Deck 18: Cardiac Function

Question 1

Serial sampling for cardiac biomarkers is described as:

A) Drawing blood samples periodically, usually at prescribed time intervals over the course of the patient's admission.
B) Drawing blood samples randomly during the first four hours after admission to the facility.
C) Drawing a blood sample once after admission to the facility.
D) Making dilutions of each blood sample and analyzing them for the appropriate cardiac biomarker.

Answer 1

Drawing blood samples periodically, usually at prescribed time intervals over the course of the patient's admission.

Question 2

Risk factors for the development of coronary heart disease include which of the following?

A) Tobacco smoking, elevated serum homocysteine, low serum LDL, and high serum levels of CRP
B) Tobacco smoking, low serum homocysteine, low serum LDL, and high serum levels of CRP
C) Hypertension, abdominal obesity, low HDL-C, high serum levels of CRP, and elevated levels of homocysteine
D) Walking at least one hour per day, low serum homocysteine, low serum CRP, and low serum levels of LDL-C

Answer 2

Hypertension, abdominal obesity, low HDL-C, high serum levels of CRP, and elevated levels of homocysteine

Question 3

Atherosclerosis is described as:

A) Hardening of the arteries that occurs over a period of many years due in part to the abnormal accumulation of lipids.
B) Syndromes that encompass a continuum of clinical presentations ranging from unstable angina to non-Q-wave AMI.
C) A degenerative condition of the muscles.
D) An acute-phase reactant whose concentration in the blood rises dramatically in response to nonspecific inflammatory stimuli.

Answer 3

Hardening of the arteries that occurs over a period of many years due in part to the abnormal accumulation of lipids.

Question 4

Which of the following statements summarizes the significance of CRP in the arterial wall?

A) It predicts the severity of arteriosclerosis.
B) It predicts the severity of atherosclerosis and is able to bind to damaged membranes and lipids.
C) It predicts the severity of atherosclerosis but cannot bind to damaged membranes and lipids.
D) It has nothing to do with either arteriosclerosis or atherosclerosis.

Question 5

The atherogenic effect of homocysteine is:

A) The toxic effect on the left ventricular wall of the heart.
B) The toxic effect of homocysteine on the adventitia or outer lining the arterial wall.
C) The toxic effect of homocysteine on the endothelial lining of the arteries, which causes plaque formation.
D) The nontoxic effect of homocysteine on the intima lining of the arteries.

Question 6

Which of the following is a cause of hyperhomocysteinemia?

A) Deficiency of one of the B complex vitamins
B) Excess of one the B complex vitamins
C) Deficiency of calcium
D) Deficiency of sodium

Question 7

Which of the following troponins have been demonstrated in patients with muscular dystrophy, and end-stage renal disease (ESRD)?

A) Cardiac troponin C isoforms
B) Cardiac troponin I
C) Cardiac troponin C
D) Cardiac troponin T

Question 8

The role of cardiac biomarkers includes which of the following?

A) Establish odds ratio, diagnosis, and treatment modalities
B) Tumor identifications, prognosis, appropriate drug therapy intervention
C) Diagnosis, monitoring, risks stratification, and therapeutic management
D) Determining life expectancy, staging diseases, population studies

Question 9

The albumin cobalt-binding test is used to measure which of the following?

A) Microalbumin
B) Ischemia modified albumin
C) Albumin/globulin ration
D) Serum cobalt

Question 10

Which of the following represents the correct sequence for the rise and fall of myoglobin, CK-MB, and cTnI after an AMI?

A) CK-MB, cTnI, myoglobin
B) cTnI, CK-MB, myoglobin
C) Myoglobin, CK-MB, cTnI
D) CK-MB, myoglobin, cTnI

Question 11

NT-pro-BNP consist of 76 amino acids and is described as a:

A) A metabolite of BNP.
B) The storage form of BNP.
C) The catabolic product of ANP.
D) The natriuretic peptide that is the inactive form.

Question 12

Which of the following statements is TRUE about cTnI?

A) Cardiac forms are never expressed in skeletal muscle.
B) Cardiac forms are expressed in skeletal muscle.
C) In fetal development, the cardiac and skeletal forms are co-expressed in skeletal and cardiac tissues.
D) It is the same as cardiac troponin C (cTnC).

Question 13

Myoglobin is a good cardiac marker because it:

A) Diffuses into the blood more quickly than CK-MB.
B) Diffuses into the blood more slowly than CK-MB.
C) Doesn't diffuse into the blood at all when cardiac tissue dies.
D) Is an extremely large protein and therefore does not diffuse into the blood very easily.

Question 14

In which of the following disorders is measurement of brain type natriuretic peptide (BNP) clinically useful?

A) Acute myocardial infarctions (AMIs)
B) Tachycardia
C) Congestive heart failure
D) Pericarditis

Question 15

Which of the following cardiac biomarkers is a better biomarker of plaque instability?

A) MPO
B) CRP
C) Lp-PLA₂
D) Leptin

Question 16

The presence of heterophile antibodies, rheumatoid factor, increased blood levels of hemoglobin and circulating cTnI autoantibodies can result in which of the following?

A) High dose hook effect with select cTn assays
B) Modification of diagnostic cut off value for cTn assays
C) False positive and/or false negative result for BNP or NT-Pro BNP assays
D) False positive and/or false negative result for cTnI assays

Question 17

What is the clinical usefulness of measuring serum adiponectin?

A) Plasma adiponectin levels may predict cardiovascular events years in advance in a population without diagnosed cardiovascular disease.
B) It is an early biomarker for AMI.
C) It is a cardiac biomarker for late presenting AMIs.
D) There are two forms of this protein, pregnancy, and acute coronary syndrome; thus, adiponectin can be used for either condition.

Question 18

Lp (a) is considered a risk factor for developing atherosclerosis due to which of the following?

A) It competes with fibrinogen for binding sites, thus interfering with clot lysis and increasing the risk of acute myocardial infarction (AMI).
B) It is produced by macrophages and expressed in atherosclerotic lesions.
C) It activates complement.
D) It competes with plasminogen for binding sites, thus interfering with clot lysis and increasing the risk of acute myocardial infarction (AMI).

Question 19

Which of the following is an advantage of POCT for cardiac biomarkers?

A) Increased turn-around time for analysis
B) Delay in rule-out of an AMI
C) Rapid identification of AMI
D) Delay in risk stratification of an AMI

Question 20

Elevated blood levels of pregnancy-associated plasma protein A (PAPP-A) may suggest which of the following?

A) A presumptive diagnosis of heart failure in breathless patients.
B) A low risk factor for developing an acute coronary syndrome (ACS).
C) An S-T segment myocardial infarction (STEMI).
D) The presence of an unstable ACS in patients without increased concentration of biomarkers of necrosis, such as cTn.

Question 21

Which of the following is an early (i.e., rapidly in similar fashion to myoglobin) biomarkers of acute myocardial infarction?

A) Unbound free fatty acid (FFAu)
B) Placental growth factor (PIGF)
C) Heart-type fatty acid binding protein (H-FABP)
D) CK-MB

Question 22

Infusion of Nesiritide is documented to act as a confounder for which of the following assays?

A) Brain natriuretic peptide (BNP)
B) Atria natriuretic peptide (ANP)
C) Cardiac troponin T
D) Myoglobin

Question 23

IL-6, protease-activated receptor signaling (PARS) and soluble CD 40 ligand function to:

A) Stabilize an embolus.
B) Induce adhesion of monocytes.
C) Stabilize the one-cell thick endothelium.
D) Resist plaque formation.

Question 24

High blood levels of adiponectin are associated with:

A) Reduced risk of heart attacks.
B) Increased risk of heart attacks.
C) Increased risk of plaque rupture.
D) Stabilizing endothelial cell structure.

Question 25

The troponin complex consists of which of the following?

A) Troponin A, troponin C, and troponin T
B) Troponin M1, troponin M2, and troponin K
C) Troponin M and troponin H
D) Troponin T, troponin I, and troponin C