QUIZ QUESTIONS Flashcards
When a person moves from a supine position to a standing position, which of the following compensatory changes occurs?
INCREASED CONTRACTILITY
At which site is systolic blood pressure the highest?
RENAL ARTERY
If the ejection fraction increases, there will be a decrease in:
END-SYSTOLIC VOLUME
An increase in contractility is demonstrated on a Frank-Starling diagram by?
INCREASED CARDIAC OUTPUT FOR A GIVEN END-DIASTOLIC VOLUME
An acute decrease in arterial blood pressure elicits which of the following compensatory changes?
DECREASED FIRING RATE OF THE CAROTID SINUS NERVE
The tendency for edema to occur will be increased by?
INCREASED VENOUS PRESSURE
Inspiration “splits” the second heart sound because
THE AORTIC VALVE CLOSES BEFORE THE PULMONIC VAVLE
Which of the following is the result of an inward Na+ current?
UPSTROKE OF THE ACTION POTENTIAL IN PURKINJE FIBERS
Pulse pressure is?
DETERMINED BY STROKE VOLUME
Myocardial contractility is best correlated with the intracellular concentration of
CA2+
Cardiac output of the right side of the heart is what percentage of the left side the heart?
100%
Which of the following changes will cause an increase in myocardial 02 consumption?
INCREASED SIZE OF THE HEART
A 24-year-old woman presents to the emergency department with severe diarrhea. When she is supine (lying down), her blood pressure is 90/60 mmHg (decreased) and her heart rate is 100 beats/min (increased). When she is moved to a standing position, her heart rate further increases to 120 beats/min. Which of the following accounts for the further increase in heart rate upon standing?
DECREASED VENOUS RETURN
During which phase of the ventricular action potential is the membrane potential closest to the K+ equilibrium potential?
PHASE 4
If the heart rate is 70 beats/min, then the cardiac output of this ventricle is closest to:
5.25 L/min
Which receptor mediates slowing of the heart?
MUSCARINIC RECPETORS
Which agent is released or secreted after a hemorrhage and causes an increase in renal Na+ reabsorption?
ALDOSTERONE
A 42-year old woman with mitral prolapse is admitted to the hospital for evaluation of her cardiac function. Which of the following values if the best index of the preload on her heart?
LEFT VENTRICULAR END-DIASTOLIC VOLUME
A 66-year-old man is referred to a cardiologist for evaluation. Physical examination reveals a diastolic murmur prominent over the left sternal border, a decrease in diastolic pressure, and an increase in pulse pressure. Which of the following is the most likely diagnosis?
AORTIC REGURGITATION
A 75-year old woman presents with fatigue, edema, and shortness of breath. Her physician prescribes a diuretic and a positive inotropic agent. Which of the following changes is primarily responsible for the improvement in her condition?
A REDUCTION IN HEART SIZE
A cardiac catheterization is performed on a 39-year-old man who presents with angina. The left ventricular pressure-volume curve shows a decreased stroke volume and ejection fraction. Which of the following mechanisms may compromise stroke volume following myocardial infraction?
AN INCREASE IN HEART RATE
A 48-year-old sedentary, obese man with four-vessel coronary occlusive disease has a massive
myocardial infraction while shovelling snow, In the blizzard conditions, it takes the ambulance over an hour to reach the man’s home. When the paramedics arrvive, the patient’s radial pulse is rapid and thready, he has pink froth coming from his mouth and he is non responsive. Increasing which of the following would lead to an increased stroke volume in Cardiogenic shock?
VENTRICULAR CONTRACTILITY
During which phase of the ventricular action potential is the conductance to CA2+ highest?
PHASE 2
Which of the following are considered likely aetiologies for atrial fibrillation?
EMPHYSEMA & RHEUMATIC HEART DISEASE
The cardiac worker cells or myocytes’ maintain a negative membrane potential because:
THE NA+/K+ PUMP, THROUGH ACTIVE TRANSPORT, MOVES 3 SODIUM IONS OUT OF AND 2 POTASSIUM IONS INTO THE CELL
&
THE CELL MEMBRANE IS MORE PERMEABLE TO POTASSIUM IONS LEADING TO A PASSIVE LOSS OF POSITIVE IONS
During which phase of the cardiac cycle is aortic pressure highest?
REDUCED VENTICULAR EJECTION
In cardiology, re-entry is defined as:
THE ABILITY OF AN IMPULSE TO RE-EXCITE A REGION OF THE HEART WHICH IT HAS ALREADY PASSED THROUGH.
Automaticity is defined as the hearts ability to:
GENERATE ITS OWN PULSES
If the ejection fraction increase, there will be a decrease in
END-SYSTOLIC VOLUME
You are treating a 19 year old with a BP of 78 / 54 and a pulse of 190. The cardiac monetary shows a wide complex tachycardia. This patient would benefit mostly from.
CARDIOVERSION
A conscious 43 year old 60 kilogram male has a wide complex rhythm at a rate of 186 on the monitor and a BP of 154 / 90. The patient has no chest pain but does feel a little weak. You anticipate a BHP order for Amiodarone of Lidocaine:
LIDOCAINE 90 mg IV can be administered, initially
&
AFTER AN INIITAL DOES OF AMIODARONE, A SECOND DOSE OF AMOIDARONE 150 MG CAN BE ADMINISTERED OVER 10 MINUTES IF THE TACHYCARDIA PERSISTS
Beta effects will be most pronounced when Dopamine is administered at:
5 - 10 UG/KG/MIN
With regard to SA and AV cells:
NA+ PERMEABILITY, LEAK CHANNELS, IS RESPONSIBLE THEIR AUTOMATICITY
&
PHASE 3 IS THE REPOLARIZATION PHASE AND DOMINATED BY POTASSIUM EFFLUX
Paroxysmal supra ventricular tachycardias (PSVT) are most often caused by:
RE-ENTRANT MECHANISIMS
In cardio version what can be done to help the machine synchronize in the R waves?
INCREASE THE GAIN OR SIZE OF THE ECG CHANGE LEADS TURN OFF ALL ADJUCT FEATURES IF POSSIBLE TURN ON AND TURN OFF THE MACHINE
Blood pressure is equal to which of the following?
HEART RATE X STROKE VOLUME X PERIPHERAL VASCULAR RESISTANCE
The most common cause of cardiac implantable pacemaker failure is:
BATTERY FAILURE
Approximately 80% of ventricular killing occurs:
DURING VENTRICULAR SYSTOLE
Which of the following is NOT a contraindication for the administration of Adenosine?
COUMADIN
Which of the following electrolytes has a major role in the depolarization of pacemaker cells and in myocardial contractility?
Calcium (Ca+)
The ______ has/have an intrinsic pacing rate of 35 to 40 beats per minute
PURKINJE CELLS
______ slow automaticity through the SA node and Purkinje system.
BETA-BLOCKERS
A positive chronotropic effect will have what effect on the heart?
INCREASED HEART RATE
The relationship between an increased ejection fraction and increased ventricular end-diastolic volume is called:
STARLING’S LAW
Which of the following statement are true for the treatment of patients in stable vs unstable tachycardia
VAGAL MANEUVERS CAN BE APPLIED TO PATIENTS WITH STABLE SVT
ADENOSINE IS AN APPROPRIATE MEDICATION FOR STABLE SVT
CARDIOVERSION IS APPROPRIATE FOR UNSTABLE SVT AND VT WITH A PULSE
Narrowing pulse pressure with drop in systolic pressure during an AMI is an indication of:
A FAILURE OF THE SYMPATHETIC RESPONSE TO COMPENSATE A POOR EJECTION FRACTION DECREASING STROKE VOLUME DEVELOPING CARDIOGENIC SHOCK WITH POTENTIAL FOR CARDIAC ARREST
The most important benefit to decreasing a patient’s anxiety in an AMI situation is it:
ALLOWS FOR A REDUCTION IN MYOCARDIAL WORKLOAD AND MYOCARDIAL OXYGEN DEMAND
Regarding angina pectoris which of the following statements are true?
THE PATIENT WILL PRESENT WITH PALE, COOL AND DIAPHORETIC SKIN
CRUSHING SUBSTERNAL PAIN MAY RADIATE TO BACK NECK , ARMS OR JAW
THE PATIENT’S BLOOD PRESSURE MAY BE HIGH, LOW OR NORMAL
An atypical MI event that follows the use of cocaine, releases which of the following chemical mediators to precipitate coronary vasospasm:
THROMBOXANE
Which of the following are part of the compensatory response to a decreasing CO?
CATECHOLAMINE RELEASE
INCREASE IN ANGIOTENSIN II
ALDOSTERONE RELEASE
Which of the following statement concerning the pathology of myocardial infraction are true?
IF THE BLOOD SUPPLY IS NOT RESTORED WITHIN 30 MIN THE HEART TISSUE BECOMES NECROTIC AND AN AREA OF INJURY AND INFLAMMATION DEVELOPS AROUND THE NECROTIC ZONE
BECAUSE THE MYOCARDIUM DOES NOT REGENERATE, THE AREA OF NECROSIS IS GRADUALLY REPLACED BY FIBROUS NONFUNCTIONAL TISSUE.
MOST INFRACTIONS ARE TRANSMURAL INVOLVING ALL THREE LAYERS OF THE HEART WITH THE MAJORITY INVOLVING THE LEFT VENTRICLE.
Complications of myocardial infraction include:
ARRHYTHMIAS CARDIOGENIC SHOCK VENTICULAR ANEURYSM
In the development of atherosclerosis which of the following statements are true?
BIFURCATION POINTS OF HIGH FLOW, HIGH-PRESSURE ARTERIES ARE OFTEN THE MOST COMMON SITES FOR LESIONS
MONOCYTES BECOME MACROPHAGES INGESTING RANCID CHOLESTEROL THAT HAS COLLECTED WITHIN THE INTIMA CHOLESTEROL-FILLED MACROPHAGES ARE CALLED foam cells, LEADS TO HYPERPLASIA OF THE MEDIA’S SMOOTH MUSCLE CELLS.
Which of the following statement concerning the coronary arteries are true?
THE LEFT ANTERIOR DESCENDING ARTERY IF OCCLUDED OFTEN RESULTS IN PUMP FAILURE WITH CLASSIC CHEST PAIN RADIATING TO THE MEDIAL ASPECT OF THE LEFT ARM
THE RIGHT CORONARY ARTERY IF OCCLUDED CAN REUSLT IN BRADYCARDIA AND HYPOTENSION WITH CHEST PAIN RADIATING TO THE NECK AND JAW
The chest pain associated with myocardial infraction is due to:
ABNORMAL MYOCARIDAL STRETCHING
ISCHEMIA AND LACTIC ACID PRODUCTION
INFLAMMATION OF INVOLVED AND ADJACENT TISSUE
Which of the following is/are the markers of choice and most specific in determining myocardial cell death:
Troponins I & T
When a myocardial fiber is in the relative refractory period, the fiber:
CAN BE PREMATURELY STIMULATED
Target organ damage that can occur from hypertension includes
RENAL DYSFUNCTION AND LEFT VENTRICULAR HYPERTROPHY
Specific symptoms of aortic dissection vary depending on
THE AORTIC BRANCHES AFFECTED IN THE DESCENT OF THE DISSECTION
The most common pathological finding in individuals with sudden cardiac death is:
ATHEROSCLEROTIC HEART DISEASE
The clinical spectrum of acute coronary syndrome includes
UNSTABLE ANGINA, STEMI AND NSTEMI
The paramedic suspects the presence of a deep vein thrombosis based on the findings of
GENERALIZED EDMEA OF THE INVOLVED EXTREMITY
The paramedic prepares a patient for electrical cardio version knowing that cardio version differs from defibrillation in that
CARDIOVERSION IS MAT BE DONE ON AN EMERGENCY BASIS WITH SEDATION OF THE PATIENT
The primary manifestations of systolic ventricular failure include
DECREASE EJECTION FRACTION AND INCREASED PULMONARY ARTERY WEDGE PRESSURE
Your patient is admitted to the hospital in hypertensive crisis. You recognize that the hypertensive urgency differs from hypertensive emergency in that:
HYPERTENSIVE EMERGENCIES ARE ASSOCIATED WITH EVIDENCE OF TARGET ORGAN DAMAGE
A patient is being transferred for an abdominal aortic aneurysm repair. The paramedic suspects rupture of the aneurysm when
THE CLIENT COMPLAINS OF SUDDEN, SEVERE BACK PAIN
The drug used in the management of a client with acute pulmonary edema that will decrease both preload and after load and provide relief of anxiety is
MORPHINE
A patient with a history of IV cocaine use has acute infective endocarditis. You closely assess the patient for signs and symptoms of
PULMONARY EMBOLI
In teaching a patient about coronary artery disease, the Community Paramedic explains the changes that occur in this disorder involve
FORMATION OF FIBROUS TISSUE AROUND CORONARY ARTERY ORIFICES
A client with a deep vein thrombosis suddenly develops dyspnea, tachypnea, and chest pain. Initially the most appropriate action by the nurse is to.
ELEVATE THE HEAD OF THE BED 30 TO 45 DEGREES TO FACILITATE BREATHING
A compensatory mechanism involved in congestive heart failure that leads to inappropriate fluid retention and additional workload of the heart is
NEUROHORMONAL RESPONSE
You suspect cardiac tamponade in a patient with acute pericarditis based on the finding of
PULSUS PARADOXUS
Indication for the use (in medicine, not just the ALSPCS) of the antidysrhythmic amiodarone (Cordarone) include:
ALL OF THE ABOVE
INITIAL TREATMENT OF ATRIAL DYSRHYTHMIAS
INITIAL TREATMENT OF VENTRICULAR DYSRHYTHMIAS
TREATMENT OF PAROXYSMAL VENTRICULAR TACHYCARDIA REFRACTORY TO OTHER ANTIDYSRHYTHMICS
Match the following drug, lisionpril (Prinivil), used to treat heart failure with its drug class:
ACE INHIBITOR
Match the following drug, milrinone (Primacor), used to treat heart failure with its drug class:
PHOSPHODIESTERASE
Which of the following is involved in slowing of heart rate and conduction?
MUSCARINIC RECEPTOR ACTIVATION
The onset of action for Nitroglycerin is:
2 MINTUES
Adenosine (Adenocard) works by blocking ____ channels in the heart and has the effect of ____ conduction through the _____ pathways.
CALCIUM, SLOWING, AV
When used to treat hypertension, diuretics such as hydrochlorothiazide (HydroDIURIL):
CAUSE A REDUCTION IN BLOOD VOLUME
Which of the following drugs has been shown to increase survival in clients with heart failure?
LISINOPRIL (Prinivil)
The most effective drugs for lowering cholesterol levels are the:
STATINS
Which of the following is a Class Ic antiarrhythmics
FLECAINIDE (Tambocor)
Procainimide (Pronestyl) is an antidysrhythmic that causes ______ blockade, whereas amiodarone (Cardarone) is a drug that causes ______ blockade.
SODIUM, POTASSIUM
You are treating a patient for chest discomfort concurrent with hypotension that has been unresponsive to oxygen and fluid replacement therapy. The patient is pale and cool to the touch, ECG shows an apparent sinus bradycardia. You decide to treat the patient with atropine. Shortly after, your patient begins to exhibit signs and symptoms different from the initial complaint. Of the following, which would be considered a “normal” side effect of the drug?
ALL OF THE ABOVE
CARDIAC PALPITATIONS
DILATED PUPILS
ANXIETY
While interviewing your patient you discover that they have stopped taking their captopril (Capoten) because of an annoying cough. Which drug do you think would be a good replacement?
LOSARTAN
Clonidine (Catapress) acts mainly on the:
ALPHA-ADRENERGIC RECEPTORS
You learn that your patient has been started on amiodarone (Cordarone). What is the most likely rationale for this?
SERIOUS VENTRICULAR DYSRHYTHMIA
Using critical thinking, select the underlying effect that results from taking propranolol (Inderal).
DECREASE IN OXYGEN CONSUMPTION BY THE HEART
Class III antiarrhythmics interfere with:
POTASSIUM OUTFLOW
Tirofiban (Aggrastat) and clopidogrel (Plavix) share the following attributes. They:
INHIBIT COAGULATION OF BLOOD AND AGGREGATION OF PLATELETS
The dihydropyridine calcium channel blockers lower blood pressure by:
REDUCING TOTAL PERIPHERAL RESISTANCE
Patient teaching regarding the use of beta blockers in treatment of MI includes beta blockers’ ability to cause:
NEGATIVE INOTROPIC EFFECT
Which of the following is a therapeutic strategy for patients with heart failure?
DECREASE CARDIAC PRELOAD
How do angiotensin converting enzyme inhibitors decrease blood pressure?
ALL OF THE ABOVE DECREASING BLOOD VOLUME INCREASING RENAL SODIUM EXCRETION BLOCKING THE CONVERSION OF ANGIOTENSIN I TO ANGIOTENSIN II DILATING ARTERIES
Beta-blocking agents will introduce:
BOTH NEGATIVE INOTROPIC AND CHRONOTROPHIC EFFECTS
Which of the following drugs has a positive inotropic effect in clients with heart failure?
DIGOXIN (LANOXIN)
Your patient is about to receive alteplase recombinant (Activase) after being diagnosed with an acute MI. You know this medication is given to:
DISSOLVE PRE-EXISTING CLOTS
Known actions of Lidocaine (Xylocaine) include:
SUPPRESSION OF ISCHEMIC ECTOPIC FOCI
Class IV antiarrythmic medications are?
NONE OF THE ABOVE
All of the following are calcium channel blocker drugs EXCEPT:
LIDOCAINE (XYLOCAINE)
Antianginal drugs accomplish therapeutic effects by doing which of the following?
ALL OF THE ABOVE SLOWING THE HEART RATE LOWERING BLOOD PRESSURE REDUCE AFTERLOAD DILATING VEINS
A woman with essential hypertension requires a drug that reduces both cardiac output and peripheral resistance
LABETALOL
Aspirin acts to inhibit platelet aggregation by:
DECREASING SYNTHESIS OF COAGULATION FACTORS
Drugs used to treat angina pectoris include all of the following EXCEPT:
ANTIARRHYTHMIC DRUGS
Which of the following medications could be used to manage atrial fibrillation?
DIGOXIN (LANOXIN)
The group of drugs that reduce the heart’s oxygen demand by decreasing the heart rate is known as the:
BETA-ADRENERGIC BLOCKERS
Compensatory mechanisms that come into play in heart failure include:
ALL OF THE ABOVE MYOCARDIAL HYPERTROPHY INCREASED SYMPATHETIC STIMULATION RENIN-ANGIOTENSIN-ALDOSTERONE MECHANISM ADH RELEASE AND ACTIVATION
One critically important effect that the arrhythmia SVT can have is:
DECREASED CORONARY PERFUSION OF MYOCARDIUM
Clinical presentation of right ventricular failure resulting from pulmonic stenosis includes
NONE OF THE ABOVE
The most common cause of secondary hypertension is:
RENAL VASCULAR DISEASE
Signs and symptoms of right-sided heart failure often include:
ASCITES, PERIPHERAL EDEMA
Which of the following statements on the aetiology and pathology of heart failure are true?
VALVULAR DISEASE LEADS TO COMPLETE VENTRICULAR CLEARING AND A DECREASED AFTER LOAD
CHF MAY BE PRIMARILY A SYSTOLIC DYSFUNCTION CAUSED BY VOLUME OVERLOAD
Which of the following statements concerning the coronary arteries are true?
THE LEFT ANTERIOR DESCENDING ARTERY IF OCCLUDED OFTEN RESULTS IN PUMP FAILURE WITH CLASSIC CHEST PAIN RADIATING TO THE MEDIAL ASPECT OF THE LEFT ARM.
THE RIGHT CORONARY ARTERY IF OCCLUDED CAN RESULT IN BRADYCARDIA AND HYPOTENSION WITH CHEST PAIN RADIATING TO THE NECK AND JAW
Starling’s law is generally expressed as follows:
AN INCREASE IN DIASTOLIC FILLING WILL INCREASE THE FORCE OF CONTRACTION
Collateral circulation is the body’s mechanism for increasing blood flow to deprived areas of the myocardium. This increase is accomplished by:
THE FORMATION OF NEW CAPILLARIES BYPASSING OBSTRUCTED ARTERIOLES
A normal time interval for the QRS complex can be:
0.08 to 0.10 second
Conductivity between the SA and AV node can be enhanced by administration of:
ATROPINE
The most frequent complication encountered during an AMI is:
DYSRHYTHMIAS
The most reliable indicator of impending Cardiogenic shock is:
A NARROWING PULSE PRESSURE
Which of the following are considered etiologies for PEA
HYPOVOLEMIA HYPOXIA HYPOTHERMIA CARIDAC TAMPONADE MASSIVE PULMONARY EMBOLISM DRUG OVERDOSE HYPERKALEMIA TENSION PNEUMOTHRORAX
All of the following are associated with atrial fibrillation expect one
AORTIC STENOSIS
Time to defibrillation is key with the probably of defibrillating back to a perfusing rhythm approaching zero after:
15 MINUTES
ST elevation in leads V5, V6 represents possible occlusion of:
CIRCUMFLEX BRACH OF LEFT CORONARY ARTERY
The normal S2 heart sound is produced by:
CLOSING OF THE SEMILUNAR VALVES
Your patient presents with an anterior wall MI. Their vital signs are: HR 92, BP 134/74, RR 14 and SpO2 of 95%. During transport they become pale, diaphoretic with increasing dyspnea. You notice that their cardiac rhythm has now changed to a second degree heart block type II at a rate of 38 bpm with a BP of 92/70 mmHg. The most appropriate therapy indicated for the patient is:
IMMEDIATE TRANSCUTANEOUS PACING WITH APPROPRIATE SEDATION
The use of vasopressor drugs has a “risk/benefit” component that includes:
INCREASED CARDIAC COMPLICATIONS AND INCREASED END-ORGAN PERFUSION
For lidocaine administrations to a patient with a perfusing rhythm, the ALSPCS dosing for adults and paediatrics are:
1.5 mg/kg IV and 1 mg/kg IV
Adenosine works by blocking _______channels in the heart and has the effect of _____conduction through the ______ pathways.
POTASSIUM, SLOWING, AV
Which of the following are considered causes for an idioventricular rhythm?
HYPOXIA
SEVERE HYPERKALEMIA
COMPLETE AV BLOCK
Which of the following are indications for synchronized cardioversion?
Ventricular tachycardia with a pulse
Unstable SVT
