Eggena 5-1

Question 1

A chest x ray shows

Answer 1

dilated lymphatics from the excess fluid in the pulmonary interstitium

Question 2

the ECG shows

Answer 2

Q waves and ST segment elevations.

Question 3

A blood sample revaled

Answer 3

marked elevation of myocardial band isozyme of creatinine phosphokinase (MB-CPK) and troponin.

Question 4

the woman sustained a massive transmural

Answer 4

myocardial infarction involving the inferior portions of the left ventricle, as indicated by the deep Q waves and ST segment elevations and the elevated MB-CPK.

Question 5

isozyme most specific for myocardial infarction

Answer 5

MB-CPK

Question 6

when muscle in the left ventricle has been injured, the ability of the left ventricle to develop pressure and eject blood into circulation during systole is

Answer 6

diminished (decreased cardiac output)

Question 7

the diminished cardiac output had been sensed by the

Answer 7

baroreceptors in the carotid sinuses. it reflexively increased heart rate by increasing sympathetic tone. s

Question 8

signs of sympathetic compensation

Answer 8

tachycardia

diaphoresis

pallor

peripheral cyanosis

Question 9

Despite normal blood pressure, she remained in

Answer 9

circulatory shock.

Question 10

pulse of patient in shock

Answer 10

wak and thready due to pulse pressure being reduced.

Question 11

the pulse pressure depends on the amount of

Answer 11

blood ejected by the left ventricle during systole and upon the vigor with which the stroke volume is ejected.

Question 12

soft first heart sound caused by

Answer 12

the inability to rapidly raise intraventricular pressure during early systole, which resulted in a slow closure of the mitral valve.

Question 13

Cause of the third heart sound

Answer 13

A left ventricle cannot eject all the blood with which it fills during diastole and becomes distended. Early during diastole when blood flows rapidly into such a dilated left ventricular chamber, an abnormalheart sound is produced.

Question 14

cause of the fourth heart sound

Answer 14

results when the left atrium ejects blood into a left ventricular chamber with walls that have been siffened by a recent myocardial infarction.

Question 15

the left ventricular pressure during diastole is similar to

Answer 15

pulmonary artery wedge pressure

Question 16

when the PAWP exceeds the plasma oncotic pressure

Answer 16

fluid accumulates in the pulmonary interstitium and becomes congested.

Question 17

the presence of edema fluid in her alveoli was detected as

Answer 17

moist rales

Question 18

congested lungs are stiffer than normal

Answer 18

and thus more work is needed to expand them on inspiration.

Question 19

the difficulty in breathing is made a little easier by taking shallow breaths, but

Answer 19

doing so more rapidly

Question 20

the ability of the left ventricle to eject a given stroke volume depends on four factors:

Answer 20

preload (proportional to PAWP)

afterload (proportional to mean aortic pressure)

ventricular muscle mass

ventricular contractility

Question 21

ventricular contractility

Answer 21

the ability of ventricular muscle fibers to generate tension, which is increased by beta-1-adrenergic receptor agonists or by stimulation of sympathetic nerves.

Question 22

three basic aims in the treatment of the patient

Answer 22

reduce preload (PAWP)

reduce afterload (peripheral vascular resistance)

increase left ventricular contractility

Question 23

to reduce preload

Answer 23

administer nitroglycerine (is a vasodilator that allows more blood to be stored in veins and less to the heart).

Question 24

to reduce afterload

Answer 24

phentolamine is prescribed. It lbocks the action of epinephrine and norepinephrine on alpha-1-adrenergic receptors.

Question 25

to increase cardiac output

Answer 25

administer dobutamine (makes the left ventricle pump more forcefully by stimulating beta-1-adrenergic receptors.