Chapter 4: Cardiovascular

Question 1

1. Cardiac cells are able to generate an impulse to contract even without an external stimulus. This is called:
   A) excitability.
   B) action potential.
   C) automaticity.
   D) chronotropic effect.

Answer 1

C) automaticity.

Question 2

2. On an electrocardiogram (EKG), the P wave represents:
   A) atrial depolarization.
   B) ventricular depolarization.
   C) atrial repolarization.
   D) ventricular repolarization

Answer 2

A) atrial depolarization.

Question 3

3. The QRS wave of an electrocardiogram (EKG) is produced by:
   A) depolarization of the atria.
   B) repolarization of the atria.
   C) depolarization of the ventricles.
   D) repolarization of the ventricles.

Answer 3

C) depolarization of the ventricles.

Question 4

4. Stimulation of alpha receptors results in:
   A) vasoconstriction (alpha 1) and vasodilation (alpha 2).
   B) vasodilation (alpha 1) and vasoconstriction (alpha 2).
   C) bronchodilation and increased heart rate.
   D) increased heart rate (alpha 1) and increased contractility (alpha 2).

Answer 4

A) vasoconstriction (alpha 1) and vasodilation (alpha 2).

Alpha 1 vasoconstriction (AnacONEda constricts)
Alpha 2

1 always constrict
2 always dilate

Question 5

5. A healthy 40-year-old man was sitting and having his blood drawn for routine labs. He suddenly becomes faint and his heart rate and blood pressure drop. He quickly awakens. What caused these symptoms?
   A) His vagus nerve was stimulated.
   B) His blood sugar dropped.
   C) He had a seizure.
   D) He had an episode of postural hypotension.

Answer 5

A) His vagus nerve was stimulated.

Question 6

6. Factor(s) that affect stroke volume include:
   A) preload.
   B) heart rate.
   C) contractility.
   D) afterload.
   E) preload, contractility, and afterload

Answer 6

E) preload, contractility, and afterload

Question 7

7. The renin-angiotensin-aldosterone pathway:
   A) is activated by renin.
   B) acts to decrease loss of sodium in urine.
   C) increases in activity in response to blood loss.
   D) can be blocked to help lower blood pressure.
   E) All of the above

Answer 7

E) All of the above

Question 8

8. What is the mechanism of death following cardiac tamponade?
   A) Impaired cardiac contraction due to inflammation surrounding a myocardial infarction
   B) Compression of the heart by the blood on the pericardial sac, which impairs filling in diastole
   C) Overdistension of the ventricles due to heart failure
   D) Venous pressure rises and pulse pressure widens

Answer 8

B) Compression of the heart by the blood on the pericardial sac, which impairs filling in diastole

Question 9

9. A 62-year-old man had a left ventricular myocardial infarction 6 weeks ago. He arrives at the emergency room complaining of chest pain that is sharp and came on suddenly. The pain is in the front of his chest. He states when he breaths in it hurts more and sitting up and leaning forward decreases the pain. A 12-lead electrocardiogram will most likely reveal:
   A) ST segment elevation in the left ventricle leads.
   B) ST segment depression in the left ventricle leads.
   C) diffuse ST segment elevation.
   D) new Q waves with reciprocal changes.

Answer 9

C) diffuse ST segment elevation.

Pericarditis - ekg shows diffuse ST segment elevation

Question 10

10. Which of the following statements related to infective endocarditis (bacterial endocarditis) is not
    correct?
    A) It is a complication of valvular heart disease.
    B) Fibrin-platelet thrombi form on rough valve surface; bacteria implant in the thrombus and incite inflammation.
    C) Microorganisms never implant on a normal heart valve.
    D) Part of valve vegetations may break loose and be carried into the circulation as emboli.

Answer 10

C) Microorganisms never implant on a normal heart valve.

Question 11

11. A patient presents to the emergency department complaining of severe chest pain. On examination, you note a temperature of 102.5ºF, a white blood count of 20,000/μL, and a friction rub near the lower left sternal border when the breath is held. What is the likely diagnosis?
    A) Pleuritis
    B) Pneumonia
    C) Myocarditis
    D) Pericarditis

Answer 11

D) Pericarditis

Friction rub LL sternal border

Question 12

12. With mitral valve prolapse, the leaflets:
    A) are narrow impeding forward blood flow during systole.
    B) prolapse into the right atrium causing altered flow.
    C) collapse into the left atrium during systole.
    D) calcify, which prevents proper opening.

Answer 12

C) collapse into the left atrium during systole.

Question 13

13. A 70-year-old woman comes in after a syncopal episode. She said she fainted while she was gardening. She said she’s been feeling a bit fatigued and short of breath but attributes this to not sleeping well. On examination, a systolic murmur is heard. Based on these findings, a common valvular disorder, and the most likely, is:
    A) mitral regurgitation.
    B) mitral stenosis.
    C) aortic regurgitation.
    D) aortic stenosis.

Answer 13

D) aortic stenosis.

ASSD = angina, syncope, systolic murmur, dyspnea

Question 14

14. An 80-year-old patient in the intensive care unit with an overwhelming systemic infection begins to exhibit splinter hemorrhages under her fingernails, hematuria, and petechia. What would be a likely cause?
    A) Cardiac tamponade
    B) Infective endocarditis
    C) Dilated cardiomyopathy
    D) Pericarditis

Answer 14

B) Infective endocarditis

Vegetation dislodges, causing splinter hemorrhages

Question 15

15. A 55-year-old man has been complaining of feeling short of breath, which he feels has been worsening over the past 4–5 months. He smokes one pack of cigarettes per day for the last 30 years, and he is a recovering alcoholic. He reports being sober for the past 6 months. A transthoracic doppler reveals systolic dysfunction. Which type of cardiomyopathy is most likely present?
    A) Restrictive cardiomyopathy
    B) Hypertrophic cardiomyopathy with obstruction
    C) Hypertrophic cardiomyopathy without obstruction
    D) Dilated cardiomyopathy

Answer 15

D) Dilated cardiomyopathy

The only cardiomyopathy with systolic dysfunction

Question 16

16. A 19-year-old athlete went out for his first day of football practice. He experienced sudden cardiac death. The cause of death was determined to be cardiomyopathy. It was most likely cardiomyopathy.
    A) dilated
    B) hypertrophic
    C) restrictive
    D) dystrophic

Answer 16

B) hypertrophic

Common cause of sudden cardiac death in young people

Hypertrophied ventricle wall d/t overworked heart

May see peaked QRS

Question 17

17. A 40-year-old man has a family history of one brother who died of heart disease at the age of 30 and a cousin who had a heart attack at the age of 40. He doesn’t know his history on his father’s side, and his mother is 75 years old and is healthy other than hypertension. He had a transthoracic echocardiogram that reveals thick, stiff ventricular walls particularly in the interventricular septum. There is reduced relaxation during ventricular filling and diastolic dysfunction. These findings are consistent with:
    A) dilated cardiomyopathy.
    B) hypertrophic cardiomyopathy.
    C) restrictive cardiomyopathy.
    D) dystrophic cardiomyopathy.

Answer 17

B) hypertrophic cardiomyopathy.

Hint- thick ventricle walls

Question 18

18. A 62-year-old woman is complaining of palpitations and feeling dizzy. She said this happened yesterday, and she sat down and it went away. She has a history of hypertension and is taking irbesartan (an angiotensin receptor blocker). Her vital signs are as follows: temperature, 98.8 ºF; pulse irregular, 110 beats per minute; respiratory rate, 20 per minute; and blood pressure, 110/70 mm/Hg. An electrocardiogram will likely reveal:
    A) ventricular tachycardia.
    B) sinus tachycardia.
    C) atrial fibrillation.
    D) second-degree atrioventricular block.

Answer 18

C) atrial fibrillation.

Question 19

19. Patients with atrial fibrillation are commonly prescribed anticoagulation to:
    A) decrease the heart rate.
    B) prevent myocardial infarction.
    C) prevent heart failure.
    D) prevent ischemic stroke.

Answer 19

D) prevent ischemic stroke.

Question 20

20. The CHA2DS2-VASc criteria used to determine the risk for thromboembolism with atrial fibrillation includes:
    A) diabetes insipidus.
    B) hypertension.
    C) gender.
    D) age.
    E) hypertension, gender, and age.

Answer 20

E) hypertension, gender, and age.

Question 21

21. Which of the following is a characteristic of ventricular remodeling in heart failure?
    A) Results in left ventricle dilation and hypertrophy
    B) Causes beta adrenergic desensitization with decrease in heart rate
    C) Causes preload reduction and subsequent fluid retention
    D) Results in improved contractility due to decreased myocyte loss

Answer 21

A) Results in left ventricle dilation and hypertrophy

Question 22

22. A patient with a history of myocardial infarction is told he has stage C heart failure, and he wants to know what this means. The description provided will include:
    A) stage C means you are at risk for heart failure.
    B) stage C means your heart failure was due to coronary disease.
    C) staging is used to determine the severity of heart failure, and stage C means you are showing clinical signs of heart failure.
    D) stage C refers to your functional capacity and ability to do things with activity.

Answer 22

C) staging is used to determine the severity of heart failure, and stage C means you are showing clinical signs of heart failure.

Question 23

23. An infant is diagnosed with a small patent ductus arteriosus (PDA). Which of the following is accurate pertaining to this case?
    A) The infant has an opening between the right and left atria.
    B) The infant will likely have difficulty breathing and difficulty with feeding and gaining weight.
    C) The infant has an opening between the pulmonary artery and aorta.
    D) The infant will be cyanotic.

Answer 23

C) The infant has an opening between the pulmonary artery and aorta.

Question 24

24. An infant is diagnosed with a small ventricular septal defect (VSD). Which of the following is accurate pertaining to this case?
    A) The infant will most likely be asymptomatic.
    B) Pulmonary blood flow is usually decreased.
    C) The infant will have a murmur and cyanosis.
    D) Shunting goes from the right ventricle to the left ventricle.

Answer 24

A) The infant will most likely be asymptomatic.

Question 25

25. A patient with a history of stable angina states that he has recently experienced an increase in the number of attacks, which occur at times when he is walking. What should you suspect?
    A) The patient continues to have stable angina.
    B) The patient has developed unstable angina.
    C) The patient has experienced an acute MI.
    D) The patient has a subendocardial necrosis.

Answer 25

B) The patient has developed unstable angina.

Angina = unstable when increased frequency, or occurs at rest

Question 26

26. Why do cardiac enzymes rise after an acute myocardial infarction?
    A) White cells are attracted to the site of muscle injury.
    B) Injured fibers increase their synthesis of cardiac muscle enzymes.
    C) Cardiac enzymes leak from the damaged muscle fibers into the bloodstream.
    D) Blood flow to the injured muscle is increased.

Answer 26

C) Cardiac enzymes leak from the damaged muscle fibers into the bloodstream.

Question 27

27. A 12-lead EKG is conducted on a 65-year-old woman with a history of type 2 diabetes mellitus. Which of the following findings represent an area that is electrically dead?
    A) ST segment depression
    B) ST segment elevation
    C) Pathologic Q waves
    D) Prolonged ST segment

Answer 27

C) Pathologic Q waves

Question 28

28. A fever; dry, cracked lips; a reddish tongue; and a rash on the extremities is characteristic of which vascular disorder in children?
    A) Raynaud disease
    B) Kawasaki disease
    C) Eisenmenger syndrome
    D) Buerger disease

Answer 28

B) Kawasaki disease

Question 29

29. In a patient with acute coronary syndrome, what is the goal time from presentation to hospital to opening of the artery (i.e., door-to-balloon time)?
    A) 30 minutes or less
    B) 60 minutes or less
    C) 90 minutes or less
    D) 120 minutes or less

Answer 29

C) 90 minutes or less

Question 30

30. The most likely place for a thrombosis to form postoperatively is:
    A) the lungs.
    B) the left side of the heart.
    C) the legs.
    D) anywhere in the body.

Answer 30

C) the legs.

Question 31

31. A severely obese patient presents to the clinic with edema of the right lower extremity that is impairing ambulation. On inspection, the healthcare provider notes that the edema does not indent with pressure, the skin on the right lower extremity is thick and rough, and distal pulses are present and equal bilateral. The healthcare provider should expect which of the following?
    A) Peripheral vascular disease
    B) Congestive heart failure
    C) Deep vein thrombosis
    D) Lymphedema

Answer 31

D) Lymphedema

Question 32

32. Which of the following individuals is the most likely to have a silent myocardial infarction (MI)?
    A) A young male who smokes
    B) A middle-aged female who has hypertension
    C) A 40-year-old pregnant female
    D) An obese male diagnosed with diabetes mellitus

Answer 32

D) An obese male diagnosed with diabetes mellitus

Question 33

33. Preeclampsia develops as a result of:
    A) placental vascular alterations stimulating the maternal inflammatory response.
    B) increased placental perfusion as a result of shunting from the mother.
    C) development of antibodies against the placenta.
    D) fluid overload from physiological volume increases in pregnancy.

Answer 33

A) placental vascular alterations stimulating the maternal inflammatory response.

Question 34

34. Which of the following clinical manifestations is a compensatory mechanism to the initial stage of shock?
    A) Decreased mean arterial pressure
    B) Elevated body temperature
    C) Vascular vasodilation
    D) Increased heart rate

Answer 34

D) Increased heart rate

Question 35

35. Septic shock is commonly caused by:
    A) gram-positive bacteria.
    B) gram-negative bacteria.
    C) fungal organisms.
    D) viral organisms.

Answer 35

B) gram-negative bacteria.

Question 36

36. Which of the following strategies is implemented when sepsis is suspected?
    A) Administer anticoagulants.
    B) Administer fluids if lactate levels are low.
    C) Administer broad spectrum antibiotics.
    D) Administer glucocorticoids to reduce inflammation.

Answer 36

C) Administer broad spectrum antibiotics.

Question 37

1. Which statement does not accurately describe the pericardium?
   a. The pericardium is a double-walled membranous sac that encloses the heart.
   b. It is made up of connective tissue and a surface layer of squamous cells.
   c. The pericardium protects the heart against infection and inflammation from the lungs and pleural space.
   d. It contains pain and mechanoreceptors that can elicit reflex changes in blood pressure and heart rate.

Answer 37

b. It is made up of connective tissue and a surface layer of squamous cells.

Question 38

2. Which cardiac chamber has the thinnest wall and why?
   a. The right and left atria; they are low-pressure chambers that serve as storage units and conduits for blood.
   b. The right and left atria; they are not directly involved in the preload, contractility, or afterload of the heart.
   c. The left ventricle; the mean pressure of blood coming into this ventricle is from the lung, which has a low pressure.
   d. The right ventricle; it pumps blood into the pulmonary capillaries, which have a lower pressure compared with the systemic circulation.

Answer 38

a. The right and left atria; they are low-pressure chambers that serve as storage units and conduits for blood.

Question 39

3. Which chamber of the heart endures the highest pressures?
   a. Right atrium
   c. Left ventricle
   b. Left atrium
   d. Right ventricle

Answer 39

c. Left ventricle

Question 40

4. What is the process that ensures mitral and tricuspid valve closure after the ventricles are filled with blood?
   a. Chordae tendineae relax, which allows the valves to close
   b. Increased pressure in the ventricles pushes the valves to close.
   c. Trabeculae carneae contract, which pulls the valves closed.
   d. Reduced pressure in the atria creates a negative pressure that pulls the valves closed.

Answer 40

b. Increased pressure in the ventricles pushes the valves to close.

Question 41

5. Regarding the heart’s valves, what is a function of the papillary muscles?
   a. The papillary muscles close the semilunar valve.
   b. These muscles prevent backward expulsion of the atrioventricular valve.
   c. They close the atrioventricular valve.
   d. The papillary muscles open the semilunar valve.

Answer 41

b. These muscles prevent backward expulsion of the atrioventricular valve.

Question 42

6. During the cardiac cycle, why do the aortic and pulmonic valves close after the ventricles relax?
   a. Papillary muscles relax, which allows the valves to close.
   b. Chordae tendineae contract, which pulls the valves closed.
   c. Reduced pressure in the ventricles creates a negative pressure, which pulls the valves closed.
   d. Blood fills the cusps of the valves and causes the edges to merge, closing the valves.

Answer 42

d. Blood fills the cusps of the valves and causes the edges to merge, closing the valves.

Question 43

9. Occlusion of the left anterior descending artery during a myocardial infarction would interrupt blood supply to which structures?
   a. Left and right ventricles and much of the interventricular septum
   b. Left atrium and the lateral wall of the left ventricle
   c. Upper right ventricle, right marginal branch, and right ventricle to the apex
   d. Posterior interventricular sulcus and the smaller branches of both ventricles

Answer 43

a. Left and right ventricles and much of the interventricular septum

Question 44

10. Occlusion of the circumflex artery during a myocardial infarction would interrupt blood supply to which area?
    a. Left and right ventricles and much of the interventricular septum
    b. Posterior interventricular sulcus and the smaller branches of both ventricles
    c. Upper right ventricle, right marginal branch, and right ventricle to the apex
    d. Left atrium and the lateral wall of the left ventricle

Answer 44

d. Left atrium and the lateral wall of the left ventricle

Question 45

11. The coronary ostia are located in the:
    a. Left ventricle
    c. Coronary sinus
    b. Aortic valve
    d. Aorta

Answer 45

ANS: D
Coronary arteries receive blood through openings in the aorta, called the coronary ostia

Question 46

12. The coronary sinus empties into which cardiac structure?
    a. Right atrium
    c. Superior vena cava
    b. Left atrium
    d. Aorta

Answer 46

ANS: A
The cardiac veins empty only into the right atrium through another ostium, the opening of a large vein called the coronary sinus.

Question 47

14. During the cardiac cycle, which structure directly delivers action potential to the ventricular myocardium?
    a. Sinoatrial (SA) node c. Purkinje fibers
    b. Atrioventricular (AV) node
    d. Bundle branches

Answer 47

c. Purkinje fibers
Each cardiac action potential travels from the SA node to the AV node to the bundle of His (AV bundle), through the bundle branches, and finally to the Purkinje fibers and the ventricular myocardium, where the impulse is stopped. The refractory period of cells that have just been polarized prevents the impulse from reversing its path. The refractory period ensures that diastole (relaxation) will occur, thereby completing the cardiac cycle. This selection is the only option that accurately describes the structure that delivers the action potential directly to the myocardium

Question 48

15. What causes depolarization of a cardiac muscle cell to occur?
    a. Decrease in the permeability of the cell membrane to potassium
    b. Rapid movement of sodium into the cell
    c. Decrease in the movement of sodium out of the cell
    d. Rapid movement of calcium out of the cell

Answer 48

b. Rapid movement of sodium into the cell
Phase 0 consists of depolarization, which lasts 1 to 2 milliseconds (ms) and represents rapid sodium entry into the cell. This selection is the only option that accurately describes the cause of cardiac muscle cell depolarization.

Question 49

16. Which event occurs during phase 1 of the normal myocardial cell depolarization and repolarization?
    a. Repolarization when potassium moves out of the cells
    b. Repolarization when sodium rapidly enters into the cells
    c. Early repolarization when sodium slowly enters the cells
    d. Early repolarization when calcium slowly enters the cells

Answer 49

d. Early repolarization when calcium slowly enters the cells

Question 50

17. Which phase of the normal myocardial cell depolarization and repolarization correlates with diastole?
    a. Phase 1
    c. Phase 3
    b. Phase 2
    d. Phase 4

Answer 50

ANS: D
Potassium is moved out of the cell during phase 3, with a return to resting membrane potential only in phase 4. The time between action potentials corresponds to diastole.

Question 50

18. In the normal electrocardiogram, what does the PR interval represent?
    a. Atrial depolarization
    b. Ventricular depolarization
    c. Atrial activation to onset of ventricular activity
    d. Electrical systole of the ventricles

Answer 50

c. Atrial activation to onset of ventricular activity

Question 51

19. The cardiac electrical impulse normally begins spontaneously in the sinoatrial (SA) node because it:
    a. Has a superior location in the right atrium.
    b. Is the only area of the heart capable of spontaneous depolarization.
    c. Has rich sympathetic innervation via the vagus nerve.
    d. Depolarizes more rapidly than other automatic cells of the heart.

Answer 51

d. Depolarizes more rapidly than other automatic cells of the heart.
The electrical impulse normally begins in the SA node because its cells depolarize more rapidly than other automatic cells. This selection is the only option that accurately explains why cardiac electrical impulses normally begin spontaneously in the SA node.

Question 52

20. What period follows depolarization of the myocardium and represents a period during which no new cardiac potential can be propagated?
    a. Refractory
    c. Threshold
    b. Hyperpolarization d. Sinoatrial (SA)

Answer 52

a. Refractory

Question 53

22. What can shorten the conduction time of action potential through the atrioventricular (AV) node?
    a. Parasympathetic nervous system
    b. Catecholamines
    c. Vagal stimulation
    d. Sinoatrial node (SA)

Answer 53

b. Catecholamines
Catecholamines speed the heart rate, shorten the conduction time through the AV node, and increase the rhythmicity of the AV pacemaker fibers. This selection is the only option that can perform that function.

Question 54

23. If the sinoatrial (SA) node fails, then at what rate (depolarizations per minute) can the atrioventricular (AV) node depolarize?
    a. 60 to 70 c. 30 to 40
    b. 40 to 60 d. 10 to 20

Answer 54

b. 40 to 60

Question 55

24. What is the effect of epinephrine on β3 receptors on the heart?
    a. Decreases coronary blood flow.
    b. Supplements the effects of both β1 and β2 receptors.
    c. Increases the strength of myocardial contraction.
    d. Prevents overstimulation of the heart by the sympathetic nervous system.

Answer 55

d. Prevents overstimulation of the heart by the sympathetic nervous system.
β3 receptors are found in the myocardium and coronary vessels. In the heart, stimulation of these receptors opposes the effects of β1- and β2-receptor stimulation and negative inotropic effect.
Thus β3 receptors may provide a safety mechanism that decreases myocardial contractility to prevent overstimulation of the heart by the sympathetic nervous system. This selection is the only option that accurately describes the effect of epinephrine on β2 receptors on the heart.

Question 56

25. Where in the heart are the receptors for neurotransmitters located?
    a. Semilunar and atrioventricular (AV) valves
    b. Endocardium and sinoatrial (SA) node
    c. Myocardium and coronary vessels
    d. Epicardium and AV node

Answer 56

c. Myocardium and coronary vessels
Sympathetic neural stimulation of the myocardium and coronary vessels depends on the presence of adrenergic receptors, which specifically bind with neurotransmitters of the sympathetic nervous system. The β1 receptors are found mostly in the heart, specifically the conduction system (AV and SA nodes, Purkinje fibers) and the atrial and ventricular myocardium, whereas the β2 receptors are found in the heart and also on vascular smooth muscle. β3 receptors are also found in the myocardium and coronary vessels. This selection is the only option that accurately identifies the location of the receptors for neurotransmitters

Question 57

26. What enables electrical impulses to travel in a continuous cell-to-cell fashion in myocardial cells?
    a. Sarcolemma sclerotic plaques
    b. Intercalated disks
    c. Trabeculae carneae
    d. Bachmann bundles

Answer 57

ANS: B
Only intercalated disks, thickened portions of the sarcolemma, enable electrical impulses to spread quickly in a continuous cell-to-cell (syncytial) fashion.

Question 58

27. Within a physiologic range, what does an increase in left ventricular end-diastolic volume (preload) result in?
    a. Increase in force of contraction
    b. Decrease in refractory time
    c. Increase in afterload d. Decrease in repolarization

Answer 58

ANS: A
This concept is expressed in the Frank-Starling law; the cardiac muscle, like other muscles, increases its strength of contraction when it is stretched. This selection is the only option that accurately describes the result of an increase in preload.

Question 59

28. As stated in the Frank-Starling law, a direct relationship exists between the _____of the blood in the heart at the end of diastole and the ______of contraction during the next systole.
    a. Pressure; force
    b. Volume; strength
    c. Viscosity; force
    d. Viscosity; strength

Answer 59

b. Volume; strength
As stated in the Frank-Starling law, the volume of blood in the heart at the end of diastole (the length of its muscle fibers) is directly related to the force (strength) of contraction during the next systole. This selection is the only option that accurately describes the relationship associated with the Frank-Starling law.

Question 60

1. In the arterial-venous circulatory system, pressure is inversely related to:
   A) velocity.
   B) volume.
   C) tension.
   D) viscosity.

Answer 60

B) volume.

Question 61

2. Turbulent blood flow can be caused by a number of factors, including:
   A) increased velocity.
   B) short vessel length.
   C) high blood viscosity.
   D) layering of blood cells.

Answer 61

A) increased velocity.

Question 62

3. Heart muscle differs from skeletal muscle tissue by being able to generate:

A) contractions.
B) calcium influx.
C) action potentials.
D) sarcomere binding.

Answer 62

C) action potentials.

Question 63

4. During ventricular systole, closure of the atrioventricular (AV) valves coincides with:
   A) atrial chamber filling.
   B) aortic valve opening.
   C) isovolumetric contraction.
   D) semilunar valves opening.

Answer 63

C) isovolumetric contraction.

Question 64

5. The difference between the end-diastolic and end-systolic volumes is the:
   A) stroke volume.
   B) cardiac output.
   C) ejection fraction.
   D) cardiac reserve.

Answer 64

A) stroke volume.

Question 65

6. Preload represents the volume work of the heart and is largely determined by:
   A) venous blood return.
   B) vascular resistance.
   C) force of contraction.
   D) ventricular emptying.

Answer 65

A) venous blood return.

Question 66

7. A large increase in heart rate can cause:
   A) increased blood viscosity.
   B) loss of action potential.
   C) decreased stroke volume.
   D) reduced cardiac contractility.

Answer 66

C) decreased stroke volume.

Question 67

8. Long-term autoregulation of local blood flow in the microcirculation is mediated by:
   A) collateral circulation.
   B) arteriovenous shunting.
   C) autonomic nervous system.
   D) metabolic needs of the tissues.

Answer 67

A) collateral circulation.

Question 68

9. The tissue factor that contributes to humoral control of blood flow by causing vasoconstriction is:
   A) histamine.
   B) bradykinin.
   C) serotonin.
   D) nitric oxide.

Answer 68

C) serotonin.

Question 69

10 The parasympathetic nervous system causes a slowing of the heart rate by
. increasing:
A) norepinephrine.
B) vessel constriction.
C) vagus nerve activity.
D) smooth muscle tone.

Answer 69

C) vagus nerve activity.

Question 70

11 A patient has entered hypovolemic shock after massive blood loss in a car
. accident. Many of the patients peripheral blood vessels have consequently collapsed. How does the Laplace law account for this pathophysiologic phenomenon?
A) Blood pressure is no longer able to overcome vessel wall tension.
B) Decreasing vessel radii have caused a decrease in blood pressure.
C) Wall thickness of small vessels has decreased due to hypotension.
D) Decreases in wall tension and blood pressure have caused a sudden increase in vessel radii.

Answer 70

A) Blood pressure is no longer able to overcome vessel wall tension.

Question 71

12 In the days following a tooth cleaning and root canal, a patient has
. developed an infection of the thin, three-layered membrane that lines the heart and covers the valves. What is this patients most likely diagnosis?
A) Pericarditis
B) Endocarditis
C) Myocarditis
D) Vasculitis

Answer 71

B) Endocarditis

Question 72

13 Following several weeks of increasing fatigue and a subsequent diagnostic
. work-up, a patient has been diagnosed with mitral valve regurgitation.
Failure of this heart valve would have which of the following consequences?
A) Backup of blood from the right atrium into the superior vena cava
B) Backflow from the right ventricle to the right atrium during systole
C) Inhibition of the SA nodes normal action potential
D) Backflow from the left ventricle to left atrium

Answer 72

D) Backflow from the left ventricle to left atrium

Question 73

14 Harmful effects on cardiac action potential are most likely to result from a
. deficit of which of the following electrolytes?
A) Magnesium (Mg2+)
B) Chloride (Cl)
C) Potassium (K+)
D) Hydrogen carbonate (HCO3)

Answer 73

C) Potassium (K+)

Question 74

15 A male patient with a history of angina has presented to the emergency department with uncharacteristic chest pain and his subsequent ECG reveals T-wave elevation. This finding suggests an abnormality with which of the following aspects of the cardiac cycle?
A) Atrial depolarization
B) Ventricular depolarization
C) Ventricular repolarization
D) Depolarization of the AV node, bundle branches, and Purkinje system

Answer 74

C) Ventricular repolarization

Peaked t wave = high potassium. Potassium involved in repolarization

Question 75

16 A patient with a history of heart failure has been referred for an
. echocardiogram. Results of this diagnostic test reveal the following findings: heart rate 80 beats per minute; end-diastolic volume 120 mL; end-systolic volume 60 mL. What is this patients ejection fraction?
A) 200 mL
B) 50%
C) .80
D) 180 mL

Answer 75

B) 50%

Question 76

17 A patient with a diagnosis of secondary hypertension has begun to
. experience signs and symptoms that are ultimately suggestive of decreased cardiac output. Which of the following factors that determine cardiac output is hypertension likely to affect most directly?
A) Preload
B) Afterload
C) Contractility
D) Heart rate

Answer 76

B) Afterload

Question 77

18 A patient who lives with a diagnosis of angina pectoris has taken a
. sublingual dose of nitroglycerin to treat the chest pain he experienced while mowing his lawn. This drug has resulted in a release of nitric oxide, which will have what effect?
A) Smooth muscle relaxation of vessels
B) Decreased heart rate and increased stroke volume
C) Increased preload
D) Reduction of cardiac refractory periods

Answer 77

A) Smooth muscle relaxation of vessels

Question 78

19 Release of which of the following humoral factors will result in
. vasodilation?
A) Norepinephrine
B) Angiotensin II
C) Serotonin
D) Histamine

Answer 78

D) Histamine

Question 79

20 Which of the following factors is the primary governor of the local control of
. blood flow?
A) Action potential
B) The nutritional needs of the tissue involved
C) Cardiac contractility and preload
D) Feedback from arterial baroreceptors and chemoreceptors

Answer 79

B) The nutritional needs of the tissue involved

Question 80

What is an infection that can lead to valve stenosis?

Answer 80

Rheumatic fever
Often causes aortic or mitral stenosis seen in younger adults (30s)

Question 81

Clinical manifestations of aortic stenosis

Answer 81

Angina, dyspnea, syncope, systolic murmur

Bradycardia, LV hyper trophy

Question 82

Clinical manifestations of aortic regurgitation

Answer 82

Angina, fatigue, dyspnea, syncope, diastolic murmur, palpitations (hammer pulse)

Question 83

Clinical manifestations of mitral stenosis

Answer 83

Angina, fatigue, edema, ascites, pulmonary hypertension, orthopnea, palpitations, diastolic murmur, opening snap S1

Question 84

/Clinical manifestations of mitral regurgitation

Answer 84

Angina, left heart hyper trophy, dyspnea, dizziness, peripheral edema, palpitations, systole murmur

Question 85

normal bp

Answer 85

< 120/80

Question 86

elevated BP

Answer 86

120-129/<80

Question 87

stage 1 htn

Answer 87

BP 130-139/80-89
increased risk of cardiovascular disease? –> start meds, reassess in 1 month, if not < 130/80, consider change/increase treatment

Question 88

stage 2 htn

Answer 88

140/90
initiate nonpharm and pharm therapies
reasses in 1 month, if not >130/80, consider change/increase in treatment