Finals Long Quiz Flashcards
All the following are adverse effects of amiodarone except:
Cinchonism
Hypothyroidism
Hyperthyroidism
Pulmonary fibrosis
Cinchonism
Which of the following drugs could cause torsades de pointes arrhythmia even within the normal therapeutic range?
Atropine
Dronedarone
Lidocaine
Quinidine
Quinidine
The renin-angiotensin-aldosterone system is a powerful system for blood pressure and volume homeostasis. The system is activated by:
A decreased parasympathetic discharge.
An increase in renal perfusion pressure.
An increased sympathetic discharge.
Right atrial distension.
Stimulation of alpha adrenergic receptors in renal juxtaglomerular cells.
An increased sympathetic discharge.
A 50-year-old man is admitted for congestive heart failure. He has no history of chest pain or ethanol abuse. On physical examination he has a blood pressure of 190/120 mmHg, mild hepatosplenomegaly, and no cardiac murmur. The heart failure is most likely due to:
Aortic Stenosis
Hypertension
Myocardial infarct
Myocardiopathy
Hypertension
Regarding the treatment of hypertensive emergencies, which is TRUE?
•Hypertension caused by pre-eclampsia can be treated with hydralazine or labetalol.
•Immediate reduction of mean arterial blood pressure in patients with hypertensive encephalopathy improves outcome.
•The treatment of hypertension in the setting of embolic stroke improves outcome.
•The treatment of hypertension in the setting of intracranial bleeds improves outcome.
Hypertension caused by pre-eclampsia can be treated with hydralazine or labetalol.
The following clinical features are reliable in distinguishing an infarct from a hemorrhage:
CT scan brain
Headache
Loss of consciousness
AOTA
CT scan brain
Virchow’s Triad, except:
I. Hypercoagulability
II. Vessel damage
III. Increased blood flow
IV. Stasis
lll
What is the key factor in describing any type of shock?
Hypotension
Hypoxemia
Inadequate tissue perfusion
Vascular collapse
Inadequate tissue perfusion
The following are important risk factors for ischemic heart disease:
I. Hyperlipidemia
ll. Obesity
III. Smoking
IV. High salt intake
ll, lll
l, ll, lll
l, ll, lV
AOTA
AOTA
This is true regarding the treatment of heart failure:
•ACE inhibitors reduce mortality.
•Beta blockers are contraindicated.
•Digoxin improves symptoms but worsens mortality.
•AOTA
ACE inhibitors reduce mortality.
A sustained blood pressure of 150/85 mmHg in a 65 year old man is indicative that he is hypertensive.
T or F
T
Hypertension is caused by the following except:
Coarctation of the aorta
Oral contraceptives
Renal artery stenosis
NOTA
NOTA
Hypertension increases the risk of developing the following except:
Angina
Asthma
Renal failure
Stroke
Asthma
Isosorbide dinitrate:
l. Causes headache
II. Causes tolerance
III. Improves in angina by causing coronary vasodilation.
IV. Reduces mortality after MI
l, lll
III, IV
l, lI, IV
AOTA
l, lI, IV
Which of the following is not true regarding the action of clopidogrel?
•Indicated in unstable angina.
•It should not be combined with aspirin.
•It can cause thrombocytopenia.
•Useful in stroke
It should not be combined with aspirin.
Which of the following group of drugs does not aggravate congestive heart failure?
Beta blocking agents
Cardiac glycosides
Corticosteroids
Estrogen
Cardiac glycosides
Death of tissue due to no blood flow
Arrhythmia
Atherosclerotic plaque
Dyslipidemia
Infarction
Infarction
Factors affecting cardiac output
l. Preload
ll. After load
III. Cardiac contractility
IV. Heart rate
I, ll
l, ll, lll
Il, lll, IV
AOTA
AOTA
True regarding transient ischemic attacks except
•Mini stroke.
•Transient loss of vision in one eye can occur.
•Usually due to cerebral embolism.
• Usually last about 7-8 hours
Usually last about 7-8 hours
Dominant effect of Amiodarone?
•Increase duration of refractory period by blocking K+ channels.
•Prolongation of AP
•Vasodilating effect
Prolongation of AP
Which of the following drugs act by blocking Na/K ATPase thus increasing cardiac muscle contractility?
Digoxin
Dobutamine
Hydralazine
Milrinone
Digoxin
Which one of the following drugs has a potassium sparing effect?
Digoxin
Furosemide
Ramipril
Spironolactone
Spironolactone
What is the ultimate goal of anti-arrhythmic therapy?
l. Maintenance of normal rhythm
II. Prevention of more serious arrhythmias
lll. Decrease the conduction velocity of the AV node
ll
lll
l, ll
AOTA
AOTA
Treatment regimens are similar for DVT and PE.
T or F
T
The following belong under ACS except:
NSTEMI
STEMI
Stable angina
Unstable angina
Stable angina
A person was admitted in a coma. Analysis of the arterial blood gave the following values: PC02 16 mm Hg. HCO3-5 mmol/L and pH 7.1. What is the underlying acid-base disorder?
Metabolic Acidosis
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Choose the incorrect statement about anion gap out of the following:
•Anion gap is decreased in Hypercalcemia.
•Anion gap is decreased in ketoacidosis.
•Anion gap is decreased in Lithium toxicity.
•In lactic acidosis anion gap is increased.
Anion gap is decreased in ketoacidosis.
Furosemide acts on which part of the nephron?
Ascending limb of the loop of Henle
Collecting duct
Descending limb of the loop of Henle
Distal tubule
Proximal tubule
Ascending limb of the loop of Henle
Which is incorrect regarding acute renal failure?
•In prerenal failure the ratio of urea: creatinine is increased above normal.
•In renal ARF the urine Na is > 10mmol/L and osmolality < 350.
•Post renal obstruction is an uncommon cause of ARF
•The most common cause of renal ARF is acute tubulointerstitial nephritis.
The most common cause of renal ARF is acute tubulointerstitial nephritis.
A common marker of chronic kidney disease (CKD) is:
Hematuria
Increased BUN
Increased creatinine
Proteinuria
Proteinuria
Complication/s of hemophilia:
l. Bleeding in the head
II. Joint swelling
III. Death
lll
l, ll
ll, lll
l, ll, lll
l, ll, lll
The reason why hemophilia is more commonly observed in human males than in females is due to:
•The disease is due to X-linked dominant mutation.
•The disease is due to Y-linked dominant mutation.
•The disease is due to X-linked recessive mutation.
•The disease is due to Y-linked recessive mutation.
The disease is due to X-linked recessive mutation.
Causes of metabolic alkalosis include all the following except:
Hypokalemia
Mineralocorticoid deficiency
Recurrent vomiting
Thiazide diuretic therapy
Mineralocorticoid deficiency
Glomerular filtration of drugs is directly related to the free or nonprotein-bound drug concentration in the plasma.
T or F
T
Which of the following does not affect the serum creatinine concentration in chronic kidney disease?
Fluid overload
Glomerular filtration rate
Skeletal muscle mass
Tubular secretory function
Fluid overload
Many drugs must be “dose-adjusted” with renal impairment. Which of the following agents must have the doses reduced with impaired renal function?
l. Allopurinol
II. Amantadine
III. Digoxin
IV. Indomethacin
l, ll, lll
l, II, IV
I, III, IV
ll, III, IV
l, ll, lll
What are the four components or systems of hemostasis?
•Extrinsic, Intrinsic, Common, Fibrinolytic
•Extrinsic, Intrinsic, Platelets, Fibrinolytic
•Vascular, Extrinsic, Intrinsic, Common
•Vascular, Platelets, Coagulation, Fibrinolytic
Vascular, Platelets, Coagulation, Fibrinolytic (nakapasunod dapat)
Heparin functions as an anticoagulant by:
•Degrades platelet plugs
•Directly degrading cross linked fibrin
•Enhancing antithrombin Ill activity
•Upregulating plasminogen solubility
Enhancing antithrombin Ill activity
Which of the following is not a prerenal cause of renal failure?
Heart failure
Hypovolemia
Obstruction of the renal artery
Pyelonephritis
Pyelonephritis
Glomerulonephritis is:
•Caused by cystitis
•Characterized by atrophied kidneys
•Caused by renal calculi
•Caused by antigen-antibody complexes in the glomerulus
Caused by antigen-antibody complexes in the glomerulus
Acute renal failure produces all of the following characteristics alterations in laboratory values except:
•azotemia
•decreased serum potassium levels
•elevated serum creatinine levels
•uremia
decreased serum potassium levels
The respiratory system compensates for metabolic disturbances while metabolic mechanisms compensate for respiratory disturbances.
T or F
T
Acute renal failure normally progresses through three phases in the following order: oliguric, diuretic, and recovery phases.
T or F
T
Prerenal failure, regardless of the specific cause, has a single common etiologic factor, which is:
•a decreased effect of aldosterone and antidiuretic hormones
•a reduction in renal perfusion
•inactivation of the renal autoregulatory mechanisms
•narrowing of afferent arterioles
a reduction in renal perfusion
Findings associated with advanced chronic kidney disease but not likely to be found with acute renal failure include:
•elevations in serum creatinine and BUN levels
•fluid volume excess
•hypocalcemia and anemia
•metabolic acidosis
hypocalcemia and anemia
A 45-year-old female with renal failure, missed her dialysis and was feeling sick, what could be the reason?
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Alkalosis
Metabolic Acidosis
Metabolic Acidosis
Rarely females experience the physiological defect of hemophilia as they do so only when they are:
•carrier for the defect
•heterozygous for the defect
•homozygous for the defect
•wives of hemophilic husbands
homozygous for the defect
A 35 year old comatose woman was brought to the ER by her sister. There was no history of any drug ingestion. The laboratory values were as follows:
Serum:
Sodium 135 mEq/L
Potassium 1.5 mEq/L
Chloride 120 mEq/L
Bicarbonate - 7 mEq/L
Anion gap 8 mEq/L
Creatinine 100 umol/L
Arterial blood:
pH 6.88
PaCO2 - 5.4 kPa
H+concentration - 132 nEq/L
Urine:
PH - 6.5
Specific gravity - 1.012
Protein - 1+
The acid-base disturbance is:
•Mixed respiratory alkalosis and metabolic acidosis
•Mixed respiratory alkalosis and metabolic alkalosis
•Mixed respiratory acidosis and metabolic alkalosis
•Mixed metabolic acidosis and respiratory acidosis
Mixed metabolic acidosis and respiratory acidosis
Which among the conditions cannot cause respiratory alkalosis:
Salicylate toxicity
Laryngeal obstruction
Anxiety
Laryngeal obstruction
What level of laboratory values if the patient has compensated metabolic alkalosis?
arterial carbon dioxide tension (PCO2): high or low
bicarbonate (HCO3): high or low
PH: high or low
PCO2: high
HCO3: high
pH: high
When a small part of the clot breaks off and travels from the site where it formed to another part of the vascular system?
Embolus
Type lll antiarrhythmic that causes Torsades de Pointes ventricular tachycardia.
Amiodarone
In all cardiovascular disorder:
The amount of force needed to overcome the pressure in the aorta.
Afterload
What is the test used for kidney function?
CBC
AKG
BUN
BUN
What type of cholesterol-lowering drugs are considered the most potent cholesterol-lowering potential?
Bile acid resins
ACE inhibitors
HMG-CoA reductase inhibitors
HMG-CoA reductase inhibitors
“Statins” (ex. pravastatin, fluvastatin, atorvastatin, simvastatin rosuvastatin)
Most life-threatening side effect or adverse reaction of statins?
rhabdomyolysis (muscle damage)
The condition where there is accumulation of nitrogenous waste products (creatinine and urea)?
Azotemia
Drug of choice for congestive heart failure (CHF)?
•TETRACYCLINE
•QUINIDINE
•DIGITALIS GLYCOSIDE (Digoxin)
DIGITALIS GLYCOSIDE (Digoxin)
Examples of Beta blockers ends with “olol”… What organ is most affected by beta blockers?
Heart and bronchi
Most common cardiovascular disorder
•MI
•Angina
•Arrhythmia
•Hypertension
Hypertension
What variable is measured in hypertension?
Diastolic and systolic blood pressure
Diuretics are sometimes prescribed to patients with heart failure to:
•Increase amount of sodium in the body
•Decrease amount of sodium in the body
Decrease amount of sodium
Haemophilia B is second most common type of haemophilia, it is also known as _________.
Christmas factor is also known as
Factor IX deficiency
Hageman factor is also known as:
Xll Coagulation factor
Factor ll
Prothrombin
What type of coagulation disorder where there is lack or defective plasma protein necessary for adhesion of platelets and vascular elements when the blood vessels are damaged; it affects both men and women:
Hemophilia A
Hemophilia B
Von Willebrand disease (VWD)
Von Willebrand disease (VWD)
Blood contains many proteins that help the blood clot when needed. One of these proteins is called?
von Willebrand factor (VWF)
Generic name of aldactone?
Spironolactone
what is the generic name of Crestor (statins)?
Rosuvastatin
According to new york heart association classification, it is the degree of effort necessary to elicit necessary symptoms is equal to those that would limit normal individuals. What class of heart failure/ functional limitation?
Class 1
Class 2
Class 3
Class 4
Class 1
According to new york heart association classification, it illicit a heart failure symptoms while at rest. What class of heart failure/ functional limitation?
Class 1
Class 2
Class 3
Class 4
Class 4
According to new york heart association classification, marked limitation of physical activity, Less than ordinary exertion causes fatigue, palpitations, or dyspnoea.
Class 1
Class 2
Class 3
Class 4
Class 3
The force exerted in intraventricular muscle at the end of diastole that determines the degree of muscle fiber stretch or the ventricular load at the end of diastole, before contraction has started.
Preload
Common markers of CKD:
•Proteinuria
•Hematuria
Proteinuria
Type of analgesic use for patients with MI:
•Mefenamic
•Acetaminophen
•Aspirin
Aspirin
deep brain thrombosis clot breaks free from the brain wall and travels to the lungs and blocks the blood supply?
Pulmonary embolism (PE)
occurs when a blood clot gets stuck in an artery in the lung, blocking blood flow to part of the lung. Blood clots most often start in the legs and travel up through the right side of the heart and into the lungs. This is called deep vein thrombosis (DVT).
3 Factors in drug dosing:
Glomerular filtration rate (GFR)
Creatinine clearance
Therapeutic window
A synthetic hormone drug that controls bleeding, used for hemophilia? Also used in Von willebrand factor to stimulate the body to release willebrand factor.
Desmopressin (synthetic hormone)
Gold standard for diagnosing cardiopulmonary arrest is the loss of what pulse:
Carotid pulse
Radial pulse
Temporal pulse
Femoral pulse
Carotid pulse
Type of shock caused by too little blood volume?
Hypovolemic shock
Type of shock caused by bacteria
Septic shock
Type of angina that has reduced blood flow that occurs at rest rather than exertion or emotional stress:
•Unstable angina
•Stable angina
•Prinzmetal angina
Prinzmetal angina
Blockage or complete blockage of the artery that leads to extensive damage of large area of the heart:
•STEMI
•NONSTEMI
STEMI
When the heart of a patient stops pumping blood around the body, normal breathing also stops.
•Heart attack
•Cardiac arrest
•Stroke
Cardiac arrest
Lifestyle modification for hypertension that provide best BP reduction:
•Smoking cessation
•Less sodium intake
•Weight loss
Weight loss
What factor does vitamin K antagonist targets:
Factor Vll
Factor Vlll
Factor V
Factor Vll
What hormones regulate the sodium:
Aldosterone
Natriuretic hormone
Antidiuretic hormone
First organ that compensates for metabolic imbalances?
•Heart
•Lungs
Lungs
Common markers used to measure GFR:
Inulin
Cystatin C
Inulin
The left ventricle is usually the first ventricle that weakens in patients with heart failure.
T or F
T
Hypercalcemia can cause cardiac rhythm disturbances.
T or F
T
All hypertensive agents can be used for pregnant patients
T or F
F
Laboratory test to monitor the intrinsic clotting pathway?
aPTT
partial thromboplastin time (PTT; also known as activated partial thromboplastin time (aPTT))
Estimated glomerular filtration rate (eGFR) is more accurate to be used as a basis for dose adjustments in patients with CKD.
T or F
T
You cannot estimate the renal function using the creatinine clearance equation in AKI patients.
T or F
T
Hematocrit decrease in iron deficiency. Hematocrit increase in vitamin B 12 deficiency.
T or F
T
In anemia, microcytic anemia is associated with decreased levels of folic acid.
T or F
F
Algorithm in hypertension treatment.
Stage l
Stage ll
1st line treatments in hypertension
Calcium channel blockers (ends with “dipines”)
ACE inhibitors (ends with “pril”)
ARBs (ends with “tan”)
Thiazide diuretics
Not 1st line
Aldosterone receptor antagonist (ex. Spironolactone)
N/A
Algorithm: 1st line treatments for black patients:
ACE inhibitors
ARBs inhibitors
Calcium channel blockers
Thiazide diuretics
Calcium channel blockers + Thiazide diuretics
Algorithm: 1st line treatments for non black patients and less than < 60 yrs old
ACE inhibitors
ARBs inhibitors
Calcium channel blockers
Thiazide diuretics
ACE inhibitors + ARBs inhibitors
Algorithm: 1st line treatments for non black patients and more than > 60 yrs old
ACE inhibitors
ARBs inhibitors
Calcium channel blockers
Thiazide diuretics
Thiazide diuretics + Calcium channel blockers
