Deck 23: Alterations of Cardiovascular Function

Question 1

A 32-year-old female presents with lower leg pain and redness. An ultrasound reveals venous thrombus. Which of the following could have caused her condition?

A) Vascular injury and inflammation
B) Heart valve damage
C) Bacterial infection
D) Atherosclerosis

Answer 1

Vascular injury and inflammation

Question 2

Most cases of combined systolic and diastolic hypertension have no known cause and are diagnosed as _____ hypertension.

A) primary
B) secondary
C) congenital
D) acquired

Answer 2

primary

Question 3

A 65-year-old female presents to the ER complaining of difficulty swallowing and shortness of breath. A CT scan would most likely reveal an aneurysm in the:

A) cerebral vessels.
B) renal arteries.
C) inferior vena cava.
D) aorta.

Answer 3

aorta.

Question 4

Orthostatic hypotension refers to a drop in blood pressure with:

A) exertion.
B) eating.
C) standing up.
D) lying down.

Question 5

A 28-year-old female presents with severe chest pain and shortness of breath. She is diagnosed with pulmonary embolism, which most likely originated from the:

A) left ventricle.
B) systemic arteries.
C) deep veins of the leg.
D) superficial veins of the arm.

Question 6

A 60-year-old male presents to his physician complaining of chest pain. He is diagnosed with atherosclerosis. This disease is caused by:

A) arterial wall thinning and weakening.
B) abnormally dilated arteries and veins.
C) abnormal thickening and hardening of vessel walls.
D) autonomic nervous system imbalances.

Question 7

A 50-year-old male is diagnosed with orthostatic hypotension. Which of the following symptoms would he most likely experience?

A) headache and blurred vision.
B) nausea and vomiting.
C) chest pain and palpitations.
D) syncope and fainting.

Question 8

Normal blood pressure for adults age 18 or older is:

A) systolic pressure less than 140 mm Hg and diastolic pressure less than 90 mm Hg.
B) systolic pressure less than 120 mm Hg and diastolic pressure less than 80 mm Hg.
C) systolic pressure less than 100 mm Hg regardless of diastolic pressure.
D) systolic pressure greater than 90 mm Hg and diastolic pressure greater than 60 mm Hg.

Question 9

A 75-year-old obese female presents to her physician complaining of edema in the lower extremities. Physical exam reveals that she has varicose veins. Which of the following is a possible cause?

A) Extreme exercise
B) Long periods of standing
C) Trauma to the deep veins
D) Ischemia

Question 10

A 30-year-old Caucasian female was recently diagnosed with primary hypertension. She reports that she eats fairly well, usually having red meat and potatoes daily. She also reports that her father has hypertension as well. Which of the following risk factors is most likely associated with this diagnosis?

A) Race
B) Diet
C) Age
D) Genes

Question 11

Individuals with Raynaud disease have severe symptoms under which of the following conditions?

A) Allergic reactions
B) Cold exposure
C) Hot water immersion
D) Tissue injury

Question 12

A 55-year-old female has undiagnosed hypertension. She presents to her physician complaining of impaired vision and chronic edema. Lab tests reveal that she also has renal insufficiency. The most likely cause for these findings is:

A) clotting and gangrene.
B) free radical injury and cell toxicity.
C) end organ damage.
D) hypertrophy and hyperplasia.

Question 13

Foam cells in a fatty streak are:

A) deposited adipose cells.
B) injured neutrophils.
C) macrophages that engulf LDL.
D) lipid-laden mast cells.

Question 14

A 52-year-old male is diagnosed with primary hypertension. He could be treated with a drug that acts by which of the following mechanisms?

A) Beta-adrenergic agonist
B) Alpha-adrenergic agonist
C) Diuretic
D) Calcium channel agonist

Question 15

The rapid onset of malignant hypertension results in:

A) atherosclerosis.
B) encephalopathy.
C) pulmonary edema.
D) acute renal failure.

Question 16

Acute orthostatic hypotension can be caused by:

A) endocrine disorders.
B) drug action.
C) idiopathic causes.
D) metabolic disorders.

Question 17

In general, atherosclerosis is caused by:

A) high serum cholesterol levels.
B) endothelial injury and inflammation.
C) an increase in antithrombotic substances.
D) congenital heart disease.

Question 18

A 60-year-old male is diagnosed with cerebral aneurysm. The most likely area for it to occur is the:

A) vertebral arteries.
B) basilar artery.
C) circle of Willis.
D) carotid arteries.

Question 19

A 65-year-old male presents for a routine checkup. A blood pressure check reveals a systolic pressure of 160 mm Hg and a diastolic pressure of 70 mm Hg. Which of the following is the most likely cause of this type of pressure elevation?

A) Vasospasm
B) Rigidity of the aorta
C) High sodium intake
D) Renal disease

Question 20

A detached blood clot is called a(n):

A) thrombus.
B) embolus.
C) thromboembolus.
D) varicosity.

Question 21

A 52-year-old female is diagnosed with coronary artery disease. She would be expected to suffer from myocardial:

A) hypertrophy.
B) ischemia.
C) necrosis.
D) inflammation.

Question 22

A 28-year-old female presents to the ER complaining of severe chest pain that worsens with respirations or lying down. She has a fever, tachycardia, and a friction rub. The most likely cause of these symptoms is:

A) acute pericarditis.
B) myocardial infarction.
C) stable angina.
D) pericardial effusion.

Question 23

A 56-year-old male presents to his physician for a checkup. Physical exam reveals edema, hepatomegaly, and muffled heart sounds. Which of the following is a concern?

A) Tamponade
B) Exudate
C) Aneurysm
D) Pulsus paradoxus

Question 24

Superior vena cava syndrome is a progressive _____ of the superior vena cava that leads to venous distention of the upper extremities and head.

A) inflammation
B) obstruction
C) distention
D) sclerosis

Question 25

A 55-year-old male died of myocardial infarction. Autopsy would most likely reveal:

A) embolization of plaque from the aorta.
B) decreased ventricular diastolic filling time.
C) platelet aggregation within the atherosclerotic coronary artery.
D) smooth muscle dysplasia in the coronary artery.

Question 26

A 49-year-old male presents to his physician complaining of chest pain. EKG reveals ST elevation. He is diagnosed with myocardial ischemia. Which of the following interventions would be most beneficial?

A) Decrease in ventricular volume with diuretic
B) Increase myocardial oxygen supply
C) Increase heart rate
D) Increase myocardial oxygen demand

Question 27

A 50-year-old obese male with hypertension and coronary artery disease visits a nutritionist for food counseling. He is told that _____ raise LDL levels and lower HDL levels and should be avoided.

A) monounsaturated fats
B) polyunsaturated fats
C) saturated fats
D) trans-fat

Question 28

A 60-year-old female had a myocardial infarction. She was brought to the hospital 30 minutes later. She survived but now has impaired ventricular function because:

A) there is a temporary alteration in electrolyte balance.
B) there is too much stress on the heart.
C) the cells become hypertrophic.
D) the resulting ischemia leads to hypoxic injury and myocardial cell death.

Question 29

A 56-year-old male is diagnosed with coronary artery disease. Which of the following modifiable risk factors would most likely influence development of this disease?

A) Eating meat
B) The geographic location of home
C) Exposure to infection
D) Cigarette smoking

Question 30

Cardiac cells can withstand ischemic conditions for _____ before irreversible cell injury occurs.

A) 1 minute
B) 20 minutes
C) 30 minutes
D) 60 minutes

Question 31

A 52-year-old male presents with pooling of blood in the veins of the lower extremities and edema. The most likely manifestation of this disorder is:

A) deep vein thrombus formation.
B) skin depigmentation.
C) stasis ulcers.
D) edema above the knee.

Question 32

A 50-year-old male with a 30-year history of smoking was diagnosed with bronchogenic cancer. He developed edema and venous distention in the upper extremities and face. Which of the following is the most likely diagnosis?

A) Thromboembolism
B) Deep vein thrombosis
C) Superior vena cava syndrome
D) Chronic venous insufficiency

Question 33

A 51-year-old male is at his health clinic for an annual physical exam. After walking from the car to the clinic, he developed a substernal pain. He also reported discomfort in his left shoulder and his jaw, lasting 2 to 3 minutes and then subsiding with rest. He indicates that this has occurred frequently over the past few months with similar exertion. He is most likely experiencing:

A) stable angina.
B) unstable angina.
C) Prinzmetal angina.
D) myocardial infarction.

Question 34

The most common cause of myocardial ischemia is:

A) idiopathic vasospasm.
B) arterial emboli from heart valve vegetation.
C) atherosclerosis.
D) venous emboli.

Question 35

A 53-year-old male presents with recurrent chest pain on exertion. He is diagnosed with angina pectoris. The pain he experiences occurs when:

A) cardiac output has fallen below normal levels.
B) the myocardial oxygen supply has fallen below demand.
C) myocardial stretch has exceeded the upper limits.
D) the vagus nerve is stimulated.

Question 36

Many valvular stenosis and regurgitation disorders in adults have a common etiology. Which of the following can result in both types of valve dysfunction?

A) Heart failure
B) Connective tissue disorders
C) Rheumatic fever or heart disease
D) Syphilis infection

Question 37

A 62-year-old male presents to his physician complaining of chest pain at rest and with exertion. He does not have a history of coronary artery disease and reports that the pain often occurs at night. He is most likely experiencing which type of angina?

A) Unstable
B) Stable
C) Prinzmetal
D) Silent

Question 38

A 68-year-old male presents to the ER complaining of chest pain. He has a history of stable angina that now appears to be unstable. He most likely has:

A) mild to moderate atherosclerosis.
B) impending myocardial infarction.
C) electrical conduction problems in the heart.
D) decreased myocardial oxygen demand.

Question 39

A 42-year-old female is diagnosed with constrictive pericarditis. She would also have a decreased cardiac output because of:

A) pericardial effusions.
B) fibrosis and calcification of the pericardial layers.
C) cardiomyopathy.
D) hemorrhage in the pericardial cavity.

Question 40

A 75-year-old male has severe chest pain and dials 911. Lab tests at the hospital reveal elevated levels of creatinine phosphate and lactic dehydrogenase. These elevated levels indicate:

A) Raynaud disease.
B) myocardial infarction.
C) orthostatic hypertension.
D) varicose veins.

Question 41

The most common cardiac valve disease in the United States, which tends to be most prevalent in young women, is:

A) mitral valve prolapse.
B) pulmonary stenosis.
C) tricuspid valve prolapse.
D) aortic stenosis.

Question 42

A 50-year-old male visits the cardiologist for an EKG. Results indicate that he has no PR interval and a variable rate QRS with rhythm irregularity. Which of the following is the most likely diagnosis?

A) Atrial tachycardia
B) Atrial fibrillation
C) Sinus dysrhythmia
D) Idioventricular rhythm

Question 43

Which valve disorder is manifested by a widened pulse pressure and throbbing peripheral pulses?

A) Mitral regurgitation
B) Mitral stenosis
C) Aortic regurgitation
D) Aortic stenosis

Question 44

A 59-year-old female is diagnosed with left ventricular failure. The decrease in kidney perfusion would ultimately cause:

A) decreased left ventricular preload.
B) increased pulmonary capillary permeability.
C) increased systemic vascular resistance.
D) decreased cardiac oxygen demand.

Question 45

In valvular _____, the valve opening is constricted and narrowed because the valve leaflets, or cusps, fail to open completely.

A) regurgitation
B) insufficiency
C) stenosis
D) incompetence

Question 46

As left heart failure progresses:

A) left ventricular preload increases.
B) systemic vascular resistance decreases.
C) left end-diastolic volume decreases.
D) pulmonary vascular resistance decreases.

Question 47

A 72-year-old female has a history of hypertension and atherosclerosis. An echocardiogram reveals backflow of blood into the left ventricle. Which of the following is the most likely diagnosis?

A) Mitral regurgitation
B) Mitral stenosis
C) Aortic regurgitation
D) Aortic stenosis

Question 48

A 67-year-old female was previously diagnosed with rheumatic heart disease. Tests reveal lipoprotein deposition with chronic inflammation that impairs blood flow from the left ventricle into the aorta. Which of the following is the most likely diagnosis?

A) Aortic sclerosis
B) Aortic stenosis
C) Valvular regurgitation
D) Valvular stenosis

Question 49

A 65-year-old male with a history of untreated hypertension is now experiencing left heart failure. The most likely reason is:

A) ventricular dilation and wall thinning.
B) myocardial hypertrophy and ventricular remodeling.
C) inhibition of renin and aldosterone.
D) alterations in alpha and beta receptor function.

Question 50

Pulmonary symptoms, such as dyspnea and cough, common to left heart failure are a result of:

A) inflammatory pulmonary edema.
B) decreased cardiac output.
C) pulmonary vascular congestion.
D) bronchoconstriction.

Question 51

A 10-year-old male presents with fever, lymphadenopathy, arthralgia, and nose bleeds. He is diagnosed with rheumatic heart disease. This disease is usually characterized by:

A) blood-borne organisms that adhere to the valvular surface.
B) antigens that bind to the valvular lining, triggering an autoimmune response.
C) high fevers that damage collagen in valve leaflets.
D) rheumatoid factor in the blood, stimulating valvular degeneration.

Question 52

A 60-year-old female was diagnosed with mitral stenosis. As a result, she has incomplete emptying of the:

A) right atrium.
B) right ventricle.
C) left atrium.
D) left ventricle.

Question 53

A 68-year-old female is experiencing left heart failure. Physical exam reveals elevated blood pressure most likely caused by:

A) sympathetic nervous system compensation for decreased cardiac output.
B) stress hormones promoting increased cardiac contractility.
C) cardiotoxic effects of catecholamines and angiotensin.
D) diastolic dysfunction.

Question 54

Inflammatory cells have difficulty limiting the colonization of microorganisms in infective endocarditis because:

A) the microorganisms are resistant.
B) the valves are avascular.
C) the microorganisms are sequestered in a fibrin clot.
D) the colonies overwhelm the phagocytes.

Question 55

A 35-year-old male presents with pulmonary hypertension. Testing reveals he is in right heart failure. Which of the following is the most likely diagnosis?

A) Aortic stenosis
B) Tricuspid regurgitation
C) Aortic regurgitation
D) Mitral regurgitation

Question 56

A 65-year-old male is diagnosed with chronic pulmonary disease and elevated pulmonary vascular resistance. Which of the following heart failures generally results from this condition?

A) Right heart failure
B) Left heart failure
C) Low-output failure
D) High-output failure

Question 57

A 72-year-old female has a history of right heart failure caused by a right ventricular myocardial infarction. Which of the following symptoms are specifically related to her right heart failure?

A) Significant edema to both lower legs and feet
B) Hypertension
C) Decreased urine output
D) Dyspnea upon exertion

Question 58

A 73-year-old female has increased pulmonary pressure resulting in right heart failure. A potential cause for her heart to fail is:

A) hypertension.
B) left heart failure.
C) acute pneumonia.
D) pericarditis.

Question 59

A 10-year-old male presents with fever, lymphadenopathy, arthralgia, and nose bleeds. He is diagnosed with rheumatic heart disease. The most likely cause of this disease is:

A) congenital heart defects.
B) HIV infections.
C) group A ß-hemolytic streptococcus infections.
D) acute pericarditis.

Question 60

A 30-year-old female presents to her physician with fever, cardiac murmur, and petechial skin lesions. She is diagnosed with infective endocarditis. The most likely cause of her disease is:

A) bacteria.
B) viruses.
C) fungi.
D) parasites.

Question 61

The most common cause of multiple organ dysfunction syndrome (MODS) is:

A) myocardial infarction.
B) pulmonary disease.
C) septic shock.
D) autoimmune disease.

Question 62

Neurogenic shock can be caused by any factor that inhibits the:

A) parasympathetic nervous system.
B) sympathetic nervous system.
C) somatic nervous system.
D) thalamus.

Question 63

A 15-year-old male who is allergic to peanuts eats a peanut butter cup. He then goes into anaphylactic shock and develops:

A) bradycardia, decreased arterial pressure, and oliguria.
B) bronchoconstriction, hives or edema, and hypotension.
C) hypertension, anxiety, and tachycardia.
D) fever, hypotension, and erythematous rash.

Question 64

The hypotensive state seen in septic shock can cause:

A) an amplified antiinflammatory response.
B) gut lining disruption and the translocation of bacteria into the bloodstream.
C) the increased oxygen demand of highly metabolic tissue.
D) the increased spread of infection.

Question 65

A 20-year-old female is being admitted to the hospital with fever and septic shock. Which set of clinical manifestations would you expect her to exhibit?

A) Bradycardia, palpitations, confusion, truncal rash
B) Severe respiratory distress, jugular venous distention, chest pain
C) Low blood pressure, tachycardia, generalized edema
D) Reduced cardiac output, increased systemic vascular resistance, moist cough

Question 66

An 82-year-old female was admitted to the hospital with confusion and severe hypotension. Her body's compensatory mechanisms are increased heart rate, vasoconstriction, and movement of large volumes of interstitial fluid to the vascular compartment. What kind of shock do you suspect?

A) Anaphylactic
B) Hypovolemic
C) Neurogenic
D) Septic

Question 67

Which organ of the body is often the first to fail in patients with multiple organ dysfunction syndrome (MODS)?

A) Liver
B) Heart
C) Lungs
D) Pancreas

Question 68

A 75-year-old female has been critically ill with MODS for longer than a week and has developed a severe oxygen supply and demand imbalance. The statement that best describes this imbalance is which of the following?

A) Increased oxygen delivery to cells fails to meet decreased oxygen demands.
B) The amount of oxygen consumed by cells depends only on the needs of cells, because there is oxygen in reserve.
C) The situation results in "supply-independent consumption."
D) The reserve has been exhausted, and the amount of oxygen consumed depends on the amount the circulation is able to deliver.

Question 69

When a person is in shock, impairment in cellular metabolism is caused by:

A) release of toxic substances.
B) free radical formation.
C) inadequate tissue perfusion.
D) lack of nervous or endocrine stimulation.

Question 70

The onset of anaphylactic shock is usually:

A) mild.
B) immediate and life threatening.
C) delayed by several hours.
D) delayed by 24 hours.

Question 71

During shock states, glucose uptake is usually:

A) enhanced.
B) normal.
C) impaired.
D) energy intensive.

Question 72

A 27-year-old male is admitted to a neurologic unit with a complete C-5 spinal cord transection. On initial assessment, he is bradycardic, hypotensive, and hyperventilating. He appears to be going into shock. The most likely mechanism of his shock is:

A) hypovolemia caused by blood loss.
B) hypovolemia caused by evaporative fluid losses.
C) vasodilation caused by gram-negative bacterial infection.
D) vasodilation caused by a decrease in sympathetic stimulation.

Question 73

A 50-year-old male was admitted to the intensive care unit with a diagnosis of acute myocardial infarction. He is being treated for shock. His cardiopulmonary symptoms include low blood pressure, tachycardia, and tachypnea. His skin is pale and cool. The primary cause of his shock is most likely:

A) rapid heart rate.
B) decreased cardiac contractility.
C) increased capillary permeability.
D) decreased afterload due to vasodilation.

Question 74

High-output failure occurs with:

A) metabolic alkalosis.
B) hypothyroidism.
C) hypovolemia.
D) anemia.

Question 75

For an infection to progress to septic shock, which of the following must occur?

A) The individual must be immunosuppressed.
B) The myocardium must be impaired.
C) The infection must be gram negative.
D) Bacteria must enter the bloodstream.

Question 76

One consequence of switching from aerobic to anaerobic cellular metabolism during shock states is:

A) decreased ATP production.
B) cellular dehydration.
C) cellular alkalosis.
D) free radical formation.