alcohol is:

Ventricular tachycardia
Atrial fibrillation
First degree AV block
Third degree AV block

Answer 2

AF

Question 3

Alcohol drinking and the presence of _________ and decreased ventricular function are determinants of malignant ventricular arrhythmias.

Premature atrial depolarizations Complete left bundle branch block Atrial flutter or atrial fibrillation Complete right bundle branch block

Answer 3

CLBBB

Question 4

The AHA does not recommend that people start drinking to lower their CV risk. However, if a person already drinks, it should be limited daily to only:

One drink for men, and none for women
Two or three drinks for men, and two drinks for women
One or two drinks for men, and one drink for women
Three or four drinks for men, and two drinks for women

Answer 4

1-2 men, 1 women

Question 5

What is considered a standard “drink”?

a. 12 ounces of beer, 5 ounces of wine, mixed drink with 1.5 ounces of liquor
b. 18 ounces of beer, 10 ounces of wine, mixed drink with 2.5 ounces of liquor
c. 15 ounces of beer, 8 ounces of wine, mixed drink with 2.0 ounces of liquor
b. 20 ounces of beer, 15 ounces of wine, mixed drink with 3.0 ounces of liquor

Answer 5

The American Heart Association (AHA) suggests that if a person already drinks, their intake be limited, with one or two drinks per day for men and only one drink for women. A “drink” is considered to be 12 ounces of beer, 5 ounces of wine, or a mixed drink containing 1.5 ounces of hard liquor. However, the AHA does not recommend that people start drinking to lower their cardiovascular risk.

Question 6

Which of the following are e”ects of beverage drinking?

a. The effects are still unknown
b. Decreased platelet aggregation
c. Increased C-reactive protein d. Increased Interleukin-6

Answer 6

Alcohol has antioxidant and antiinflammatory effects.
It is associated with a decrease in C-reactive protein as well as interleukin-6. 21
The beneficial effect is limited to low to moderate drinking, 22 and it appears to be more pronounced in men compared with women. In heavy drinkers, the opposite occurs. Heavy drinking and binge drinking are associated with an increase in inflammatory markers. After mild to moderate alcohol drinking, there is a decrease in platelet aggregation. However, binge drinking may have the opposite effect,

Question 7

__________ is the earliest echocardiographic abnormality in heavy alcoholic beverage drinkers, and is observed in up to onethird of asymptomatic patients?

a. Mitral regurgitation
b. Left ventricular dilatation
c. eccentric hypertrophy
d. Diastolic dysfunction
e. Reduced systolic function

Answer 7

diastolic dysfunction

Question 8

Poor prognostic indicators for alcoholic cardiomyopathy includes ________:

QRS duration of 90 milliseconds or less
Sinus bradycardia
Atrial fibrillation
Presence of beta blocker therapy

Answer 8

Factors that were associated with the best recovery of ejection fraction included narrow QRS, beta blocker therapy, and lack of use or need for diuretic therapy.

Question 9

Patients with alcoholic cardiomyopathy who completely stop drinking alcohol may normalize their ejection within __________.

Four years
One year
Three years
Two years

Answer 9

1 year

Question 10

The expected e”ect of heavy alcohol intake on lipids includes __________.

Decreased LDL
Increased HDL
Decreased total cholesterol
Increased triglycerides

Answer 10

Alcohol increases high-density lipoprotein (HDL) and may reduce low-density lipoprotein (LDL). It may even have some favorable effect on lipoprotein(a) (Fig. 84.2). 17 In addition, moderate intake of beer enhances the antioxidative properties of HDL; thus it prevents lipid deposition in blood vessel walls. Severe alcohol consumption may increase triglyceride levels, blunting the beneficial effect of moderate alcohol drinking.

Question 11

Which of the following statements are TRUE regarding Ecigarettes?

Smoking with E-cigarettes does not result in an increase in blood pressure.

The use of E-cigarettes with nicotine promotes parasympathetic predominance.

Flavoring like cinnamon flavor is generally safe with no e!ects on endothelial cell viability.

BP elevation is longer after an E-cigarette with nicotine than with a standard cigarette.

Answer 11

Blood pressure was elevated for a longer time (45 minutes) after using an e-cigarette with nicotine than with a standard cigarette (15 minutes).

Those who smoked e-cigarettes without nicotine did not have an increase in blood pressure. Studies of heart rate variability have shown the use of e-cigarettes with nicotine was associated with a marked shift in cardiac sympathovagal balance towards sympathetic predominance, whereas this shift did not occur with e‐cigarettes without nicotine.

Question 12

Typical chest X-ray finding associated with E-cigarette lung injury is ___________.

Patchy consolidations with a cavitary lesion
Coarse reticulonodular densities in the posterior segments of the upper lobes
Tree-in-bud appearance of the bronchi
Ground-glass appearing bilateral infiltrates

Answer 12

GGO (EVALI)

Question 13

Specific treatment for E-cigarette lung injury includes: *

Switching to standard cigarettes Anti-histamines and leukotriene receptor antagonists Daily use of long acting beta antagonists Cessation of E-cigarette use

Answer 13

stop vape

pathophysio: over 80% of cases included use of tetrahydrocannabinol (THC). One leading theory suggested by the CDC is that contaminants such as vitamin E acetate oil, which is often used to dilute THC, may be responsible for EVALI.

Question 14

The risk of MI after cocaine abuse increases up to 24-fold within __________.

12 hours
6 hours
24 hours
1 hour

Answer 14

1 hour; dissection 12 hours

Question 15

Which of the following is NOT a recommended medication to reverse cocaine-induced coronary vasoconstriction?

Nitrates
Verapamil
Phentolamine
Beta-blockers

Answer 15

Nitrates, phentolamine (an alpha-receptor blocker), and verapamil (a calcium channel blocker) have been shown to reverse cocaine-induced coronary vasoconstriction

Although beta blockers represent an essential therapy in the mitigation of hyperadrenergic states and are known to reduce myocardial oxygen demand, the use of beta blockers in the setting of cocaine-induced vasoconstriction is still debated because of the concern that β1 /β2 -blockade might lead to unopposed alpha-stimulation, resulting in coronary artery vasoconstriction.

Question 16

Which vascular pathology is related to cocaine use, and has an average interval from cocaine use to onset of symptoms within 12 hours?

Deep venous thrombosis
Aortic dissection
Saccular aneurysm
Acute limb ischemia

Answer 16

aortic dissection

Question 17

Mild to moderate caffeine intake are associated with what change in cardiac rhythm?

Sinus tachycardia
Ventricular arrhythmias
Atrial fibrillation
Atrial flutter

Answer 17

sinus tachycardia

It can increase sinus rate, but in doses associated with moderate coffee drinking it does not stimulate atrial fibrillation, nor is it associated with ventricular arrhythmias at moderate doses. However, caffeine overdose is associated with tachycardia, arrhythmias, and hypertension.

Question 18

The use of opiates (opium, heroin, etc.) is associated with what change in cardiac rhythm?

Shortened PR interval
Prolongation of
QT interval Widening QRS complex
Prolongation of PR interval

Answer 18

Some of these drugs prolong the QT interval

Methadone is high risk for c ing QT prolongation and ventricular arrhythmias, even at low doses. Tramadol, fentanyl, and oxycodone are intermediate in risk and may be more of a problem at higher doses. Morphine and buprenorphine are lower risk and do not usually cause QT prolongation or torsades de pointes at routine dosing levels.

Question 19

Which is TRUE about the use of cannabidiol (CBD) oil?

a. Increases propensity for ventricular arrhythmias
b. Worsens stress-induced hypertension
c. Worsens resting hypertension
d. No cardiac side effects were noted in its use

Answer 19

No cardiac side effects were noticed during the use of CBD oils, and there are reports that it may reduce both resting and stress-induced hypertension.

Question 20

Which of the following heavy metals is NOT associated with increase in cardiovascular disease?

Mercury
Arsenic
Lead
Cadmium

Answer 20

A recent meta-analysis showed exposure to the heavy metals arsenic, lead, cadmium, and copper was associated with increased cardiovascular disease including coronary artery disease and stroke. However, mercury was not associated with an increase in cardiovascular disease.

Question 21

Which of the following statements correctly describes cardiac myxomas:

a. Incidence peaks at 40-60 years old
b. Usually familial in occurrence
c. Male to female ratio is 3:1
d. >80% are found in the right atrium

Answer 21

Most myxomas (>80%) are most commonly found in the left atrium and in decreasing frequencies in the right atrium, right ventricle, and left ventricle (Fig. 98.8). 16 , 22
The incidence of cardiac myxoma peaks at 40 to 60 years of age, with a female to male ratio of approximately 3:1.
Most myxomas occur sporadically

Question 22

Which of the following systemic vasculitides affects the large arteries:

Kawasaki disease
Wegener granulomatosis
Churg-Strauss syndrome
Polyarteritis nodosa

Answer 22

large: giant cell, Takayasu, Kawasaki
medium: Churg-Strauss, PAN, Wegener, microscopic polyangiitis

Question 23

One of the following rheumatic diseases causes premature atherosclerosis:

Churg-Strauss syndrome
Gout
Granulomatous polyangiitis
Kawasaki disease

Answer 23

premature atherosclerosis: Systemic lupus erythematosus, Rheumatoid arthritis, Ankylosing spondylitis, Psoriatic arthritis, Gout, Takayasu arteritis, Giant cell arteritis

Question 24

Heparin- induced thrombocytopenia:

More common with LMWH than unfractionated heparin
Decrease in the platelet count of at least 30% from baseline
More common in surgical than medical patients
Platelet count falls 24-48hrs after starting heparin

Answer 24

More common in surgical than medical patients

(see table 95.5)

Question 25

Amiodarone is iodine rich anti arrhythmic agent containing 30% iodine by weight. It is structurally similar to levo-thyroxine and causes abnormalities in thyroid function. The prevalence of hypothyroidism in amiodarone treated patients is:

15-30%
50-60%
<5 %
10-20%