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krazyyy Flashcards

1
Q

It represents the ventricular repolarization

a. P wave
b. QRS Complex
c. ST-T-U Complex
d. J Point

A

C

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2
Q

It measures the time between atrial and ventricular depolarization

a. PR interval
b. QT interval
c. ST segment
d. QRS interval

A

A

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3
Q

Retrograde P waves are described as:

a. negative in aVR, positive in lead II
b. positive in aVR, negative in lead II
c. negative in aVR, negative in lead II
d. positive in aVR, positive in lead II

A

B

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4
Q

Left axis deviation may occur as normal variant but is more commonly associated with the following, except:

a. left ventricular hypertrophy
b. left posterior fascicular block
c. inferior myocardial block
d. hemiblock

A

B

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5
Q

The following can cause abnormal u waves except:

a. dofetilide
b. amiodarone
c. sotalol
d. digoxin

A

D

should be quinidine

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6
Q

Intermittent palpitations are commonly caused by

a. premature atrial contractions
b. premature ventricular contractions
c. atrial fibrillation
d. atrial flutter
e. two of the options

A

E. a & b

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7
Q

Which of these drugs is the best choice for
abolishing acute supraventricular tachycardia?
a. Esmolol
b. Adenosine
c. Lidocaine
d. Amiodarone

A

B. Adenosine
In adult patients without heart failure or SA or AV nodal disease, parenteral verapamil can be used to terminate supraventricular tachycardia, although adenosine is the agent of first choice.
❌Esmolol - class 2 antiarrhythmic; intraoperative andmother acute arrhythmias
❌Lidocaine - class 1B; agent of choice for termination of ventricular tachycardia and prevention of ventricular fibrillation after cardioversion in the setting of acute ischemia
❌Amiodarone - class 3; maintain normal SR in atrial fibrillation and prevent recurrent v-tach

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8
Q

Which class of anti-arrhythmic drugs inhibits the phase 4 depolarization in SA and AV nodes?

a. Class IA
b. Class IB
c. Class II
d. Class III
e. Class IV

A

Class I - Phase 0 - Na channel blockade
Class II - Beta blockers - decrease sympathetic activity
Class III - Phase 3 - Potassium rectifier channel blockade
Class IV - Phase 4 - Ca channel blockade in SA/AV nodes

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9
Q

A patient with new-onset syncope has a blood pressure of 120/90 mmHg and a harsh systolic ejection murmur at the base, radiating to both carotids. Auscultation of the second heart sound at
the base might reveal which of the following findings?
a. It is accentuated.
b. It is diminished.
c. It is normal in character.
d. It is widely split due to delayed ventricular ejection.

A

B. Diminished
Diminished S2 supports the diagnosis of aortic stenosis
The finding of a systolic ejection murmur radiating to the carotids is classically associated with AORTIC STENOSIS.
The murmur results from turbulent flow of blood through a narrowed aortic valve as it is ejected from the left ventricle during systole. The diagnosis of aortic stenosis is further supported by a soft S2, as A2 (the sound of aortic valve closure) is delayed and may disappear as the condition progresses

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10
Q

Which of the following statements best describes a paradoxical pulse?

a. It is an increase in pulse wave amplitude during inspiration.
b. It is a decrease in pulse wave amplitude during expiration.
c. It is an increase in pulse wave amplitude during expiration.
d. It is a decrease in pulse wave amplitude during inspiration.

A

D. It is a decrease in pulse wave amplitude during inspiration.

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11
Q

Which of the following is the most commonly occluded in coronary artery disease leading to impairment or infarction of the conduction system?

a. Left circumflex artery
b. Right coronary artery
c. Left anterior descending artery
d. Left main coronary artery

A

C. Left anterior descending artery

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12
Q

All of the following are factors that will raise the stroke volume in essential hypertension EXCEPT

a. Increased venous return and filling time thus increases end diastolic volume in preload
b. High blood calcium level affecting inotropy of the heart thus decreases end systolic volume
c. Hyperkalemia affecting inotropy of the heart thus increases and systolic volume
d. Decreased vascular resistance thus decreases end systolic volume in afterload.

A

SURPRISE!!! WALANG SAGOT HAHAHAHA IANSWER PO NATIN

baka B

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13
Q

Which of these calcium channel blockers has the greatest depressant effect on the heart and may decrease heart rate and cardiac output?

a. Nifedipine
b. Diltiazem
c. Verapamil
d. Clevidipine

A

C. Verapamil
Cardiodepressant effect (greatest to least)
Verapamil > Diltiazem > Dihydropyridines (Nifedipine, Clevidipine)

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14
Q

The causes of systolic hypertension with a wide pulse pressure include the following EXCEPT.

a. Aortic regurgitation
b. Thyrotoxicosis
c. Patent ductus arteriosus
d. None of the options

A

D. None of the options

***MAY PHOTO FROM HARRISONS

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15
Q

Which is most likely the preferred antihypertensive agent for asymptomatic atherosclerosis?

a. Calcium channel blockers
b. Beta blockers
c. Angiotensin converting enzyme inhibitors
d. Angiotensin receptor blockers

A

D. ANGIOTENSIN II RECEPTOR BLOCKERS

● Telmisartan is the only ARB indicated for the reduction of CV morbidity in patients with manifest atherosclerotic CVD.

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16
Q

Which one of the following is NOT a potassium-sparing diuretic?

a. Amiloride
b. Triamterene
c. Hydrochlorothiazide
d. Spironolactone

A

C. Hydrochlorothiazide
Hydrochlorothiazide is a thiazide diuretic - may cause hypokalemia
✔Amiloride, triamterene, and spironolactone are all potassium-sparing diuretics.

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17
Q

Which of these heart sounds occurs during the closure of the atrioventricular valves?

a. S1
b. S2
c. S3
d. S4

A

A. S1
S1 - Occurs during closure of atrioventricular valves
(mitral and tricuspid)
S2 - Occurs when semilunar valves (aortic and pulmonic)
close

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18
Q

All of the following are class 3 antiarrhythmic drugs. Which one is the EXCEPTION?

a. Flecainide
b. Sotalol
c. Ibutilide
d. Dronedarone

A

A. Flecainide

Flecainide is Class 1C

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19
Q

A class I antiarrhythmic drug acts by blocking voltage-sensitive sodium (Na+) channels. Which one of the following is NOT a class I antiarrhythmic drug?

a. Dofetilide
b. Flecainide
c. Procainamide
d. Disopyramide

A 
A. Dofetilide
❌Dofetilide is a class III antiarrhythmic drug.
✔Flecainide - class 1C
✔Procainamide - class 1A
✔Disopyramide - class 1A
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20
Q 
All of the following are criteria for metabolic syndrome. Which one is the EXCEPTION?
a. Waist circumference of >102cm in
males and >88cm in females
b. Preexisting diabetes mellitus
c. Elevated HDL
d. Preexisting hypertension
A

C.

Dyslipidemia = increased LDL, DECREASED HDL

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21
Q

Which of the following about blood pressure is correct?

a. BP = CO x SV
b. BP = SV x HR
c. BP = SV x PVR
d. BP = CO x PVR

A

D. BP = CO x PVR

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22
Q

Approximately one third of patients receiving long-term therapy of this antiarrhythmic agent develop reversible lupus-related symptoms is.

a. Disopyramide
b. Procainamide
c. Adenosine
d. Vernakalant

A

B. Procainamide
A troublesome adverse effect of long-term procainamide therapy is a syndrome resembling lupus erythematosus and usually consisting of arthralgia and arthritis. In some patients, pleuritis, pericarditis, or parenchymal pulmonary disease also occurs
Approximately one third of patients receiving long-term procainamide therapy develop these reversible lupus-related symptoms

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23
Q

Which of the following antihypertensive agents has a noticeably short duration of action and releases nitric oxide in the endothelium?

a. Atenolol
b. Captopril
c. Hydrochlorothiazide
d. Nitroprusside

A

D. Nitroprusside

24
Q

Which of these hemodynamic parameters of stroke volume will change the width of the pressure-volume loop by changing the position of the isovolumic systolic pressure curve?

a. Contractility
b. Preload
c. After load
d. Any of the options

A

B
Stroke volume index is determined by three factors:
Preload: The filling pressure of the heart at the end of diastole.
Contractility: The inherent vigor of contraction of the heart muscles during systole.
Afterload: The pressure against which the heart must work to eject blood during systole.

25
Q

Which drug reduces sympathetic and increases parasympathetic tone, resulting in blood pressure lowering and bradycardia?

a. Clonidine
b. Methyldopa
c. Guanabenz
d. Guanethidine

A

A. CLONIDINE
● Clonidine, methyldopa, and guanabenz – alpha-2 agonist, increase nila ang sympa so NO
● Guanethidine - sympathetic nerve terminal blocker, so increase parasympathetic action
● Clonidine reduces sympathetic and increases parasympathetic tone, resulting in blood pressure lowering and bradycardia

26
Q

Methyldopa is now used primarily for hypertension during pregnancy. The most common undesirable effect particularly at the onset of treatment is:

a. Postural hypotension
b. Nausea
c. Sedation
d. Headache

A

C. SEDATION

The most common undesirable effect of methyldopa is sedation, particularly at the onset of treatment.

27
Q

Which of the following is a β1-selective blocker with vasodilating properties?

a. Carvedilol
b. Nebivolol
c. Bisoprolol
d. Labetalol

A

B. NEBIVOLOL
Nebivolol is the most highly selective β1-adrenergic receptor blocker, although some of its metabolites do not have this level of specificity. Nebivolol has the additional quality of eliciting vasodilation.

28
Q 
Which of the following JVP waves is a
result of passive filling of the atrium while
the tricuspid valve is closed during
ventricular systole?
a. A wave
b. V wave
c. X descent
d. Y descent
A

B. V WAVE
■ The first elevation, the presystolic a wave, reflects the slight rise in atrial pressure that accompanies atrial contraction. It occurs just prior to S1 and before the carotid upstroke.
■ The following trough, the x descent, starts with atrial relaxation. It continues as the RV, contracting during
systole, pulls the floor of the atrium downward, and ends just before S2. During ventricular systole, blood continues to flow into the right atrium from the venae cavae.
■ The tricuspid valve is closed, the chamber begins to fill, and right atrial pressure begins to rise again, creating the second elevation, the v wave. When the tricuspid valve opens early in diastole, blood in the right atrium flows passively into the RV, and right atrial pressure falls again, creating the second trough, or y descent.

29
Q

Which of the following Beta blockers was first to be effective in hypertension and ischemic heart disease?

a. Metoprolol
b. Propranolol
c. Atenolol
d. carvedilol

A

B. PROPRANOLOL
Propranolol was the first blocker shown to be effective in
hypertension and ischemic heart disease

30
Q

Which of the following class I antiarrhythmic drugs induce the symptoms of blurred vision, tinnitus, headache, disorientation, and psychosis?

a. Class IA
b. Class IB
c. Class IC
d. Class ID

A

a. Class IA
Quinidine (Class 1a)
Large doses may induce symptoms of cinchonism:
Blurred vision, tinnitus, headache, disorientation, and
psychosis

31
Q

Aschoff bodies is the pathologic hallmark of rheumatic heart disease and it is most frequently seen in which of the following tissues?

a. Epicardium
b. Myocardium
c. Endocardium
d. Mitral valve

A

B. MYOCARDIUM
- Aschoff bodies may be seen in all three layers of
the heart (Robbins)
- Two-hit hypothesis: antibody attack of valve
endothelium facilitates extravasation of T cells, leading to Aschoff bodies formation that is characteristic in rheumatic myocarditis
(Braunwald’s)

32
Q

Which of the following conductive tissues of the heart requires an implantable pacemaker if the cardiac function is defective?

a. Atrioventricular bundle
b. Atrioventricular node
c. Sinoatrial node
d. Purkinje fiber

A

B. ATRIOVENTRICULAR NODE/ C. SINOATRIAL
NODE
- Bradyarrhythmias due to either primary sinus
node dysfunction or to AV conduction defects
are readily treated through implantation of
permanent pacemaker. (Chapter 238, p. 1722)
- The main therapeutic Intervention in SA node dysfunction is permanent pacing. (Chapter 239, p. 1725)
- Temporary or permanent artificial pacing is the most reliable treatment for patients with symptomatic AVconduction system disease. (Chapter 240, p.1730)

33
Q

A 20-year old girl develops subcutaneous nodules over the skin of her arms and torso 3 weeks after about of acute pharyngitis. She manifests choreiform movements and begins to complain of pain in her knees and hips, particularly with movement. A friction rub is heard on auscultation of her chest. An abnormality detected by which of the following serum laboratory findings is most characteristic of the disease?

a. Antistreptolysin O antibody fiber
b. Antinuclear antibody titer
c. Creatinine level
d. Troponin level

A

A. ANTISTREPTOLYSIN O TITER

***may table sa Harrison’s ipakita ko nalang

34
Q

According to Jones Criteria (2015), the major criteria of ARF is high risk populations include/s the following:

a. Polyarthralgia
b. Polyarthritis
c. Monoarthritis
d. Any of the options

A

D. ANY OF THE OPTIONS
- Major criteria for Moderate and High Risk Populations: Carditis, Arthritis (polyarthritis, monoarthritis, or polyarthralgia), Chorea, Erythema marginatum, Subcutaneous nodules

35
Q

Which of these statements about rheumatic heart disease is/are correct?
a. It commonly affects the pre-school children
b. The peak prevalence age is between the age of 20 and 30’s
c. It tends to be more common in males than
females
d. Any of the options

A

B. for verification kasi walng ratio

36
Q

All of the following statements are true about heart sounds. Which one is the exception?

a. S1 is louder at the apex of the heart
b. S2 is louder at the base of the heart
c. S1 coincides with the pulsation of the heart
d. None of the options

A

D

37
Q

All of the following are factors that will raise the stroke volume in essential hypertension, EXCEPT
a. Increased venous return and filling time thus
increases end diastolic volume in preload
b. High blood calcium level affecting inotropy of the
heart thus decreases end systolic volume.
c. Hyperkalemia affecting inotropy of the heart
thus increases end systolic volume.

A

B TALAGA
[C?
Inc. in EDV / contractility = inc. in SV
Inc. in ESV = dec. in SV]

38
Q

The following statement/s is/are TRUE about chronic rheumatic heart disease.

a. Only 10% of patients who experience ARF will develop clinical carditis.
b. Resolution of carditis is seen more in aortic involvement.
c. Younger age of the first episode of ARF is a risk for its development.
d. Any of the options

A

● 60% of ARF patients develop RHD

39
Q

A 12-year-old girl presented with dyspnea and knee pain. She has a history of sore throat 4 weeks prior to the onset of symptoms. Her ASO titer is high/ On PE, she has a systolic murmur at the apex. She eventually died. An autopsy of the heart shows Aschoff bodies in the epicardium, myocardium and endocardium layers.
Which of the following is the most probable underlying cause of death?
a. Acute rheumatic fever
b. Chronic rheumatic fever
c. Scarlet fever
d. Bacterial endocarditis

A

A. ACUTE RHEUMATIC FEVER

40
Q

Which of these hemodynamic parameters of stroke volume will change the width of the pressure-volume loop by changing the position of the isovolumic systolic pressure curve

a. Contractility
b. Preload
c. Afterload
d. AOTA

A

B. (pero for verification po)

41
Q

Which of these options about acute rheumatic fever is/are correct?

a. It is commonly equal in both sexes.
b. The molecular mimicry plays a great role in the development of carditis.
c. It has genetic susceptibility.
d. Any of the options.

A

D. ANY OF THE OPTIONS
- No clear gender association for ARF
- Findings of familial clustering …. Confirm that susceptibility to ARF is an inherited characteristic
- Most widely accepted theory of RF pathogenesis
is based on the concept of molecular mimicry
Harrison’s p. 2541-2542

42
Q 
Which of the following is a fundamental
characteristic of the internal jugular venous pulse?
a. It is biphasic
b. It is readily palpable
c. It cannot be occluded with pressure.
d. It is not affected by inspiration.
A 
A. It is biphasic
[“POLICE”
Palpation: non-palpable
Occlusion: readily occludable
Location: b/w heads of SCM; lateral to carotid
Inspiration: drops w/ inspiration
Contour: Biphasic waveform
Erection/position: drops when sitting erect]
43
Q

All of the following are diagnostic features of mitral
valve changes in rheumatic fever EXCEPT:
a. There is thickening at the leaflet edges
b. There is fusion of the commissures
c. There is chordal shortening and fusion.
d. None of the options

A

D. None of the options

44
Q
  1. All of the ff options are true about jugular venous pressure EXCEPT
    a. It uses the internal jugular vein
    b. it estimates the central venous pressure
    c. The normal mean JVP is 6-8mmHg
    d. NOTA
A

d. NOtA
Normal mean jugular venous pressure (right atrial
pressure / central venous pressure), determined as the vertical distance above the midpoint of the right atrium, is 6 to 8 cm H2O
The waveform generated by phasic flow to the right
atrium is accurately reflected in the internal jugular vein.

45
Q 
Which of the ff is a normal blood pressure based
on JNC 8 criteria?
a. SBP < 120mmHg or DBP <80mmHg
b. SBP ≤ 129mmHg or DBP <80mmHg
c. SBP < 120mmHg and DBP <90mmHg
d. SBP ≤ 120mmHg and DBP <80mmHg
A

a. SBP < 120mmHg or DBP <80mmHg
Normal Systolic <120 , Diastolic <80
(Harrisons)

46
Q

An increased DBP is caused by the ff physiological changes of the heart.
a. Increased preload increased contractility, and decreased compliance of the aorta
b. Increasing heart rate decreases filling of the
coronary arteries leaving a greater volume of blood in the aorta during diastole.
c. Decreasing heart rate, increases filling of the
coronary arteries leaving a less volume of blood in the aorta during diastole.
d. Decreased preload, decrease contractility or
increased afterload

A

d. Decreased preload, decrease contractility or
increased afterload systolic pressure will progressively increase due to an increase in stroke volume and cardiac output. Diastolic pressure, on the contrary, will continually decrease
The stroke volume is the amount of blood pumped out of the heart after one contraction. It is the difference in
end-diastolic (EDV) and end-systolic volume (ESV). It
increases with increased contractility, increased preload,
and decreased afterload

47
Q

A 12 year old girl presented with dyspnea and knee pain. She revealed a history of sore throat 4 weeks prior to the onset of symptoms. Her ASO titer is high. On PE, she has a systolic murmur at the apex. She survived but presented with high-grade fever as well. Her blood CS turned positive for S. viridans. Despite
appropriate management, she died. An autopsy of the heart shows large, irregular masses on the valve cusps that may extend into chordae. Which of the following is the specific cause of death?
a. Acute infective endocarditis
b. Subacute infective endocarditis
c. Rheumatic heart disease
d. NOTA

A

B

48
Q

A 12 year old girl presented with dyspnea and knee
pain. She revealed a history of sore throat 4 weeks
prior to the onset of symptoms. Her ASO titer is high.
On PE, she has a systolic murmur at the apex. She
survived but presented with high-grade fever as well.
Her blood CS turned positive for S. viridans. Despite
appropriate management, she died. An autopsy of the
heart shows large, irregular masses on the valve cusps that may extend into chordae. Which of the following is the specific cause of death?
a. Acute infective endocarditis
b. Subacute infective endocarditis
c. Rheumatic heart disease
d. NOTA

A

D - arf

Acute Rheumatic Fever
✔Sore throat
✔Knee pain = arthralgia
✔Pancarditis (epi/myo/endocarditis)
✔Aschoff bodies
2 major JONES criteria
J - joints (arthritis/arthralgia)
❤ - heart (endo/myo/peri/pancarditis)
N - nodules
E - erythema marginatum
S - Sydenham’s chorea
49
Q

A clenched fist held over the chest to describe ischemic chest pain is a sign known as

a. Murphy
b. Halstead
c. Cullen
d. Levine

A

D.

50
Q

A 12-year-old girl presented with dyspnea and knee pain. She revealed a history of sore throat 4 weeks prior to the onset of symptoms. Her ASO titer is high. On PE, she has a systolic murmur at the apex. The patient improved but was lost to follow up, only to come back after 12 years, now with worsening dyspnea. On PE: diastolic murmur at apex was appreciated. She eventually died. An autopsy of the heart shows a fish-mouth deformity of the mitral valve. Which of these valvular heart diseases is the immediate cause of her death?

a. Mitral valve Stenosis
b. Mitral valve Regurgitation
c. Mitral valve Prolapse
d. None of the options

A

A. Mitral valve stenosis?? (fish mouth deformity)

✔Systolic murmur at the apex

51
Q

It supplies the right border of the heart

a. sino-atrial nodal branch of RCA
b. right marginal branch
c. antrioventricular nodal branch
d. posterior interventricular branch
e. interior interventricular branch

A

B

a. sino-atrial nodal branch of RCA - SA node
c. antrioventricular nodal branch - AV node
d. posterior interventricular branch - adjacent areas of both ventricles

52
Q

The right coronary artery supplies the following, except:

a. right atrium
b. SA node
c. AV node
d. diaphragmatic surface of left ventricle
e. anterior third of IV septum

A

E

53
Q

The P wave is upright in the following leads, except:

a. I
b. II
c. V1 to V2
d. aVF

A

C

negative in aVR, V1 to V2

54
Q

The normal sequence of the electrical activation of the heart is as follows:

a. SA node -> AV junction -> AV node -> bundle of His -> right and left bundle branch -> Purkinje fibers -> ventricular myocardium
b. SA node -> AV node -> bundle of His -> AV junction -> right and left bundle branch -> Purkinje fibers -> ventricular myocardium
c. SA node -> AV node -> AV junction -> bundle of His -> right and left bundle branch -> Purkinje fibers -> ventricular myocardium
d. SA node -> AV node -> bundle of His -> right and left bundle branch -> Purkinje fibers -> AV junction -> ventricular myocardium

A

B

55
Q

The leads that correspond to the inferior view of the are are the following, except:

a. II
b. III
c. aVL
d. aVF

A

C

56
Q

Head-up Tilt Testing is useful diagnosis and therapy for the following except:

a. Recurrent idiopathic vertigo
b. Recurrent TIA
c. Repeated falls
d. Severe CAD with proximal coronary stenosis

A

D

57
Q

Subclass of Class I antiarrhythmic drugs with high potency and slowest kinetics include the following:

a. Flecainide
b. Lidocaine
c. Quinidine
d. Procainamide

A

A

Class Ic - Flecainide & Propafenone

CVS-Respi (5 decks)

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