Question 1

Which of the following is the most important symptom of coronary atherosclerotic heart disease?&#10;A) pitting edema&#10;B) dysphagia&#10;C) dyspnea&#10;D) chest pain

Accepted Answer

Chest pain is the most important symptom of coronary atherosclerotic heart disease.The pain may be brief,as in angina pectoris resulting from temporary ischemia of the myocardium,or it may be prolonged,as in unstable angina or acute MI.Ischemic myocardial pain results from an imbalance between the oxygen supply and the oxygen demand of the muscle.

Question 2

Which of the following is true concerning the incidence and prevalence of ischemic heart disease in the United States?&#10;A) About 50% of the population is estimated to have some form of cardiovascular disease.&#10;B) Cardiovascular disease begins in middle life.&#10;C) The annual mortality rate for cardiovascular diseases has been declining since 1940.&#10;D) Cancer has replaced coronary heart disease as the leading cause of death in the United States after age 65.

Accepted Answer

The annual mortality rate has been declining since 1940.From 1970 to 2000,mortality from coronary heart disease decreased by 50%,and from stroke,by 60%.Despite this decline,cardiovascular diseases continue to pose the most serious threat to health in America,accounting for about 33% of all deaths.More than 70 million AmericAnswer (about 25% of the population)are estimated to have some form of cardiovascular disease,with about 13 million having coronary heart disease.Coronary heart disease is the leading cause of death in the United States after age 65.Autopsy studies in the United States have shown that cardiovascular disease begins at an early age.

Question 3

Which of the following is the single most important modifiable risk factor for coronary heart disease?&#10;A) diet high in cholesterol&#10;B) failure to exercise&#10;C) smoking cigarettes&#10;D) smoking cigars

Accepted Answer

Cigarette smoking is the single most important modifiable risk factor for coronary heart disease.Persons who smoke 20 or more cigarettes daily have a two- to four-fold increase in coronary heart disease.Pipe and cigar smoking apparently convey little risk for development of heart disease.

Question 4

Which of the following is a serum enzyme determination used to establish the diagnosis of acute myocardial infarction (MI)and to determine the extent of infarction?&#10;A) stress thallium-201 perfusion scintigraphy&#10;B) 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMG-CoA)&#10;C) troponin I and troponin T&#10;D) streptokinase (SK)

Accepted Answer

Serum markers of acute MI most commonly used in clinical practice include troponin I,troponin T,and creatine kinase isoenzyme (CK-MB).These enzymes are released only when cell death (infarction)or injury to the myocyte occurs.For investigation of acute MI,troponin assays have largely replaced creatine kinase (CK)and CK-MB determinations because these markers are more specific in differentiating cardiac muscle damage from trauma to skeletal muscle or other orgAnswer.

Question 5

Which of the following is true when planning dental treatment for a patient with stable angina or a past history of MI without ischemic symptoms?&#10;A) Administration of nitrous oxide should be avoided.&#10;B) NSAIDs should be avoided in patients with established cardiovascular disease.&#10;C) Nitroglycerin should be administered prophylactically.&#10;D) A pulse oximeter should be used.

Accepted Answer

NSAIDs should be avoided in patients with established cardiovascular disease,especially for those whose cardiac history includes an MI.In a recent study,the use of NSAIDs in patients with previous MI was shown to increase the risk for a subsequent myocardial infarction,even after only 7 days of NSAID administration.

Question 6

Which of the following is true of unstable angina?&#10;A) Pain is precipitated by physical effort and is relieved by cessation of the precipitating activity.&#10;B) Pain is relieved by nitroglycerin.&#10;C) Pain is not relieved by nitroglycerin.&#10;D) a and b&#10;E) a and c

Accepted Answer

Unstable angina is defined as new-onset pain,pain that is increasing in frequency or intensity,pain that is precipitated by less effort than before,or pain that occurs at rest.This pain is not readily relieved by nitroglycerin.Stable angina is pain that is predictably reproducible,unchanging,and consistent over time.Pain typically is precipitated by physical effort,such as walking or climbing stairs,but also may occur with eating or stress.Pain is relieved by cessation of the precipitating activity,by rest,or with the use of nitroglycerin.

Question 7

Which of the following is true for an MI with ST segment elevation (STEMI)?&#10;A) It is due to partial blockage of coronary blood flow.&#10;B) It is due to complete blockage of coronary blood flow.&#10;C) Early fibrinolytic therapy will improve the outcome for a patient with STEMI.&#10;D) a and c&#10;E) b and c

Accepted Answer

An MI with ST segment elevation is due to complete blockage of coronary blood flow and more profound ischemia involving a relatively large area of myocardium.An MI without ST segment elevation (non-STEMI)is due to partial blockage of coronary blood flow.Early fibrinolytic therapy improves outcomes in STEMI but not in non-STEMI.

Question 8

Which of the following is true of stable angina?&#10;A) pain is predictably reproducible, unchanging, and consistent&#10;B) nitroglycerin relieves pain&#10;C) management involves behavioral modification and lifestyle intervention&#10;D) all of the above

Accepted Answer

Stable angina is pain that is predictably reproducible,unchanging,and consistent over time.Pain typically is precipitated by physical effort such as walking or climbing stairs but also may occur with eating or stress.Pain is relieved by cessation of the precipitating activity,by rest,or with the use of nitroglycerin.Medical management of a patient with stable angina includes identification and treatment of associated diseases that can precipitate or worsen angina,reduction in risk factors for cardiovascular disease,behavioral modifications and lifestyle interventions,pharmacologic management,and revascularization by percutaneous catheter-based techniques or by coronary artery bypass surgery

Question 9

Which of the following is the most common cause of sudden cardiac death?&#10;A) ventricular fibrillation&#10;B) myocardial infarction&#10;C) coronary atherosclerosis&#10;D) pulmonary embolism

Accepted Answer

The most common cause of sudden cardiac death is ventricular fibrillation,a form of abnormal electrical activity resulting from interruption of the heart's electrical conduction system.

Question 10

Which of the following types of blood cells engulf lipid molecules to become foam cells?&#10;A) red blood cells&#10;B) macrophages&#10;C) neutrophils&#10;D) basophils

Accepted Answer

Atheroma formation is initiated by adherence of monocytes to an area of injured or altered endothelium.The attached monocytes then migrate into the intima of the vessel and become macrophages.Lipids derived from LDLs also enter through the injured or dysfunctional endothelium,forming extracellular deposits or small pools.Macrophages then engulf lipid molecules to become foam cells,which are characteristic features of the fatty streak.

Deck 4: Ischemic Heart Disease