Deck 3: Ischemic Cardiovascular Conditions and Other Vascular Pathologies

Question 1

Which of the following statements BEST explains how myocardium tissue perfusion occurs primarily during periods of muscle relaxation (diastole)?

A)All fluids follow the path of least resistance and flow from higher to lower pressure.
B)The right ventricle has a lower pressure than the left ventricle during systole resulting in less difference in blood flow in the right coronary artery between systole and diastole.
C)During diastole,full coronary arteries create high pressures,driving blood into the myocardium when intramyocardial pressure drops.
D)When the aortic valve closes,pressure is transmitted through dilated Valsalva sinuses to openings of coronary arteries.

Answer 1

C
Statements A,B,and D all relate to preliminary processes that lead to coronary artery filling,but statement C discusses specifically how a high- to low-pressure gradient is created during diastole leading to enhanced blood flow into the myocardium tissue.

Question 2

Which of the following risk factors has been shown to be associated with leukocytosis,lower serum high-density lipoprotein,elevated fibrinogen and plasma catecholamine levels,and increased blood pressure?

A)Elevated cholesterol
B)Physical inactivity
C)Diabetes
D)Cigarette smoking

Answer 2

D
In comparison to nonsmokers,smokers have been shown to manifest leukocytosis,lower serum high-density lipoprotein levels,elevated fibrinogen and plasma catecholamine levels,and increased blood pressure.

Question 3

Which of the following is characteristic of the "sclerotic" phase of atherosclerosis?

A)Fatty streaks in the artery
B)Accumulation of lipid by monocytes
C)Stretched endothelium by enlarging foam cells
D)Aggregation of platelets forming a thrombus

Answer 3

D
When the endothelium is overstretched enough to cause an intima-based lesion,exposing the underlying connective tissue to the circulation,platelets aggregate forming a thrombus.The formation of a thrombus is characteristic of the "sclerotic" phase.Answers A,B,and C describe processes occurring in the "atherosis" phase.

Question 4

The processes of atherosclerosis development occur in which of the following arterial layers?

A)Adventitia
B)Media
C)Intima
D)All of the above

Question 5

Which of the following layers of the coronary arteries is selectively permeable to low-density lipoprotein (LDL)leading to the possible development of myocardial ischemia?

A)Adventitia
B)Media
C)Intima
D)None of the above

Question 6

Which of the following monitoring tools is MOST useful to the clinician when attempting to correlate functional activities and myocardial capabilities in a patient diagnosed with chronic stable angina?

A)Product of exercise HR and systolic BP
B)Maximum heart rate during specific activity
C)Systolic blood pressure at end of activity
D)Highest rating of perceived exertion (RPE)

Question 7

Which of the following blood pressure recordings would be considered hypertensive?

A)132/85
B)142/95
C)119/78
D)128/88

Question 8

Which of the following interventions would result in the highest survival rate from ventricular fibrillation sudden cardiac arrest?

A)Entry into emergency medical system within 15 minutes
B)Administration of CPR within 10 minutes
C)Immediate CPR and AED shock within 3 to 5 minutes
D)AED shock within 15 minutes

Question 9

In an older adult aged 70 years without known disease,which of the following interventions would have the HIGHEST impact on reducing the risk for coronary heart disease similar to younger subjects?

A)Age is too strong of a risk factor;therefore,overall risk could not be altered.
B)Have the older adult follow a low carbohydrate diet.
C)Encourage the older adult to walk daily for a minimum of 30 minutes.
D)Have the older adult consume a low dose of aspirin daily.

Question 10

Which of the following factors is defined as a type of amino acid found in blood that when elevated has been linked to increased risk for development of cardiovascular diseases?

A)C-reactive protein
B)Homocysteine
C)Factor VII
D)Lipoprotein a (Lpa)

Question 11

Which of the following determinants of myocardial blood flow will cause restriction to flow into restriction to flow into the capillary beds of the endocardium if elevated?

A)Diastolic blood pressure
B)Vasomotor tone
C)Resistance to flow
D)Left-ventricular end-diastolic pressure

Question 12

Which of the following ratios is the BEST predictor for developing cholesterol-related blockages in an artery?

A)Total cholesterol/high-density lipoproteins
B)Total cholesterol/low-density lipoproteins
C)Triglycerides/high-density lipoproteins
D)Gram level of saturated fat/mg level of cholesterol

Question 13

Which of the following layers of the coronary arteries is responsible for making adjustments to the luminal diameter?

A)Adventitia
B)Media
C)Intima
D)All of the above

Question 14

Which of the following clinical cues exhibited by a patient with stable angina should alert the health care provider to notify the patient's physician?

A)Reports chest discomfort in morning that was relieved with minor activity.
B)Reports chest discomfort several times a week.
C)Reports chest discomfort at a lower level of activity than usual.
D)Reports chest discomfort resolution with rest or decrease of activity intensity.

Question 15

Which of the following determinants of myocardial blood flow will inhibit flow of blood to the myocardium?

A)Increased diastolic blood pressure
B)Increased vasomotor tone
C)Decreased vasomotor tone
D)Lower left-ventricular end-diastolic pressure

Question 16

The presence of an obstruction that causes permanent damage to heart muscle fibers downstream,thus inhibiting heart muscle function,is BEST termed which of the following?

A)Angina pectoris
B)Coronary artery disease
C)Coronary heart disease
D)Atherosclerosis

Question 17

The accumulation of lipids by monocytes between endothelial cells is termed:

A)foam cells.
B)fibrous cap.
C)thrombus.
D)Sclerosis.

Question 18

In a patient with coronary artery disease,beta-blocking medications may be prescribed.Which of the following statements BEST describes the reasoning?

A)Beta-blockers lower resting heart rate,increasing diastolic filling time.
B)Beta-blockers lower the intramyocardial pressures,increasing muscle relaxation.
C)Beta-blockers lower the vasomotor tone in the media,increasing the diameter of the artery.
D)Beta-blockers lower the aortic pressure during systole,increasing blood flow to coronary arteries.

Question 19

In a patient with diabetes,which of the following physiological changes is a result of increased glycosylation?

A)Increase sensitivity to enzymes
B)Elevated high-density lipoprotein
C)Enhanced fibrin degrading by fibrinogen
D)Enhanced thrombus formation

Question 20

Which of the following risk factors is considered nonmodifiable?

A)Cigarette smoking
B)High blood pressure
C)Increased age
D)Physical inactivity

Question 21

Which of the following pathological changes is MOST associated with diastolic dysfunction in hypertensive heart disease?

A)Impairment of left-ventricular relaxation leading to stiffer left ventricle
B)Subnormal left-ventricular functional reserve during exercise
C)Impairment of ventricular contraction
D)Increase in end-systolic volume

Question 22

Which of the following clinical signs/symptoms is MOST characteristic of ST segment elevation myocardial injury (STEMI)?

A)Q wave infarction occurring distal to a totally occluded coronary artery
B)Non-Q wave infarction affecting subendocardial region
C)Blood flow interruption is less than 30 minutes
D)Coronary arteries are not completely blocked

Question 23

Which of the following peripheral muscular adaptations that occurs with aerobic exercise would benefit the patient with intermittent claudication the MOST?

A)Increased collateral circulation or capillary density
B)Increased blood viscosity
C)Reduced pain threshold
D)Improvements in anaerobic metabolism

Question 24

Which of the following medical interventions targets prophylaxis or treatment for arrhythmias?

A)Use of nitrates
B)Use of fibrinolysis
C)Use of amiodarone
D)Use of morphine

Question 25

A 72-year-old male arrives for a physical therapy evaluation for treatment of his low back pain.The patient has a history of peripheral vascular disease,diabetes,and hypercholesteremia.He reports leg pain and fatigue with walking.The physical therapist feels it is appropriate to include a vascular screen and testing in the evaluation.Which of the following signs/symptoms would be MOST indicative of an abdominal aortic aneurysm?

A)Fatigue with walking
B)Numbness in the lower extremities
C)Pulsating mass in the abdominal area
D)High blood pressure at rest

Question 26

A pathological permanent dilation of an artery wall that is usually uniform in shape,but can resemble a sac or outpouching,is termed:

A)stenosis.
B)aneurysm.
C)atherosclerosis.
D)bruit.

Question 27

Which of the following pathological myocardium changes results in an exaggerated and early peak value of substances such as CK-MB and cardiac-specific troponin T and I?

A)Development of coagulative necrosis with contraction bands in myocardial tissue
B)Occurrence of hemorrhage within zones of irreversibly injured myocytes
C)Mitochondria in necrotic areas developing calcium phosphate deposits
D)Reperfusion of myocardium promotes removal of intracellular proteins

Question 28

A 56-year-old male with a history of obesity,type II diabetes,and a high-stress management occupation is scheduled for a physical therapy evaluation for treatment of low back pain.As a physical therapist which of the following guidelines is MOST appropriate to follow during the initial and subsequent physical therapy sessions?

A)Monitor BP at rest and during exercise for at least the first three to four sessions.
B)If BP is normal or unremarkable at rest during the evaluation,there is no need to continue monitoring.
C)It is recommended the patient stop his medication for blood pressure that results in unpleasant side effects.
D)It is recommended the PT only provide manual therapy to the patient if his resting BP is 200/100.

Question 29

Which of the following medical interventions is the MOST optimal regimen for primary and secondary prevention of a stroke?

A)Aspirin
B)Lipid-lowering medication
C)Antihypertensive medication
D)A combination of all the above

Question 30

Which of the following factors would be MOST associated with a good prognosis post-myocardial infarction?

A)Development of atrial fibrillation
B)Persistent systolic hypotension (<90 mm Hg)
C)Elevation of left-ventricular end-diastolic pressure
D)Small infarction size with increase in scar formation