MCQ questions and answers Flashcards
In veterinary patients with thyrotoxicosis:
A. the absolute T4 values is the primary determinant of the clinical signs and severity of these signs.
B. there is rarely an inciting event that can be identified.
C. the degree and rate of change in the thyroid hormone is more important that the actual value itself.
D. there is a difference in total T4 and free T4 compared to patients with stable hyperthyroidism.
C. the degree and rate of change in the thyroid hormone is more important that the actual value itself.
In a recent study investigating urine sodium concentrations to distinguish between hypoadrenocorticism and nonadrenal causes of hyponatremia, a urine sodium value less than _________ suggests that hypoadrenocorticism is unlikely the cause.
A. 40 mmol/L
B. 20 mmol/L
C. 55 mmol/L
D. 30 mmol/L
D. 30 mmol/L
Cardiovascular manifestations of thyrotoxicosis include
A. a 50% decline in systemic vascular resistance through dilation of the resistance arterioles.
B. a decrease in cardiac output due to concentric hypertrophy of the myocardium.
C. increased concentrations of plasma and urine catecholamines.
D. increased mean arterial blood pressure due to an increased diastolic pressure.
A. a 50% decline in systemic vascular resistance through dilation of the resistance arterioles.
Which of the following may be indicated as part of perioperative treatment for a patient with a suspected pheochromocytoma?
A. Patient ideally receives two weeks of beta blockade prior to alpha-adrenergic blockade.
B. Anesthetic protocol to include premedication with an anticholinergic drug and acepromazine.
C. Post-operative anticoagulant therapy with heparin to reduce risk of thromboembolic complications.
D. Administration of calcium gluconate to promote vasodilation and to control ventricular arrhythmias.
C. Post-operative anticoagulant therapy with heparin to reduce risk of thromboembolic complications.
A prospective, observational study of 27 client-owned dogs with naturally occurring septic peritonitis was published in 2013. Investigators measured coagulation profiles including platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), D-dimer and fibrinogen concentrations, total protein C (PC) and antithrombin (AT) activities, and thromboelastography (TEG) pre-operatively and on days 1 and 3 post-operatively. The major findings of this study included:
A. PC and AT deficiencies were more common, and mean activities were lower, in nonsurvivors compared to survivors
B. The maximum amplitude, α angle and coagulation index from preoperative TEG were significantly greater in survivors compared to nonsurvivors
C. Both A and B.
D. None of the above
C. Both A and B.
A prospective, observational study comparing 31 cats with naturally occurring sepsis to 33 healthy control cats was published in 2016. Investigators compared history; clinical signs; results of hematologic, serum biochemical, and hemostatic tests; diagnosis; and outcome between the two groups. The major findings of this study included:
A. Protein C and antithrombin were significantly lower in the septic group.
B. Disseminated intravascular coagulopathy was common in the septic group.
C. Median prothrombin time and activated partial thromboplastin time were both longer in the septic group.
D. On multivariate analysis, disseminated intravascular coagulopathy was associated with death in the septic group.
A. Protein C and antithrombin were significantly lower in the septic group.
According to the cell-based model of coagulation, which is the sole relevant initiator of coagulation in vivo?
A. Tissue factor
B. von Willebrand factor
C. Thrombin
D. Factor VIIa
A. Tissue factor
Which of the following does not control thrombin generation, according to the cell-based model of coagulation?
A. Activated protein C (aPC)
B. Tissue pathway factor inhibitor (TFPI)
C. Factor XIIIa (FXIIIa)
D. Thrombomodulin (TM)
C. Factor XIIIa (FXIIIa)
QuikClot Combat Gauze is the primary hemostatic dressing used by all branches of the military, per Committee on Tactical Combat Casualty Care (CoTCCC) guidelines. What are its primary active ingredient and mechanism of action?
A. Chitosan; cross-links red blood cells and platelets to form a mucoadhesive physical barrier
B. Kaolin; activates factor XII (FXII)
C. Smectite; absorbs plasma water, forms a clay substance that adheres to site of injury
D. Microporous polysaccharide derived from potato starch; absorbs plasma water, thereby concentrating platelets and clotting factors at the site of injury
B. Kaolin; activates factor XII (FXII)
A randomized cadaveric ex vivo study recently evaluated the mechanical strength of three regions of ventral abdominal wall in cats (preumbilical, umbilical and postumbilical) following full-thickness vs fascia-only closure. The major findings included which of the following?
A. Load to failure was lowest in the post-umbilical group.
B. Load to failure was similar in males and females.
C. There was no difference between fascia-only and full thickness closure.
D. Both A and C are correct.
D. Both A and C are correct.
A retrospective study recently evaluated the influence of preoperative septic peritonitis (PSP) and stapled vs hand-sewn anastomoses on the incidence of intestinal resection and anastomosis (IRA). The major findings included which of the following?
A. Risk factors for dehiscence included stapled anastomoses in a PSP patient
B. Risk factors for dehiscence included hand-sewn technique in a PSP patient
C. PSP was a risk factor for dehiscence; there was no association between technique and risk for dehiscence in dogs with PSP.
D. Indication for IRA significantly influenced risk for dehiscence.
B. Risk factors for dehiscence included hand-sewn technique in a PSP patient
A randomized nonblinded controlled crossover study of surgical personnel (veterinary students, technicians, interns, residents and faculty in a veterinary teaching hospital (n=21) recently evaluated the influence of nail characteristics on surface bacterial counts. Major findings included which of the following?
A. Duration of nail polish application was a risk factor for increased bacterial counts.
B. Chipped nail polish was a risk factor for increased bacterial counts.
C. Nail biting was a risk factor for increased bacterial counts.
D. Nail length was a risk factor for increased bacterial counts.
D. Nail length was a risk factor for increased bacterial counts.
What type of surgical needle is designed to pierce tissue with a sharp tip and spread the tissue without cutting it and may be best used in the intestines?
A. Cutting
B. Reverse cutting
C. Taper
D. Blunt point
C. Taper
In a 2018 study by Grimes et al of dogs with uroabdomen, what was the prognosis for dogs that had surgical intervention for a uroadomen?
A. Good, 79% of dogs with surgical intervention survived to hospital discharge
B. Fair, 58% of dogs with surgical intervention survived to hospital discharge
C. Excellent, 91% of dogs with surgical intervention survived to hospital discharge
D. Guarded, 49% of dogs with surgical intervention survived to hospital discharge
C. Excellent, 91% of dogs with surgical intervention survived to hospital discharge
The security of a suture knot is determined by multiple factors. Which of the following is NOT one of those factors?
a. Tissue tension
b. Length of the cut ends
c. Structural conformation of the knot
D. Material coefficient
a. Tissue tension
A 25 kg 3-year-old male neutered Golden Retriever presents 30 minutes following ingestion of 43 mg/kg of carprofen. Emesis is induced via administration of apomorphine, the dog is administered Toxiban (activated charcoal with Sorbitol) and started on Misoprostol, an H2 blocker and intravenous lactated Ringer’s solution at 100 ml/hr. A physical examination and complete blood work performed 6 hours following admission reveals a lactate of 5.4 mmol/l (< 2.5 mmol/l), pH 7.32 (7.35-7.45), HCO3 18 mmol/l (20-24 mmol/l), PvCO2 32 (35-40 mmHg), heart rate 96 BPM, respiratory rate 22 bpm, temperature 38.4o Celsius (101.1 o Fahrenheit) with all other parameters, including blood pressure, within reference limits. The most likely cause of hyperlactatemia in this patient is type…
B1 lactic acidosis
B2 lactic acidosis
B3 lactic acidosis
B4 lactic acidosis
B2 lactic acidosis
In a recent (2015****) retrospective study of 67 critically ill dogs with hypotension hospitalized in the intensive care unit (JAVMA, Vol 246, No. 1, January 1, 2015), what were the odds of survival in dogs that did not have hyperlactatemia compared to dogs that did have hyperlactatemia?
2.41 times as likely to survive
4.16 times as likely to survive
3.23 times as likely to survive
5.52 times as likely to survive
3.23 times as likely to survive
A 2-year-old mix breed female spayed dog weighing 20 kg presents for vomiting. The dog is diagnosed with a septic abdomen secondary to a foreign body causing GI perforation. Following initial resuscitation and therapy the dog is taken to surgery. While receiving positive pressure ventilation under anesthesia the dog’s mean arterial blood pressure falls to 45 mmHg, heart rate is 156 BPM, and the pulse pressure variation (PPV) is calculated at 8%. Based on these findings and recent veterinary literature, what can you conclude about this patient’s intravascular volume status? The patient is most likely…
A fluid non-responder
A fluid responder
Difficult to ascertain based on the information given
Both A and B
A fluid non-responder
The 3 causes of death commonly reported in cats with hypertrophic cardiomyopathy are congestive heart failure, arterial thromboembolism and sudden death. What are two risk factors associated with increased risk of death for all three causes?
left atrial fractional shortening and left ventricular septal wall thickness
spontaneous echo-contrast and an auscultable gallop rhythm
left atrial to aortic root diameter and left atrial emptying fraction
systolic anterior motion of the mitral valve and regional wall hypokinesis
left atrial to aortic root diameter and left atrial emptying fraction
To minimize the adverse effects of reperfusion injury after achieving return of spontaneous circulation (ROSC) following cardiopulmonary arrest (CPA), supplemental oxygen should be titrated to what arterial partial pressure of oxygen (PaO2)?
200 – 300 mmHg
100-200 mmHg
80-100 mmHg
60-80 mmHg
80-100 mmHg
Which of the following statements is MOST CORRECT in describing the mechanisms of microparticle formation?
A. When the cell becomes activated the enzyme complex, floppase, transports the negatively charge aminophospholipids from the outer membrane leaflet to the inner membrane leaflet.
B. Intracellular calcium increases as a consequence of cellular activation and this results in the increased activity of scramblase and floppase and reduction in the activity of flippase.
C. Increased intracellular cytosolic calcium originating uniquely from the endoplasmic reticulum results in reorganization of the cytoskeletal structures and membrane blebbing.
D. Cellular activation results in disruption of the phospholipid asymmetry, leading to membrane contracture and budding resulting in internalization of the biologically active aminophospholipids within the microparticle.
B. Intracellular calcium increases as a consequence of cellular activation and this results in the increased activity of scramblase and floppase and reduction in the activity of flippase.
Which of the following statements MOST ACCURATELY describes the role microparticles have in the activation of the coagulation cascade.
A. Microparticles are derived from the plasma cell membranes of platelets which contain tissue-factor and activate the extrinsic coagulation pathway.
B. Microparticles are derived from the plasma membrane of multiple cell types and express negatively charged aminophospholipids, which support the enzymatic reactions involved in various hemostatic processes.
C. Microparticles are derived from the plasma membrane of endothelial cells and express endothelial protein C receptor (EPCR) which binds protein C , resulting in its inactivation.
D. Microparticles are not implicated in the pathophysiological state of coagulation.
B. Microparticles are derived from the plasma membrane of multiple cell types and express negatively charged aminophospholipids, which support the enzymatic reactions involved in various hemostatic processes.
Which is the MOST CORRECT description of how the immune system response is initiated in a patient with a bacterial infection?
A. Toll-like receptors on innate immune system cells recognize the extracellular “Alarmins”, which are released due to tissue damage secondary to the invading microbes.
B. Pathogen-associated molecular patterns (PAMPS) are recognized by the innate immune system by pathogen recognition receptors (PRRS) which results in the activation of signal transduction cascade.
C. DAMPS (damage–associated molecular patterns) are released from damaged and apopotic cells and bind to the innate immune system cells via nuclear factor kappa beta (NF-Kβ).
D. RANTES (regulated upon activation, normal T cell expressed and secreted) is secreted by the innate immune system when a monocyte-antigen presenting cell binds to dendritic cells.
B. Pathogen-associated molecular patterns (PAMPS) are recognized by the innate immune system by pathogen recognition receptors (PRRS) which results in the activation of signal transduction cascade.
What lung volume remains after a normal tidal volume breath?
A. Vital capacity
B. Functional Residual Capacity
C. Residual Volume
D. Physiologic dead space
B. Functional Residual Capacity
Which of the following statements concerning the cytokine profile of this patient is the MOST ACCURATE?
A. Tumor necrosis factor-alpha ( TNF-α) and Interleukin -1 (IL-1) are elevated in a stable manner for the first 24 hours leading to downstream activation of cytokine cascades.
B. Interleukin-6 release is in response to TNF-α and IL-1 and has both proinflammatory and anti-inflammatory properties.
C. Macrophage migration inhibitory factor (MIF) is acutely released (within 30 minutes) from monocytes/macrophages due to “Alarmins” binding to Toll-like membrane receptors.
D. Soluble cytokine receptors and receptor antagonists, such as soluble tumor necrosis factor- receptor (sTNFR-) and interleukin-1 receptor (IL-1Ra, IL-1R2) are only present during the “compensatory anti-inflammatory response syndrome” (CARS).
B. Interleukin-6 release is in response to TNF-α and IL-1 and has both proinflammatory and anti-inflammatory properties.
Fick’s law of diffusion states that the transfer of gas through a sheet of tissue is inversely proportional to which of the following variables?
A. Area
B. Diffusion constant
C. Difference in gas partial pressure between the two sides
D. Thickness of the tissue
D. Thickness of the tissue
What is the volume of dissolved oxygen (represented as ml of O2 in 100 ml of blood) when the PaO2 is 100 mmHg?
A. 100
B. 10
C. 3
D. 0.3
D. 0.3
What is the total oxygen capacity of blood (ml of oxygen in 100 ml of blood) with the following parameters: Hb = 15 g/dl, SaO2= 100%, PaO2 = 100 mmHg?
A. 15.55
B. 20.7
C. 11.05
D. 7.35
B. 20.7
Peripheral chemoreceptors located in the carotid body at the bifurcation of the carotid arteries respond to changes in pH, PO2 and PCO2. Which of the following statements is true?
The response to PCO2 is extremely important in control of respiration
The peripheral chemoreceptors are maximally stimulated with a PaO2 of 500 mmHg
The peripheral chemoreceptors are maximally stimulated with a PaO2 below 50 mmHg
The response of peripheral chemoreceptors to an increase in pH causes increased respiration
The peripheral chemoreceptors are maximally stimulated with a PaO2 below 50 mmHg
What of the following statements is INCORRECT regarding hyperbaric oxygen therapy (HBOT)?
A. HBOT is provided by inhalation of 100% oxygen inside a treatment chamber with a pressure greater than pressure at sea level (> 1 atm)
B. Common indications for HBOT include carbon monoxide toxicity, compartment syndrome, and necrotizing soft tissue infection
C. HBOT pressures > 3 atm does not increase dissolved oxygen in blood enough such that tissue oxygenation can be maintained without hemoglobin
D. HBOT at pressures > 3 atm can cause grand mal seizures secondary to neuotoxicity
C. HBOT pressures > 3 atm does not increase dissolved oxygen in blood enough such that tissue oxygenation can be maintained without hemoglobin
Which clinical sign is MOST supportive of a primary (platelet associated) hemostatic disorder?
A. Hemarthrosis
B. Hematomas
C. Melena
D. Hemoperitoneuim
C. Melena
Which of the following statements is true regarding the use of the buccal mucosal bleeding test (BMBT) to assess platelet function?
A. BMBT measurements are well standardized, objective and generally correlate well with clinical outcomes
B. The test is stopped 15 seconds after there is no further bleeding from the incision
C. A 11 blade scalpel blade can be utilized to produce standardized superficial incisions for the test
D. BMBT lacks sensitivity and specificity with variable results reported in animals and people
D. BMBT lacks sensitivity and specificity with variable results reported in animals and people
All of the following are platelet alpha granule contents EXCEPT
A. Adhesion molecules like P-selectin, fibrinogen, fibronectin
B. Chemokines like PF4, CCL3, thromboglobulin
C. Ions like calcium, magnesium and phosphate
D. Fibrinolytic factors like A2 macroglobulin, plasminogen, PAI-1
C. Ions like calcium, magnesium and phosphate
Type 1 Von Willebrand disease is typically as a result of
A. Low VWF concentrations with preferential reduction in the high molecular weight multimers
B. Low VWF concentrations with preferential reduction in the low molecular weight multimers
C. Low level of all VWF multimer sizes with bleeding severity inversely correlated to VWF concentration
D. Complete absence of VWF
C. Low level of all VWF multimer sizes with bleeding severity inversely correlated to VWF concentration
A recent study by Cavanagh et al “Retrospective evaluation of fluid overload and relationship to outcome in critically ill dogs” concluded that
A. Critically ill dogs didn’t have an increased risk of developing fluid overload during hospitalization and there was no association between fluid therapy and mortality
B. Critically ill dogs had an increased risk of developing fluid overload during hospitalization and there was a weak but significant association between fluid therapy and mortality.
C. Critically ill dogs had an increased risk of developing fluid overload during hospitalization and there was no association between fluid overload and mortality
D. Critically ill dogs had an increased risk of developing fluid overload during hospitalization and there was a strong association between fluid overload and mortality
B. Critically ill dogs had an increased risk of developing fluid overload during hospitalization and there was a weak but significant association between fluid therapy and mortality.
Based on the 2018 ACVIM consensus statement regarding the diagnosis of immune-mediated hemolytic anemia, what is the recommend ratio of drops of blood: drops of saline to perform a saline agglutination test?
a. 1:1
b. 1:2
c. 1:10
d. 1:4
d. 1:4
Based on the same 2018 ACVIM consensus statement, which canine infectious disease has the highest chance of causing immune-mediated hemolytic anemia?
a. Ehrlichia canis
b. Dirofilaria immitis
c. Leishmania infantum
d. Babesia gibsoni
d. Babesia gibsoni
Which organisms have been demonstrated to cause a Coombs positive anemia?
For some of these organisms, such as
Leishmania spp., D. immitis, and Bartonella spp., Coombs’ test-positive
anemia is observed commonly
Based on a review of immune thrombocytopenia by Levine, et al in 2019, what is the mechanism of thrombopoietin production?
a. Constitutive production by the kidney
b. Megakaryocyte “sensing” of the level of young, sialic acid-rich platelets
c. Decreased binding levels of the myeloproliferative leukemia protein receptor
d. Clearance of aged platelets via the Ashwell-Morrell receptor in the liver
d. Clearance of aged platelets via the Ashwell-Morrell receptor in the liver
According to the 2019 ACVIM consensus statement regarding the treatment of immune-mediated hemolytic anemia, which of the following would be a reasonable choice as a secondary immunosuppressive agent?
a. Intravenous immunoglobulin (IVIG)
b. Cyclophosphamide
c. Tacrolimus
d. Mycophenolate mofetil
d. Mycophenolate mofetil
Based on the recent consensus recommendations for the use of anti-thrombotic therapy in veterinary critical care, for which of the following disease states is routine prophylactic administration of antithrombotic agents recommended?
a. Cats with sepsis
b. Dogs with cancer
c. Dogs with hyperadrenocorticism
d. Cats with hypertrophic cardiomyopathy
d. Cats with hypertrophic cardiomyopathy
With respect to the management of arterial thromboembolism, what guidelines were provided by the recent consensus statement on the rational use of antithrombotic in veterinary critical care?
a. Antiplatelet drugs may be more effective than anticoagulants in dogs with venous thromboembolic disease.
b. Anticoagulant drugs are more effective than antiplatelet drugs in dogs with venous thromboembolic disease.
c. Antiplatelet drugs are equally effective as anticoagulant drugs in dogs with venous thromboembolic disease.
d. No evidence based recommendation can be made on the use of antiplatelet drugs in dogs with venous thromboembolic disease.
b. Anticoagulant drugs are more effective than antiplatelet drugs in dogs with venous thromboembolic disease.
In considering the discontinuation of anti-thrombotic therapy, based on the recent consensus statement on the rational use of antithrombotics in veterinary critical care…
a. low-molecular-weight heparin can be stopped abruptly.
b. unfractionated heparin administered as a CRI can be stopped abruptly.
c. unfractionated heparin administered subcutaneously can be stopped abruptly.
d. factor Xa inhibitors can be stopped abruptly.
a. low-molecular-weight heparin can be stopped abruptly.
Based on a recent consensus statement on the rational use of antithrombotics in veterinary critical care, which of the following statements is correcting regarding oral aspirin administration?
a. May be effective for the prevention of arterial thromboembolism (ATE) in dogs.
b. May be used as a sole agent for prevention of ATE in cats
- Is effective for the prevention of venous thromboembolism in dogs
- Is associated with significant adverse effects when used at doses recommended to prevent ATE in dogs
a. May be effective for the prevention of arterial thromboembolism (ATE) in dogs.
Which of the following statements correctly identifies the pathophysiological events associated with anaphylaxis?
A. IgE mediated reactions occur when the antibody binds to high-affinity IgE receptors (FcεRI) in the plasma membrane of platelets and neutrophils.
B. IgE independent events are mediated by IgG antibodies binding to FcγRIII receptors on macrophages.
C. Non-immunological pathways occur when there is degranulation of platelets with the help of immunoglobulins.
D. Nitric oxide production is markedly decreased during anaphylaxis in dogs and cats
IgE independent events are mediated by IgG antibodies binding to FcγRIII receptors on macrophages.
Which of the following statements concerning the chemical mediators of anaphylaxis and any associated pathophysiological response time is correct?
a. IgE antibodies bind to tissue mast cells and trigger the production of histamine, leukotrines and platelet activating factor within seconds to hours.
b. Activation of the arachidonic acid cascade produces newly synthesized proinflammatory mediators within 5 to 30 minutes.
c. A multitude of cytokines and chemokines are synthesized and released within 12 to 24 hours of the start of an anaphylactic event.
d. The complement system produces the anaphylatoxins C3a, C4a and C5a within 24 hours of the start of an anaphylactic event.
a. IgE antibodies bind to tissue mast cells and trigger the production of histamine, leukotrines and platelet activating factor within seconds to hours.
There are well recognized species differences in terms of the clinical manifestations that arise during an anaphylactic event. Which of the following statements concerning clinical manifestations is correct?
A. The severity of shock in the dog is directly related to the degree of congestion in the liver and gall bladder.
B. The clinical signs demonstrated by cats are related to the neurologic and hepatic systems.
C. Clinical manifestations of an anaphylactic event, once resolved, often do not reoccur.
D. Systemic anaphylactic reactions are a common manifestation in cats
A. The severity of shock in the dog is directly related to the degree of congestion in the liver and gall bladder.
A 4-year-old 20 kg mixed breed male neutered dog presents to your clinic with acute collapse, hematemesis and hematochezia, and a bee stinger is located in the upper lip. Which of the following statements is most accurate with relation to this case?
A. Histamine released into the portal system from the gastrointestinal tract likely resulted in portal hypertension, hepatic congestion, and a dramatic decrease in venous return.
B. The best indicators of anaphylaxis in this dog is a dramatic increase in alkaline phosphatase (ALP) and an increased thickening (halo or double rim effect) of the gallbladder wall (greater than 10 mm).
C. Bee envenomation is one of the best know triggers of anaphylaxis and is mediated solely through the IgE-dependent hypersensitivity pathway.
D. The major components of bee venom: melittin, phospholipase A2 and hyaluronidase, cause alterations that have not been investigated in dogs.
A. Histamine released into the portal system from the gastrointestinal tract likely resulted in portal hypertension, hepatic congestion, and a dramatic decrease in venous return.
What effects do angiotensin-converting enzyme inhibitors (e.g., enalapril, benazepril, lisinopril) have on the cardiovascular system?
a. Arterial and venous vasodilation, increased preload, increased afterload
b. Arterial and venous vasodilation, decreased preload, decreased afterload
c. Arterial and venous vasodilation, increased preload, decreased afterload
d. Arterial and venous vasodilation, decreased preload, increased afterload
b. Arterial and venous vasodilation, decreased preload, decreased afterload
What is the mechanism of action of telmisartan?
a. Blocks the effects of aldosterone in the distal convoluted tubule and collecting duct, decreasing sodium reabsorption and potassium excretion.
b. Displaces angiotensin II from its receptor, antagonizing all effects, including vasoconstriction, sympathetic activation, aldosterone release and renal sodium reabsorption.
c. Blocks the influx of calcium into vascular smooth muscle cells, thereby inhibiting contraction and ultimately decreasing systemic vascular resistance.
d. Competitively inhibit conversion of angiotensin I to angiotensin II, ultimately resulting in systemic vasodilation.
b. Displaces angiotensin II from its receptor, antagonizing all effects, including vasoconstriction, sympathetic activation, aldosterone release and renal sodium reabsorption.
Which of the following statements about hydralazine is TRUE?
a. Hydralazine acts directly on arteriolar smooth muscle to increase peripheral vascular resistance
b. Hydralazine may cause potassium and bicarbonate retention
c. The most common adverse events in veterinary medicine are reflex tachycardia, weakness, GI upset and a lupus-like reaction
d. Hydralazine acts directly on arteriolar smooth muscle and also has antioxidant effects
d. Hydralazine acts directly on arteriolar smooth muscle and also has antioxidant effects