Pathopharm Exam 1-S4 Flashcards
Which statement made by a student indicates the healthcare professional needs to describe the pericardium again?
a. The pericardium is a double-walled membranous sac that encloses the heart.
b. It is made up of connective tissue and a surface layer of squamous cells.
c. The pericardium protects the heart against infection and inflammation from the lungs and pleural space.
d. It contains pain and mechanoreceptors that can elicit reflex changes in blood
pressure and heart rate.
b. It is made up of connective tissue and a surface layer of squamous cells.
Which cardiac chambers have the thinnest wall and why?
a. The right and left atria; they are low-pressure chambers that serve as storage units and conduits for blood.
b. The right and left atria; they are not directly involved in the preload, contractility, or afterload of the heart.
c. The left ventricle; the mean pressure of blood coming into this ventricle is from the lung, which has a low pressure.
d. The right ventricle; it pumps blood into the pulmonary capillaries, which have a lower pressure compared with the systemic circulation.
a. The right and left atria; they are low-pressure chambers that serve as storage units and conduits for blood.
Which chamber of the heart endures the highest pressures?
a. Right atrium
b. Left atrium
c. Left ventricle
d. Right ventricle
c. Left ventricle
What is the process that ensures mitral and tricuspid valve closure after the ventricles are filled with blood?
a. Chordae tendineae relax, which allows the valves to close.
b. Increased pressure in the ventricles pushes the valves to close.
c. Trabeculae carneae contract, which pulls the valves closed.
d. Reduced pressure in the atria creates a negative pressure that pulls the valves closed.
b. Increased pressure in the ventricles pushes the valves to close.
A student asks the healthcare professional to explain the function of the papillary muscles. What response by the professional is best?
a. The papillary muscles close the semilunar valves.
b. These muscles prevent backward expulsion of the atrioventricular valves.
c. They open the atrioventricular valves.
d. The papillary muscles open the semilunar valves.
b. These muscles prevent backward expulsion of the atrioventricular valves.
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.
Oxygenated blood flows through which vessel?
a. Superior vena cava
b. Pulmonary veins
c. Pulmonary artery
d. Coronary veins
b. Pulmonary veins
A healthcare professional tells a student that a patient has lost atrial kick. What would the student expect to see when examining this patient?
a. Improvement in atrial dysrhythmias
b. Increased blood pressure
c. Signs of decreased cardiac output
d. Elevations in serum troponin levels
c. Signs of decreased cardiac output
Occlusion of the left anterior descending artery during a myocardial infarction would interrupt blood supply to which structures?
a. Left and right ventricles and much of the interventricular septum
b. Left atrium and the lateral wall of the left ventricle
c. Upper right ventricle, right marginal branch, and right ventricle to the apex
d. Posterior interventricular sulcus and the smaller branches of both ventricles
a. Left and right ventricles and much of the interventricular septum
Where are the coronary ostia located?
a. Left ventricle
b. Aortic valve
c. Coronary sinus
d. Aorta
d. Aorta
The coronary sinus empties into which cardiac structure?
a. Right atrium
b. Left atrium
c. Superior vena cava
d. Aorta
a. Right atrium
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
A healthcare professional is caring for a patient who has a delay in electrical activity reaching the ventricle as seen on ECG. What ECG finding would the healthcare professional associate with this problem?
a. A prolonged ST interval
b. Variability in measurement with heart rate
c. PR interval measuring 0.28 sec
d. A QRS complex measuring 0.08 sec
c. PR interval measuring 0.28 sec
The cardiac electrical impulse normally begins spontaneously in the sinoatrial (SA) node because of what reason?
a. It has a superior location in the right atrium.
b. It is the only area of the heart capable of spontaneous depolarization.
c. It has rich sympathetic innervation via the vagus nerve.
d. It depolarizes more rapidly than other automatic cells of the heart.
d. It depolarizes more rapidly than other automatic cells of the heart.
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 can shorten the conduction time of action potential through the atrioventricular (AV) node?
a. Parasympathetic nervous system
b. Catecholamines
c. Vagal stimulation
d. Sinoatrial node (SA)
b. Catecholamines
A patient had a myocardial infarction that damaged the SA node, which is no longer functioning as the pacemaker of the heart. What heart rate would the healthcare provider expect the patient to have?
a. 60 to 70 beats/min
b. 40 to 60 beats/min
c. 30 to 40 beats/min
d. 10 to 20 beats/min
b. 40 to 60 beats/min
What is the effect of epinephrine on Beta-3 receptors on the heart?
a. Decreases coronary blood flow
b. Supplements the effects of both 1 and 2 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
Where in the heart are the receptors for neurotransmitters located?
a. Semilunar and atrioventricular (AV) valves
b. Endocardium and sinoatrial (SA) node
c. Myocardium and coronary vessels
d. Epicardium and AV node
c. Myocardium and coronary vessels
What enables electrical impulses to travel in a continuous cell-to-cell fashion in myocardial cells?
a. Sarcolemma sclerotic plaques
b. Intercalated disks
c. Trabeculae carneae
d. Bachmann bundles
b. Intercalated disks
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 healthcare professional explains to a student that the amount of volume of blood in the heart is directly related to the _____ of contraction.
a. Pressure
b. Strength
c. Viscosity
d. Speed
b. Strength
Pressure in the left ventricle must exceed pressure in which structure before the left ventricle can eject blood?
a. Superior vena cava
b. Aorta
c. Inferior vena cava
d. Pulmonary veins
b. Aorta
A healthcare professional is caring for a patient who has continuous increases in left ventricular filing pressures. What disorder would the professional assess the patient for?
a. Mitral regurgitation
b. Mitral stenosis
c. Pulmonary edema
d. Jugular vein distention
c. Pulmonary edema
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
The Bainbridge reflex is thought to be initiated by sensory neurons in which cardiac location?
a. Atria
b. Aorta
c. Sinoatrial (SA) node
d. Ventricles
a. Atria
A healthcare professional cares for older adults in a skilled nursing facility. What should the professional assess for in these individuals related to cardiovascular functioning?
a. Increased rate of falling and dizzy spells
b. Improved exercise tolerance
c. A gradual slowing of the heart rate
d. Progressive ECG changes
a. Increased rate of falling and dizzy spells
Reflex control of total cardiac output and total peripheral resistance is controlled by what mechanism?
a. Parasympathetic stimulation of the heart, arterioles, and veins
b. Sympathetic stimulation of the heart, arterioles, and veins
c. Autonomic control of the heart only
d. Somatic control of the heart, arterioles, and veins
b. Sympathetic stimulation of the heart, arterioles, and veins
What is the most important negative inotropic agent?
a. Norepinephrine
b. Epinephrine
c. Acetylcholine
d. Dopamine
c. Acetylcholine
The right lymphatic duct drains into which structure?
a. Right subclavian artery
b. Right atrium
c. Right subclavian vein
d. Superior vena cava
c. Right subclavian vein
A patient had a motor vehicle crash and suffered critical injuries to the brainstem. What physiological responses would the healthcare professional expect to see?
a. Prolonged QRS segment
b. Shortened PR interval
c. Pulse and blood pressure changes
d. Fluid overload
c. Pulse and blood pressure changes
What is an expected change in the cardiovascular system that occurs with aging?
a. Arterial stiffening
b. Decreased left ventricular wall tension
c. Decreased aortic wall thickness
d. Arteriosclerosis
a. Arterial stiffening
What is the major determinant of the resistance that blood encounters as it flows through the systemic circulation?
a. Volume of blood in the systemic circulation
b. Muscle layer of the metarterioles
c. Muscle layer of the arterioles
d. Force of ventricular contraction
c. Muscle layer of the arterioles
What physical sign does the healthcare professional relate to the result of turbulent blood flow through a vessel?
a. Increased blood pressure during periods of stress
b. Bounding pulse felt on palpation
c. Cyanosis observed on exertion
d. Murmur heard on auscultation
d. Murmur heard on auscultation
What is the major effect of a calcium channel blocker such as verapamil on cardiac contractions?
a. Increases the rate of cardiac contractions
b. Decreases the strength of cardiac contractions
c. Stabilizes the rhythm of cardiac contractions
d. Stabilizes the vasodilation during cardiac contractions
b. Decreases the strength of cardiac contractions
An early diastole peak caused by filling of the atrium from peripheral veins is identified by which intracardiac pressure?
a. A wave
b. V wave
c. C wave
d. X descent
b. V wave
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.
Which factor is responsible for the hypertrophy of the myocardium associated with hypertension?
a. Increased norepinephrine
b. Adducin
c. Angiotensin II
d. Insulin resistance
c. Angiotensin II
What pathologic change occurs to the kidney’s glomeruli as a result of hypertension?
a. Compression of the renal tubules
b. Ischemia of the tubule
c. Increased pressure from within the tubule
d. Obstruction of the renal tubule
b. Ischemia of the tubule
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.
Regarding the endothelium, what is the difference between healthy vessel walls and those that promote clot formation?
a. Inflammation and roughening of the endothelium of the artery are present.
b. Hypertrophy and vasoconstriction of the endothelium of the artery are present.
c. Excessive clot formation and lipid accumulation in the endothelium of the artery are present.
d. Evidence of age-related changes that weaken the endothelium of the artery is present.
a. Inflammation and roughening of the endothelium of the artery are present.
A healthcare professional is caring for four patients. Which patient does the professional assess for pulmonary emboli (PE) as the priority?
a. Deep venous thrombosis
b. Endocarditis
c. Valvular disease
d. Left heart failure
a. Deep venous thrombosis
Which factor can trigger an immune response in the bloodstream that may result in an embolus?
a. Amniotic fluid
b. Fat
c. Bacteria
d. Air
a. Amniotic fluid
Which statement best describes thromboangiitis obliterans (Buerger disease)?
a. Inflammatory disorder of small- and medium-size arteries in the feet and sometimes in the hands
b. Vasospastic disorder of the small arteries and arterioles of the fingers and, less commonly, of the toes
c. Autoimmune disorder of the large arteries and veins of the upper and lower extremities
d. Neoplastic disorder of the lining of the arteries and veins of the upper extremities
a. Inflammatory disorder of small- and medium-size arteries in the feet and sometimes in the hands
A patient has been diagnosed with Raynaud disease and asks for an explanation. What statement by the healthcare professional is best?
a. Inflammatory disorder of small- and medium-size arteries in the feet and sometimes in the hands
b. Neoplastic disorder of the lining of the arteries and veins of the upper extremities
c. Vasospastic disorder of the small arteries and arterioles of the fingers and, less commonly, of the toes
d. Autoimmune disorder of the large arteries and veins of the upper and lower extremities
c. Vasospastic disorder of the small arteries and arterioles of the fingers and, less commonly, of the toes
A patient who has lung cancer calls the clinic reports facial and neck swelling severe enough so that shirts no longer fit. What question by the healthcare professional there would be most appropriate?
a. “Have you gained weight recently?”
b. “Are your feet and ankles swollen?”
c. “Does your voice sound hoarse?”
d. “When was your last chemotherapy?”
c. “Does your voice sound hoarse?”
What term is used to identify when a cell is temporarily deprived of blood supply?
a. Infarction
b. Ischemia
c. Necrosis
d. Inflammation
b. Ischemia
A person wishes to reduce the risk of developing coronary artery disease. This person has a normal lipid panel. What risk factor reduction would the healthcare professional advise for this person?
a. Eating a low-fat diet
b. Controlling the blood pressure
c. Avoiding air pollution
d. Moderate alcohol use
b. Controlling the blood pressure
Nicotine increases atherosclerosis by the release of which neurotransmitter?
a. Histamine
b. Nitric oxide
c. Angiotensin II
d. Epinephrine
d. Epinephrine
Which substance primarily contains cholesterol and protein?
a. Very low-density lipoproteins (VLDLs)
b. Low-density lipoproteins (LDLs)
c. High-density lipoproteins (HDLs)
d. Triglycerides
b. Low-density lipoproteins (LDLs)
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)
Cardiac cells can withstand ischemic conditions and still return to a viable state for how many
minutes?
a. 10
b. 15
c. 20
d. 25
c. 20
A patient reports chest pain that occurs most often during sleep. What treatment does the healthcare professional discuss with the patient?
a. Treatment of obstructive sleep apnea
b. Short-acting nitroglycerin tablets
c. A low-dose aspirin regimen
d. Oral calcium channel blockers
d. Oral calcium channel blockers
A patient who had a myocardial infarction is going to cardiac rehabilitation where progressive exercise is monitored by health care professionals. When would this patient be most vulnerable to injury and complications?
a. Between 5 and 9 days
b. Between 10 and 14 days
c. Between 15 and 20 days
d. Between 20 and 30 days
b. Between 10 and 14 days
A patient in the Emergency department is suspected of having a myocardial infarction (MI). The initial cardiac troponin 1 level was negative. What action by the healthcare professional is best?
a. Prepare the patient for thrombolytic therapy.
b. Dismiss the patient because the lab was negative.
c. Schedule repeat lab within a few hours.
d. Give the patient oxygen and pain medication.
c. Schedule repeat lab within a few hours.
What electrocardiogram (ECG) change would the healthcare professional assess for when a patient’s myocardial infarction extends through the myocardium from the endocardium to the epicardium?
a. Prolonged QT interval
b. ST elevation
c. ST depression
d. Prolonged PR interval
b. ST elevation
How does angiotensin II increase the workload of the heart after a myocardial infarction (MI)?
a. By increasing the peripheral vasoconstriction
b. By causing dysrhythmias as a result of hyperkalemia
c. By reducing the contractility of the myocardium
d. By stimulating the sympathetic nervous system
a. By increasing the peripheral vasoconstriction
A healthcare provider is assessing a patient who has a pericardial effusion and notes a pulsus paradoxus. A student asks for an explanation of how this occurs. What description by the professional is best?
a. Diastolic filling pressures of the right ventricle and reduction of blood volume in both ventricles
b. Blood ejected from the right atrium and reduction of blood volume in the right ventricle
c. Blood ejected from the left atrium and reduction of blood volume in the left ventricle
d. Diastolic filling pressures of the left ventricle and reduction of blood volume in all four heart chambers
d. Diastolic filling pressures of the left ventricle and reduction of blood volume in all four heart chambers
A patient reports sudden onset of severe chest pain that radiates to the back and worsens with breathing and when lying down. What action by the healthcare professional is most appropriate?
a. Prepare to assist with an immediate pericardiocentesis.
b. Inform the patient about the side effects of diuretics.
c. Facilitate the patient getting an immediate ECG.
d. Teach the patient about a course of antiinflammatory medications.
d. Teach the patient about a course of antiinflammatory medications.
A disproportionate thickening of the interventricular septum is the hallmark of which form of cardiomyopathy?
a. Dystrophic
b. Hypertrophic
c. Restrictive
d. Dilated
b. Hypertrophic
Amyloidosis, hemochromatosis, or glycogen storage disease usually causes which form of cardiomyopathy?
a. Infiltrative
b. Restrictive
c. Septal
d. Hypertrophic
b. Restrictive
Which condition is a cause of acquired aortic regurgitation?
a. Congenital malformation
b. Cardiac failure
c. Rheumatic fever
d. Coronary artery disease (CAD)
c. Rheumatic fever
A patient in the clinic reports fever, arthralgia, a rash, and nosebleeds. What other information should the healthcare professional elicit from this patient?
a. Family history of Marfan’s disease
b. History of a recent bacterial infection
c. History of any recent chest trauma
d. Any illnesses in family members
b. History of a recent bacterial infection
What is the most common cause of infective endocarditis?
a. Virus
b. Fungus
c. Bacterium
d. Rickettsiae
c. Bacterium
A patient is diagnosed with chronic obstructive pulmonary disease (COPD) and has elevated pulmonary vascular resistance. Which complication would the health care professional assess the patient for?
a. Right heart failure
b. Left heart failure
c. Restrictive cardiomyopathy
d. Hypertrophic cardiomyopathy
a. Right heart failure
What cardiac pathologic condition contributes to ventricular remodeling?
a. Left ventricular hypertrophy
b. Right ventricular failure
c. Myocardial ischemia
d. Contractile dysfunction
c. Myocardial ischemia
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
What is the cause of the dyspnea resulting from a thoracic aneurysm?
a. Pressure on surrounding organs
b. Poor oxygenation
c. Formation of atherosclerotic lesions
d. Impaired blood flow
a. Pressure on surrounding organs
Which statement is true concerning the cells’ ability to synthesize cholesterol?
a. Cell production of cholesterol is affected by the aging process.
b. Cells produce cholesterol only when dietary fat intake is low.
c. Most body cells are capable of producing cholesterol.
d. Most cholesterol produced by the cells is converted to the low-density form.
c. Most body cells are capable of producing cholesterol.
What is the trigger for angina pectoris?
a. Atherosclerotic lesions
b. Hyperlipidemia
c. Myocardial necrosis
d. Myocardial ischemia
d. Myocardial ischemia
Most cardiovascular developments occur between which weeks of gestation?
a. Fourth and seventh weeks
b. Eighth and tenth weeks
c. Twelfth and fourteenth weeks
d. Fifteenth and seventeenth weeks
a. Fourth and seventh weeks
The presence of the foramen ovale in a fetus allows what to occur?
a. Right-to-left blood shunting
b. Left-to-right blood shunting
c. Blood flow from the umbilical cord
d. Blood flow to the lungs
a. Right-to-left blood shunting
The student studying pathophysiology learns which fact about circulation at birth?
a. Systemic resistance and pulmonary resistance fall.
b. Gas exchange shifts from the placenta to the lung.
c. Systemic resistance falls and pulmonary resistance rises.
d. Systemic resistance and pulmonary resistance rise.
b. Gas exchange shifts from the placenta to the lung.
When does systemic vascular resistance in infants begin to increase?
a. One month before birth
b. During the beginning stage of labor
c. One hour after birth
d. Once the placenta is removed from circulation
d. Once the placenta is removed from circulation
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
Older children with an unrepaired cardiac septal defect experience cyanosis because of which factor?
a. Right-to-left shunts
b. Left-to-right shunts
c. Obstructive lesions
d. Mixed lesions
a. Right-to-left shunts
A baby has been born with Down syndrome. What congenital heart defect does the healthcare professional assess this baby for?
a. Coarctation of the aorta (COA)
b. Tetralogy of Fallot
c. Atrial septal defect (ASD)
d. Ventricular septal defect (VSD)
d. Ventricular septal defect (VSD)
An infant has a continuous machine-type murmur best heard at the left upper sternal border throughout systole and diastole. The healthcare professional suspects a congenital heart disorder. What other assessment finding is inconsistent with the professional’s knowledge about this disorder?
a. Bounding pulses
b. Active precordium
c. Thrill on palpation
d. Signs of heart failure
c. Thrill on palpation
An infant has a crescendo-decrescendo systolic ejection murmur located between the second and third intercostal spaces along the left sternal border. The healthcare professional suspects an atrial septal defect (ASD). For what other manifestation does the healthcare professional assess to confirm the suspicion?
a. Wide, fixed splitting of the second heart sound
b. Loud, harsh holosystolic murmur
c. Cyanosis with crying and feeding
d. Rapid deterioration with acidosis
a. Wide, fixed splitting of the second heart sound
An infant has a loud, harsh, holosystolic murmur and systolic thrill that can be detected at the left lower sternal border that radiates to the neck. These clinical findings are consistent with which congenital heart defect?
a. Atrial septal defect (ASD)
b. Ventricular septal defect (VSD)
c. Patent ductus arteriosus (PDA)
d. Atrioventricular canal (AVC) defect
b. Ventricular septal defect (VSD)
Where can coarctation of the aorta (COA) be located?
a. Exclusively on the aortic arch
b. Proximal to the brachiocephalic artery
c. Between the origin of the aortic arch and the bifurcation of the aorta in the lower abdomen
d. Between the origin of the aortic arch and the origin of the first intercostal artery
c. Between the origin of the aortic arch and the bifurcation of the aorta in the lower abdomen
A parent brings a 10-year-old child to the clinic and reports a mottled appearance to the skin and legs cramps when the child is in physical education class. What diagnostic testing or treatment does the healthcare professional prepare the family for?
a. Immediate cardiac catheterization
b. Administration of prostaglandin
c. Multiple-stage surgical correction
d. An echocardiogram
d. An echocardiogram
What is the initial manifestation of aortic coarctation observed in a neonate?
a. Heart failure (HF)
b. Cor pulmonale
c. Pulmonary hypertension
d. Cerebral hypertension
a. Heart failure (HF)
A parent asks the healthcare professional to explain why a child diagnosed with Tetralogy of Fallot squats frequently. What explanation by the professional is best?
a. Reduces the chest pain
b. Controls dizziness
c. Relieves hypoxia
d. Improves headache
c. Relieves hypoxia
An infant diagnosed with a small patent ductus arteriosus (PDA) would likely exhibit which symptom?
a. Intermittent murmur
b. Lack of symptoms
c. Rapid decompensation
d. Triad of congenital defects
b. Lack of symptoms
A newborn has chronic sustained hypertension but otherwise appears healthy. What diagnostic testing does the healthcare professional facilitate as the priority?
a. Cardiac catheterization
b. Echocardiogram
c. Serum electrolytes
d. Renal function studies
d. Renal function studies
Which condition is consistent with the cardiac defect of transposition of the great vessels?
a. The aorta arises from the right ventricle.
b. The pulmonary trunk arises from the right ventricle.
c. The right ventricle pumps blood to the lungs.
d. An intermittent murmur is present.
a. The aorta arises from the right ventricle.
Which scenario describes total anomalous pulmonary venous return?
a. The foramen ovale closes after birth.
b. Pulmonary venous return is to the right atrium.
c. Pulmonary venous return is to the left atrium.
d. The left atrium receives oxygenated blood.
b. Pulmonary venous return is to the right atrium.
A healthcare professional assesses a systolic ejection murmur at the right upper sternal border that transmits to the neck and left lower sternal border. What condition does the professional prepare to educate the parents on?
a. Coarctation of the aorta
b. Pulmonic stenosis
c. Aortic stenosis
d. Hypoplastic left heart syndrome
c. Aortic stenosis
A healthcare professional is assessing a baby in the neonatal intensive care unit who is very unstable. The professional hears a systolic ejection click at the upper left sternal border with a thrill palpated at the upper left sternal border. What procedure does the professional prepare the parents for the baby to have?
a. Heart transplant
b. Balloon angioplasty
c. Prostaglandin infusion
d. High dose aspirin
b. Balloon angioplasty
Which heart defect results in a single vessel arising from both ventricles, providing blood to both the pulmonary and systemic circulations?
a. Coarctation of the aorta
b. Tetralogy of Fallot
c. Total anomalous pulmonary connection
d. Truncus arteriosus
d. Truncus arteriosus
A 9-year-old child has a blood pressure of 112/72 mmHg in the school nurse’s office. What action by the school nurse is most appropriate?
a. Inform the parents the child might be dehydrated.
b. Note the normal finding in the child’s records.
c. Calculate the child’s Body Mass Index.
d. Refer the child for medication.
b. Note the normal finding in the child’s records.
Calcium Channel Blocker that is selective for myocardium with little vasculature activity?
Phenylkalkylamines (papaverine)
Verapamil
Calcium Channel Blocker that is primarily effective on vasculature only?
Dihydropyridines
Amlodipine
Felodipine
Calcium Channel Blocker that is primarily used for vasculature but can cause reflexive tachycardia?
Nifedipine
Belongs to Dihydropyridine class
Calcium Channel Blocker that effects both vasculature and myocardium?
Benzythiazepine
Diltiazem
Which type of angina is caused by coronary vasospasm which results in reduction of coronary blood flow at rest?
Prinzmetals Angina or Variant Angina
Coronary circulation receives what % of cardiac output?
4%
The normal myocardium accounts for what percent of the total body oxygen consumption?
11%
Heart rate
Coronary perfusion pressure
Arterial oxygen content
Coronary artery diameter
All depend on what?
Myocardial oxygen supply
Heart rate
Ventricular preload
Afterload
Contractility
All depend on what?
Myocardial oxygen demand
Nitrates do what to blood flow?
Vasodilation leading to DECREASED PRELOAD
At what plaque size reduction does sufficient reduction in blood flow and anginal symptoms begin?
Greater than 50% is bad
Beta blockers do what to affect Angina?
Decreased myocardial work and oxygen consumption by decreasing HR.
Calcium Channel blockers do what to affect Angina?
Maximize coronary vasodilation by decreasing afterload
The most important control of coronary blood flow is?
Local myocardial metabolism
Which drug can cause Reflex mediated Tachycardia?
Nitrates
due to high doses and decreasing BP so much they become tachycardic to compensate.
Nitrates redistribute coronary blood flow to what region?
Subendocardial
Most common side effect of Nitrates?
Headache due to meningeal vascular dilation
Which Beta blocker would you not give to asthmatics?
Propanolol due to beta 2 blockade bronchoconstriction
This diuretic acts on the Thick Ascending Limb of the Loop of Henle?
Furosemide (Lasix)
High Ceiling Diuretics
This diuretic causes a large rapid diuresis up to 1L in first two hours?
High Ceiling Diuretics
Furosemide (Lasix)
Furosemide (Lasix) is what type of diuretic and acts where?
High ceiling diuretic
Thick ascending limb loop of henle
This diuretic acts on the proximal end of the distal tubule?
Hydrocholorothiazide
Thiazide diuretics
Which diuretic is first line therapy for CHF?
Thiazides
Hydrochlorothiazide
Major side effect of Thiazide diuretics?
Hypokalemia
Hyperglycemia
Metabolic alkalosis
This diuretic acts in the proximal tubule to decrease bicarbonate conversion?
Carbonic Anhydrase Inhibitors
Acetazolamide
This diuretic acts in the late distal tubule and collecting ducts?
Spironolactone and Amiloride
Potassium sparing diuretics
Which diuretic is potassium sparing?
Spironolactone
Which drug is a Neprilysin inhibitor used to treat CHF by cleaving proteins and decrease preload/afterload?
Now used as diagnostic marker for ALL cancer?
Entresto
Inhalational anesthesia agents do what to myocardial contractility?
Depress contractility
Decrease systemic vascular resistance
Hypotension
What 3 things make up Stroke Volume?
Preload
Afterload
Contractility
In cardiac failure Starling curve is displaced _____ meaning increase in preload to maintain performance?
Downward
The RAAS system is used to do what?
Decrease in cardiac output causes Renin release from kidneys which cleaves angiotensinogen from the liver to make Angiotensin I and meets with ACE from the Lungs to make Angiotensin II which causes vasoconstriction to increase volume and preload to the heart but also causes increased afterload.
Ventricular end diastolic volume is also known as?
Preload
Venous smooth muscle tone is under _____ control?
Sympathetic + Humoral control
Atrial kick enhances what?
Ventricular filling
Not critical at rest
The amount of what is the most important acute factor in changing Starling curve?
Amount of Norepinephrine
How does increased HR affect atrial kick?
Decreased atrial kick which decreased Cardiac Output
Intracavity ventricular pressure + Radius / Divided by wall thickness
is what?
Laplace’s Law
Left ventricular stroke volume is ____ proportional to afterload?
Direct or Inverse?
Inverse
What can cause CHF?
Arrhythmias
MI
PE
Systemic Hypertension
Which class of drugs reduce afterload in CHF?
ACE inhibitors Lisinopril/Enalapril
ARBs Losartan
Which drug is used to improve contractility in CHF by increasing intracellular calcium?
Milrinone
Last line therapy
Which drugs block Angiotensin I to Angiotensin II?
Ace Inhibitors
Enalapril
Captopril
Lisinopril
First line therapy for CHF include?
Diuretics and Ace Inhibitors/ARBS
Which drug can cause a vasodilation of renal vasculature to decrease Renin secretion?
Dopamine
Which drug is preferred and produces less arrhythmogenic tachycardia?
Dopamine or Dobutamine?
Dobutamine
Short term inotropic support in hospital setting
Which drug for CHF is an inhibitor of the Na-K-ATPase to increase calcium concentrations and prolong refractory period?
Digoxin
Virchow triad is associated with which disorder?
DVT
Venous stasis
Venous damage
Hypercoagulable
120-139 Diastolic
80-90 Systolic
?
Prehypertension
Elevated systolic blood pressure with normal Diastolic?
Isolated systolic hypertension
CAUSE ORGAN DAMAGE
140+ Systolic
90 Diastolic
?
Hypertension
Which type of hypertension has NO known cause? 95%
Primary (essential) HTN
Which type of hypertension is caused by altered hemodynamics from underlying drug or disease?
Secondary HTN
Which hypertension is associated with hypertrophy and hyperplasia, fibrosis of the tunica intima and media “vascular remodeling”?
Complicated HTN
Which hypertension is associated with rapid progression and diastolic pressure of 140?
Malignant HTN
Fusiform aneurysm is a type of what?
True Aneurysm
Collects all around vessel
Circumferential aneurysm is a type of what?
True Aneurysm
Small, Donut shape
Saccular aneurysm is a type of what?
False aneurysm
Outpouch along ONE wall.
What is an Inflammatory disease of the small and medium peripheral arteries.
Mainly young men who smoke?
Thromboangiitis obliterans
(Buerger disease)
What is a vasospasm in the arteries of the fingers and less common in the toes? Change in skin color caused by ischemia.
Raynauds
Raynauds phenomenon vs Raynaud disease?
Phenomenon- Secondary to other disease or condition.
Disease- Primary vasospastic disorder of unknown origin.
Intermittent claudication is associated with which disease?
Peripheral artery disease.
Pain with walking due to obstructed blood flow.
Subendocardial infarction?
NSTEMI
Not complete through wall
Transmural infarction?
STEMI
Complete through wall
Which cardiac disorder is manifested by a widened pulse pressure?
Aortic Regurgitation
Which are painful erythematous nodules on the pads of fingers and toes associated with Infective Endocarditis?
Osler nodes or Janeway Lesions
Osler Nodes
Which are Nonpainful hemorrhagic lesions on the palms and soles associated with Infective Endocarditis?
Osler nodes or Janeway Lesions?
Janeway Lesions
A fetal heart is completely present by what gestation?
8 weeks
