Exam 4 Flashcards
5 phases of cardiac cycle
Phase 1: Atrial systole or ventricular diastole
Phase 2: Isovolumetric ventricular systole
Phase 3: Ventricular ejection (semilunar valves open)
Phase 4: Isovolumetric ventricular relaxation (aortic valve closes)
Phase 5: Passive ventricular filling (mitral & tricuspid valves open)
shortens conduction time through AV node
acetylcholine
permit rapid transmission of theaction potentialinto the cell
T-tubules
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.
d. Blood fills the cusps of the valves and causes the edges to merge, closing the valves.
During the cardiac cycle, which structure directly delivers action potential to the ventricular myocardium?
a. Sinoatrial (SA) node
b. Atrioventricular (AV) node
c. Purkinje fibers
d. Bundle branches
c. Purkinje fibers
A patient has a problem with Phase 0 of the cardiac cycle. What electrolyte imbalance would the healthcare professional associate most directly with this problem?
a. Hyperkalemia
b. Hyponatremia
c. Hypercalcemia
d. Hypomagnesemia
b. Hyponatremia
What period follows depolarization of the myocardium and represents a period during which no new cardiac potential can be propagated?
a. Refractory
b. Hyperpolarization
c. Threshold
d. Sinoatrial (SA)
a. Refractory
A patient has a disorder affecting ventricular depolarization. What ECG finding would the healthcare professional associate with this condition?
a. Shortened PR interval
b. Prolonged QRS interval
c. QT interval variability
d. Absence of P waves
b. Prolonged QRS interval
What is the effect of epinephrine on E3 receptors on the heart?
a. Decreases coronary blood flow
b. Supplements the effects of both E1 and E2 receptors
c. Increases the strength of myocardial contraction
d. Prevents overstimulation of the heart by the sympathetic nervous system
d. Prevents overstimulation of the heart by the sympathetic nervous system
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
a. Increase in force of contraction
The resting heart rate in a healthy person is primarily under the control of which nervous system?
a. Sympathetic
b. Parasympathetic
c. Somatic
d. Spinal
b. Parasympathetic
What is the initiating event that leads to the development of atherosclerosis?
a. Release of the inflammatory cytokines
b. Macrophages adhere to vessel walls.
c. Injury to the endothelial cells that line the artery walls
d. Release of the platelet-deprived growth factor
c. Injury to the endothelial cells that line the artery walls
When endothelial cells are injured, what alteration contributes to atherosclerosis?
a. The release of toxic oxygen radicals that oxidize low-density lipoproteins (LDLs)
b. Cells are unable to make the normal amount of vasodilating cytokines.
c. Cells produce an increased amount of antithrombotic cytokines.
d. Cells develop a hypersensitivity to homocysteine and lipids.
b. Cells are unable to make the normal amount of vasodilating cytokines.
What effect does atherosclerosis have on the development of an aneurysm?
a. Atherosclerosis causes ischemia of the intima.
b. It increases nitric oxide.
c. Atherosclerosis erodes the vessel wall.
d. It obstructs the vessel
c. Atherosclerosis erodes the vessel wall.
Nicotine increases atherosclerosis by the release of which neurotransmitter?
a. Histamine
b. Nitric oxide
c. Angiotensin II
d. Epinephrine
d. Epinephrine
Which elevated value may be protective of the development of atherosclerosis?
a. Very low-density lipoproteins (VLDLs)
b. Low-density lipoproteins (LDLs)
c. High-density lipoproteins (HDLs
d. Triglycerides
c. High-density lipoproteins (HDLs
Which laboratory test is an indirect measure of atherosclerotic plaque?
a. Homocysteine
b. Low-density lipoprotein (LDL)
c. Erythrocyte sedimentation rate (ESR)
d. C-reactive protein (CRP)
d. C-reactive protein (CRP)
In systolic heart failure, what effect does the renin-angiotensin-aldosterone system (RAAS) have on stroke volume?
a. Increases preload and decreases afterload
b. Increases preload and increases afterload
c. Decreases preload and increases afterload
d. Decreases preload and decreases afterload
b. Increases preload and increases afterload
Which of the following events initiates the process of atherosclerosis?
Oxidation of LDL in the vessel wall
Formation of the fatty streak in the tunica media
Thrombosis in the vessel lumen
Endothelial injury and release of cytokines
Endothelial injury and release of cytokines
The most common consequence of atherosclerosis is:
A. increased blood flow through the diseased vessels.
B. formation of aneurysms.
C. autoimmune destruction of the vessel wall.
D. obstruction of the blood vessel lumen.
D. obstruction of the blood vessel lumen.
Which of the following white blood cells play a role in the development of the fatty streak in atherosclerosis?
Mast cells
Neutrophils
Macrophages
Lymphocytes
Macrophages
Which of the following forms of dyslipidemia is associated with the development of the fatty streak in atherosclerosis?
High LDL
Low LDL
High HDL
Low triglycerides
A) High LDL
Growth factors, including Angiotensin II, contribute to the development of atherosclerosis by stimulating which of the following events?
Smooth muscle proliferation
Endothelial injury
Cardiac muscle toxicity
Activation of phagocytes
smooth muscle proliferation
A risk factor that is associated with atherosclerosis and primary hypertension is:
a high-sodium diet.
advanced age.
hyperhomocysteinemia.
a low-potassium diet.
A) advanced age.
Atherosclerosis of the aorta can cause isolated systolic hypertension by:
promoting thrombus formation.
stimulating increased cardiac output.
decreasing arterial distensibility.
increasing lumen diameter.
decreasing arterial distensibility.
Congestive heart failure (CHF) results in which of the following intraventricular hemodynamic changes?
Increased left ventricular preload
Increased ejection fraction
Decreased right ventricular preload
Decreased right ventricular end-diastolic pressure
Increased left ventricular preload
Of the following diseases, which is the most common cause of right heart failure?
Primary hypertension
Infective endocarditis
Left heart failure
Pericarditis
Left heart failure
Manifestations of increased left atrial and pulmonary venous pressures in left (congestive) heart failure include:
syncope.
weak pulses and decreased skin temperature.
oliguria.
dyspnea and cough.
dyspnea and cough.
a net movement of sodium into the cell, and the membrane potential decreases, or “moves forward,” from a negative value (in millivolts) to zero
depolarization
negative polarity of the resting membrane potential is reestablished.
repolarization
Activation
Inside of the cell becomes less negatively charged.
depolarization
: Deactivation
Membrane potential
repolarization
6 steps of action potential
phase 4 - resting potential
phase 0 - sodium channels open
phase 1 - sodium channels close
phase 2 - calcium channels open/ fast K channels close
phase 3 - calcium channels close/ slow K channel open
phase 4- resting potential,
Increases electrical conductivity and the strength of the myocardial contraction
Sympathetic nerves
Slows conduction of action potentials through the heart and reduces the strength of contraction.
Parasympathetic nerves (vagal)
increased filling pressure of the right heart results in increased cardiac output.
Frank-Starling law of the heart
Is the pressure generated at the end of diastole.
Preload
also called left ventricular end-diastolic pressure (LVEDP).
two primary factors of preload
Amount of venous return to the ventricle
Blood left in the ventricle after systole or end-systolic volume
When _____ exceeds physiologic range, further muscle stretching causes a decline in cardiac output.
preload
Is the resistance to ejection during systole.
Afterload
is a good index of afterload for the left ventricle.
Aortic systolic pressure
_________ afterload: Heart contracts more rapidly.
Decreased
________ afterload: Slows contractions and increases work load.
Increased
Which event triggers congenital heart defects that cause acyanotic congestive heart failure?
a. Right-to-left shunts
b. Left-to-right shunts
c. Obstructive lesions
d. Mixed lesions
b. Left-to-right shunts
the heart is unable to generate an adequate cardiac output such that inadequate perfusion of tissues or increased diastolic filling pressure of the left ventricle, or both, occurs; consequently, pulmonary capillary pressures are increased
heart failure
heart failure with reduced ejection fraction
left heart failure (congestive HF)
type of HF with enlarged ventricles
pump out 40-50 % less blood
systolic
reduced EF
type of HF with stiff ventricles that fill less blood than usual
diastolic
preserved EF
% of blood pumped out of the heart relative to amount of blood present at end-diastole
Ejection fraction (EF):
s/s (Peripheral Edema) Exercise intolerance Elevated JVD Tachycardia HSM Increased abdominal girth (ascites) Peripheral edema (feet, ankles, legs) Increased CVP
right sided HF
s/ (Pulmonary Edema) Exercise intolerance Change in level of responsiveness Tachycardia Crackles, wheezes, hemoptyisis Decreased uop below 30cc/2 hours S3 hesart sound Increased PAWP
left sided HF
is defined as the inability of the right ventricle to provide adequate blood flow into the pulmonary circulation at a normal central venous pressure
Right heart failure
thickening and hardening of the vessel are caused by the accumulation of lipid-laden macrophages within the arterial wall, which leads to the formation of a lesion called a plaque.
Atherosclerosis
chronic inflammatory condition that results from the interaction of numerous pathophysiologic processes culminating in damage to arterial walls.
Atherosclerosis
begins with injury to the endothelial cells that line artery walls
Atherosclerosis
Symptoms and signs are the result of inadequate perfusion of tissues.
Atherosclerosis
The most important negative inotropic agent
acetylcholine released from the vagus nerve
affect contractility and include hormones, neurotransmitters, or medication
Inotropic agents
________ and ______, are the most important endogenous positive inotropic agents
epinephrine and norepinephrine,
Increases force of contraction
Positive inotropy:
Decreases force of contraction
Negative inotropy:
Erythrocyte lifespan
120 days
Is the process of blood cell production in adult bone marrow or in the liver and/or spleen of the fetus.
Hematopoiesis
Fetal hematopoiesis occurs primarily in which structure?
a. Gut
b. Spleen
c. Bone marrow
d. Thymus
b. Spleen
6 steps in the iron cycle
Bone marrow Erythrocyte Production Erythrocytes Erythrocyte Destruction Reticulo-endothelial System Plasma iron
Which nutrients are necessary for hemoglobin synthesis? (Select all that apply.)
a. Protein
b. Iron
c. B6 (pyridoxine)
d. Vitamin C
e. Cobalamin (vitamin B12)
f. Pantothenic acid
b. Iron
c. B6 (pyridoxine)
Is the oxygen carrying protein of the erythrocyte
Hemoglobin
1 erythrocyte, 300 hemoglobin molecules
Heme is synthesized in the _________ and can carry one molecule of oxygen
mitochondria
Most plasma proteins are produced by the____
liver.
Which statements about plasma proteins are correct? (Select all that apply.)
a. Provide clotting factors.
b. Transport triglycerides.
c. Synthesize complement proteins.
d. Create hydrostatic pressure.
e. Transport cholesterol.
a. Provide clotting factors.
b. Transport triglycerides.
c. Synthesize complement proteins.
e. Transport cholesterol.
Which statements characterize albumin? (Select all that apply.)
a. It retains sodium to maintain water balance.
b. It provides colloid osmotic pressure.
c. It is synthesized in the liver.
d. It is a carrier for drugs that have low water solubility.
e. It is a small molecule.
b. It provides colloid osmotic pressure.
c. It is synthesized in the liver.
d. It is a carrier for drugs that have low water solubility.
What is the effect of low plasma albumin?
a. Clotting factors decrease, thus increasing the chance of prolonged bleeding.
b. Fewer immunoglobulins are synthesized, thus impairing the immune function.
c. Less iron is stored, thus increasing the incidence of iron deficiency anemia.
d. Osmotic pressure decreases; thus water moves from the capillaries to the interstitium.
d. Osmotic pressure decreases; thus water moves from the capillaries to the interstitium.
What is the most abundant class of plasma protein?
a. Globulin
b. Albumin
c. Clotting factors
d. Complement proteins
b. Albumin
What is the role of thromboxane A (TXA2) in the secretion stage of hemostasis?
a. Stimulates the synthesis of serotonin.
b. Promotes vasodilation.
c. Stimulates platelet aggregation.
d. Promotes formation of cyclooxygenase
c. Stimulates platelet aggregation
Counters the effects of PGI2 produced by endothelial cells
Thromboxane A2
performed to evaluate vitamin B12 absorption.
Schillings test
A patient has polycythemia vera and presents to the Emergency Department with plethora and
neurological changes. The student asks the healthcare professional to explain the primary cause
of these symptoms. What response by the professional is best?
a. Decreased erythrocyte count
b. Destruction of erythrocytes
c. Increased blood viscosity
d. Tissue destruction by macrophages
c. Increased blood viscosity
What does treatment for polycythemia vera involve?
a. Therapeutic phlebotomy and radioactive phosphorus
b. Restoration of blood volume by plasma expanders
c. Administration of cyanocobalamin
d. Blood transfusions
a. Therapeutic phlebotomy and radioactive phosphorus
What is the cause of polycythemia in the fetus?
a. Fetal hemoglobin has a greater affinity for oxygen as a result of diphosphoglycerate (DPG).
b. The fetus has a different hemoglobin structure of two - and two -chains rather than two -and two -chains.
c. Increased erythropoiesis occurs in response to the hypoxic intrauterine environment.
d. The lungs of the fetus are undeveloped and unable to diffuse oxygen adequately to the pulmonary capillaries
c. Increased erythropoiesis occurs in response to the hypoxic intrauterine environment
A patient is admitted to the hospital with multiple myeloma (MM). Which diagnostic test should the healthcare professional assess as the priority?
a. Serum potassium level
b. Serum calcium level
c. Bone scan or limb x-rays
d. Bone marrow biopsy
b. Serum calcium level
In infectious mononucleosis (IM), what does the Monospot test detect?
a. Immunoglobulin E (IgE)
b. Immunoglobulin M (IgM)
c. Immunoglobulin G (IgG)
d. Immunoglobulin A (IgA)
b. Immunoglobulin M (IgM)
Which classic clinical manifestations are symptoms of infectious mononucleosis (IM)? (Select all that apply.)
a. Lymph node enlargement
b. Hepatitis
c. Pharyngitis
d. Edema in the area of the eyes
e. Fever
a. Lymph node enlargement
c. Pharyngitis
e. Fever
Multiple Myeloma acronym
Calcium elevation
Renal complications
Anemia
Bone disease
a complex aqueous liquid containing a variety of organic and inorganic elements
plasma
What are the primary anticoagulant mechanisms? (Select all that apply.)
a. Antithrombin III
b. Tissue factor pathway inhibitor
c. Hematopoiesis
d. Protein C
e. Phagocytosis
a. Antithrombin III
b. Tissue factor pathway inhibitor
d. Protein C
is abundant in vascular subendothelium and adventitial cells surrounding larger blood vessels and body organs, particularly the skin, brain, lungs, kidney, and placenta.
Tissue thromboplastin
hich hemoglobin is made from oxidized ferric iron (Fe3+) and lacks the ability to bind oxygen?
a. Deoxyhemoglobin
b. Oxyhemoglobin
c. Methemoglobin
d. Glycosylated hemoglobin
c. Methemoglobin
Which form of iron (Fe) can be used in the formation of normal hemoglobin?
a. Fe+
b. Fe2+
c. Fe3+
d. Fe4+
b. Fe2+
A patient has pernicious anemia and asks the healthcare professional to explain the disease.
Which statement by the professional is most accurate?
a. The lack of certain foods in your diet
b. Your body cannot absorb vitamin B12.
c. You are not getting enough vitamin C.
d. Your bone marrow has stopped working.
b. Your body cannot absorb vitamin B12
A patient has chronic anemia associated with chronic renal failure. What substance does the healthcare professional tell the patient is needed to treat this anemia?
a. Iron
b. Erythropoietin
c. Cobalamin (vitamin B12)
d. Folate
b. Erythropoietin
What term is used to describe the capacity of some erythrocytes to vary in size, especially in relationship to some anemias?
a. Poikilocytosis
b. Isocytosis
c. Anisocytosis
d. Microcytosis
c. Anisocytosis
What is the fundamental physiologic manifestation of anemia?
a. Hypotension
b. Hyperesthesia
c. Hypoxia
d. Ischemia
c. Hypoxia
The paresthesia that occurs in vitamin B12 deficiency anemia is a result of which of these?
a. Reduction in acetylcholine receptors in the postsynaptic nerves
b. Myelin degeneration in the spinal cord
c. Destruction of myelin in peripheral nerves
d. Altered function of neurons in the parietal lobe
b. Myelin degeneration in the spinal cord
Which of these describes how the body compensates for anemia?
a. Increasing rate and depth of breathing
b. Decreasing capillary vasoconstriction
c. Hemoglobin holding more firmly onto oxygen
d. Kidneys releasing more erythropoietin
a. Increasing rate and depth of breathing
Which of these classified as a megaloblastic anemia?
a. Iron deficiency
b. Pernicious
c. Sideroblastic
d. Hemolytic
b. Pernicious
A patient has defective secretion of the intrinsic factor leading to anemia. What treatment option does the healthcare professional discuss with the patient?
a. Increasing iron sources in the diet such as red meat.
b. Vitamin B12 injections initially given once a week.
c. Having relatives tested for bone marrow donation.
d. Better control of the patient’s underlying disorder.
b. Vitamin B12 injections initially given once a week
After a person has a subtotal gastrectomy for chronic gastritis, which type of anemia will result?
a. Iron deficiency
b. Aplastic
c. Folic acid
d. Pernicious
d. Pernicious
Which condition resulting from untreated pernicious anemia (PA) is fatal?
a. Brain hypoxia
b. Liver hypoxia
c. Heart failure
d. Renal failure
c. Heart failure
Which anemia produces small, pale erythrocytes?
a. Folic acid
b. Hemolytic
c. Iron deficiency
d. Pernicious
c. Iron deficiency
. A patient in the healthcare clinic reports fatigue, weakness, and dyspnea, as well as pale conjunctiva of the eyes and brittle, concave nails. What assessment by the healthcare professional is most appropriate for the suspected anemia?
a. Blood pressure and apical pulse
b. Oral mucus membranes and tongue
c. Ability to swallow foods and liquids
d. Skin and sclera for normal coloration
b. Oral mucus membranes and tongue
A healthcare professional in an urban clinic is seeing a patient who has iron deficiency anemia (IDA). What question by the professional is most appropriate to assess for the cause of IDA?
a. “How many times a week do you have iron-rich foods?”
b. “Have you ever noticed any blood in your stool?”
c. “Do you have a history of heart valve replacement?”
d. “Have you had any recent viral infections?”
b. “Have you ever noticed any blood in your stool?”
A healthcare professional works with recent refugees. A mother brings in her children who have been diagnosed with iron deficiency anemia. What action by the professional is most appropriate?
a. Educate the mother on an iron-rich diet.
b. Arrange to test for parasitic infections.
c. Explain the weekly iron infusions.
d. Teach the mother to give iron supplements.
b. Arrange to test for parasitic infections.
A healthcare professional is reviewing a patient’s laboratory results and sees that the patient has
a low reticulocyte count and a high iron level. Which type of anemia does the professional associate these findings with?
a. Folate deficiency anemia
b. Iron deficiency anemia
c. Hemolytic anemia
d. Anemia of chronic disease
a. Folate deficiency anemia
In aplastic anemia (AA), pancytopenia develops as a result of what?
a. Suppression of erythropoietin to produce adequate amounts of erythrocytes
b. Suppression of the bone marrow to produce adequate amounts of erythrocytes, leukocytes, and thrombocytes
c. Lack of DNA to form sufficient quantities of erythrocytes, leukocytes, and thrombocytes
d. Lack of stem cells to form sufficient quantities of leukocytes
b. Suppression of the bone marrow to produce adequate amounts of erythrocytes, leukocytes, and thrombocytes
A student asks the professor what the most common pathophysiologic process is that triggers aplastic anemia (AA). What response by the professor is most accurate?
a. Autoimmune disease against hematopoiesis by activated cytotoxic T (Tc) cells
b. Malignancy of the bone marrow in which unregulated proliferation of erythrocytes
crowd out other blood cells
c. Autoimmune disease against hematopoiesis by activated immunoglobulins
d. Inherited genetic disorder with recessive X-linked transmission
a. Autoimmune disease against hematopoiesis by activated cytotoxic T (Tc) cells
An allogenic bone marrow transplantation remains the preferred method for treating which anemia?
a. Polycythemia vera
b. Aplastic
c. Sideroblastic
d. Anemia of chronic disease (ACD
b. Aplastic
What does the student learn about warm autoimmune hemolytic anemia?
a. Warm autoimmune hemolytic anemia occurs primarily in children.
b. It is self-limiting and rarely produces hemolysis.
c. Erythrocytes are bound to macrophages and sequestered in the spleen.
d. Immunoglobulin M coats erythrocytes and binds them to receptors on monocytes.
c. Erythrocytes are bound to macrophages and sequestered in the spleen.
A student asks the professor to explain the jaundice that accompanies hemolytic anemia. Which
statement is by the professor is most accurate?
a. Erythrocytes are destroyed in the spleen.
b. Heme destruction exceeds the liver’s ability to conjugate and excrete bilirubin.
c. The patient has elevations in aspartate transaminase (AST) and alanine
transaminase (ALT).
d. The erythrocytes are coated with an immunoglobulin.
b. Heme destruction exceeds the liver’s ability to conjugate and excrete bilirubin.
Shortened erythrocyte life span, ineffective bone marrow response to erythropoietin, and altered
iron metabolism describe the pathophysiologic characteristics of which type of anemia?
a. Aplastic
b. Sideroblastic
c. Anemia of chronic disease
d. Iron deficiency
c. Anemia of chronic disease
