PRACTICE TEST FROM WIKI (Please put in questions from your own lectures) Flashcards
Ischemic Heart Disease 1:
1.) Which of the following is false?
A) Heart disease is currently the leading cause of death in this country.
B) Since the late 1960s deaths from coronary heart disease have decreased; this is mainly attributed to anti-hypertensives, anti-arrhythmics, and the connection of smoking to heart disease.
C) Age and male gender are risk factors for coronary artery disease that are not treatable.
D) Smoking decreases your level of HDL, and can increase your risk of coronary artery disease by ~50%.
B- Anti-arrhythmics was a trick, the two drug classes thought to be partially responsible for this decrease are anti-hypertensives and drugs that treat hypercholesterolemia. So it’s statins and anti-hypertensives.
Ischemic Heart Disease 1:
2.) The coronary circulation is unique. Which of the following is not true of coronary circulation?
A) The myocardium depends on aerobic metabolism.
B) The left ventricle is perfused in diastole only, which makes bradycardia a risk factor for ischemia.
C) Even during rest a near maximum amount of oxygen is extracted from arterial blood.
D) As a near maximal amount of O2 is extracted from arterial blood, if demand for O2 increases you need to increase flow rate to provide the increased O2.
B-It’s true that the LV is mainly perfused in diastole, so this would make tachycardia a risk factor for ischemia, not bradycardia.
Ischemic Heart Disease 1:
3.) Coronary blood flow rate and oxygen content of blood determine the supply of myocardial O2. There are three main factors that contribute to coronary blood flow rate. Which of the following is not one of the 3 main contributing factors to flow rate?
A) Perfusion pressure
B) Vascular resistance
C) Inotropic state
D) Perfusion time
C- Inotropic state is discussed mainly as a factor influencing myocardial O2 demand, not supply.
Ischemic Heart Disease 2:
1.) Which is not true of coronary artery bypass?
A) The internal mammary artery is frequently used; the internal mammary artery seems much more resistant to atherosclerosis than venous grafts.
B) RCTs have shown that grafting may be better than angioplasty when multiple blockages are present.
C) Thus far prosthetic materials have not been successfully developed as bypass grafts.
D) Prosthetic grafts are successful as long as they also elute antiproliferative drugs.
D- Prosthetic grafts have not been developed successfully; there are successful stents that elute anti-proliferative drugs.
Ischemic Heart Disease 2:
2.) Which of the following is not a problem with balloon angioplasty?
A) Acute occlusion
B) Restenosis
C) A and B
D) High risk of vessel rupture
D- Risk of rupture from this procedure does not seem to be very high; someone even inquired about it in class.
Ischemic Heart Disease 2:
3.) Changes in the ST segment are particularly important when discussing ischemia. Which of the following is false when discussing the ST segment?
A) ST depression absent at rest but present with exercise can be seen in stable angina.
B) The ST segment should not be isoelectric in a healthy patient.
C) ST depression at rest can be seen in unstable angina.
D) ST elevation can be seen in an acute MI.
B- The ST segment should be isoelectric; it should be at baseline in a normal ECG.
Secondary prevention of cardiovascular disease:
1) Edna Greenwood is a post MI 75 year old woman with hypertension, dyslipidemia, and diabetes. Which of her drugs is not a pharmacologic secondary prevention according to the CAD guidelines?
A) aspirin
B) metoprolol
C) lisinopril
D) insulin
E) all are on the guidelines
Answer- D antiplatelet drugs, beta blockers, and RAAS inhibitors are all on the guidelines. Although diabetes is a significant risk factor, diabetes treatment is pharmacologic and lifestyle not just pharmacologic according to the guidelines
Secondary prevention of cardiovascular disease:
2) All of the following patients should be on aspirin, which patient also requires thienopyridines?
A) Bob a 49 year old male 6 months post PCI
B) Mary a 35 year old female 3 weeks post-stroke
C) Angelene a 66 year old female with symptomatic PAD
D) Lionel a 63 year old male post-bypass surgery
Answer: A- after a percutaneous coronary intervention (PCI) you need to be on thienopyridines in addition to aspirin for a year. The others can be on aspirin alone
Secondary prevention of cardiovascular disease:
3) Haans is a 55 year old male with hypertension. Which intervention is not recommended to achieve control?
A) diuretics
B) limit the sodium intake
C) beta blockers
D) RAAS inhibitors
E) Calcium channel blockers
F) vasodilators
G) all are recommended
Answer: G all are great!
Secondary prevention of cardiovascular disease:
4) Which is NOT true about diabetes:
A) Diabetes contributes to atherosclerosis
B) Glycemic control will reduce MI outcomes
C) Diabetes confers the same mortality risk as a prior MI
D) CAD events are also contributed to by diabetes
Answer: B glycemic control does not reduce MI outcomes
Secondary prevention of cardiovascular disease:
5) Eva heard that obesity facilitates the risk factors for cardiac disease, which is why she limits her caloric intake but doesn’t really pay attention to the macronutrient composition, she exercises sometimes but not always, and she feels like she doesn’t need nutrition counseling. Which is essential for Eva to change if she wants to achieve weight loss?
A) Pay attention to macronutrient composition
B) Exercise every day
C) Get nutritional counseling
Answer: C- according to our slides caloric restriction is key (which she is doing), macronutrient composition doesn’t matter as much, physical activity is just a useful adjunct but nutrition counseling is essential!
Tools of the Trade:
1. George is 28 years old. Suppose he takes an exercise treadmill test (ETT), or a pharmacological dobutamine stress test. In order to be comfortable in the results of the test you should make sure that his heart rate got at least to?
A. 220 B. 192 C. 163 D. 154 E. 144
Answer: C
85% of maximal heart rate, which is estimated at 220-Age
(220 - 28) x 0.85 = 163ish (163.2 to be exact)
Tools of the trade:
3. In which of the following scenarios would it be okay to give someone an exercise stress test?
A. Uncompensated heart failure B. Critical aortic stenosis C. Acute pericarditis D. Advanced AV block E. Evaluation following revascularization
Answer: E: A-D are all contraindications of an exercise stress test.
Laboratory Findings for Heart Disease Detection and Management
- Troponin I and Troponin T are useful tests for diagnosing a myocardial infarction (MI). These tests are thought to be extremely sensitive to the heart, and are highly sensitive (90%) and specific (76%). Which of the following scenarios would be most likely to have a high level of Troponins?
A. A 56 year old male comes into the Emergency Department via ambulance. He began having chest pain “like an elephant sitting on his chest” 30 minutes prior to arrival, and immediately called 911. His family history is positive for coronary artery disease (CAD), and his EKG shows moderate ST-Elevation in the anterior leads.
B. A 78 year old female comes into the cardiology office complaining of chest pain. She presented to an urgent care facility the day prior after 2 days of mild, varying chest pain, that seems to be worse in the early afternoon and in the evening. The pain is described as a burning sensation in the center of the chest and has woken the patient up from sleep.
C. A 55 year old male had sudden onset chest pain this morning, and presents to the ED at noon after taking prevacid (lansoprazole) for his GERD. When his symptoms didn’t get better, he decided to come in. “It just felt like really bad heartburn,” he said. “I felt like my breakfast was too much or snd upon EKG evaluation, has large ST-elevations in leads V4, V5, and V6 as well as I and AvFomething…” He has crushing left-sided chest pain and mild nausea, shortness of breath, a.
D. A 95 year old male comes into the Emergency Department extremely short of breath. He became increasingly worse over the past 2 days, and has come in because it has become so bad that he feels that he needs help to breathe. He has previously been self sufficient, walks several miles every day with mild chest discomfort, and has been stable at NYHA Class II. He has BNP levels of 3000 pg/ml, and CXR reveals widespread inflammation in all lung fields, supported by rales on physical exam. He has mild cardiomegaly, but otherwise denies chest pain, and has normal heart sounds except for a 4/6 systolic murmur over the apex of the heart.
ANSWER: While answer A displays a likely STEMI (ST-Elevation, Myocardial Infarction), the presentation is too fast for an elevated troponin level. Answer B is a great presentation for a non-cardiac event, e.g. GERD, which will often wake patients from their sleep due to leakage of the acid back into their esophagous. Notice that the times of maximal pain are post-meal times (early afternoon = post-lunch, evening = post dinner). Answer D is a great presentation of an elderly gentleman with pneumonia due to steadily increasing onset, relatively rapid change from well to poor, and BNP levels indicative of a high probability of HF (remember 90% specific, 76% sensitive for HF-cause). Thus the C, the gentleman with the 4+ hour old MI is the only one who would have an elevated troponin level.
Laboratory Findings for Heart Disease Detection and Management
2. What is the mechanism by which BNP levels increase within the peripheral blood and indicated heart failure?
A. BNP is released by over-stressed atria in systolic heart failure
B. BNP is released by over-stressed atria in diastolic heart failure
C. BNP is released by over-stressed atria in systolic and diastolic heart failure
D. BNP is released by over-stressed ventricles in systolic heart failure
E. BNP is released by over-stressed ventricles in diastolic heart failure
F. BNP is released by over-stressed ventricles in systolic and diastolic heart failure
ANSWER F: Remember for BNP - this is related to increased stretch and volume in the ventricles and is not able to distinguish between systolic and diastolic heart failure.
