Deck 24: Cardiology

Question 1

Which of the following conditions is most likely to cause hypertrophy of the left ventricle (abbreviated: LVH):

A) Dehydration
B) Chronic hypertension
C) Chronic hepatitis
D) Hyperlipidemia

Answer 1

Chronic hypertension

Question 2

A holosystolic murmur is heard:

A) At the apex of the heart
B) At the right sternal border
C) Early in systole
D) Throughout systole

Answer 2

At the apex of the heart

Question 3

A physiologic murmur is heard:

A) Only during atypical stresses, such as anemia, fever or exercise. It does not indicate structural diseases of the heart.
B) During deep inspiration.
C) Only in children.
D) During diastole.

Answer 3

Only during atypical stresses, such as anemia, fever or exercise. It does not indicate structural diseases of the heart.

Question 4

An arterial obstruction usually causes:

A) Diminished blood flow
B) Increased blood flow
C) Neither increased nor decreased blood flow

Question 5

The basilar, carotid, and vertebral arteries all supply blood to:

A) The heart
B) The kidneys
C) The brain
D) The intestines

Question 6

Arteriography is used to identify problems that develop within:

A) the esophagus
B) the stomach
C) an artery
D) a fallopian tube

Question 7

People who suffer out-of-hospital cardiac arrest:

A) Rarely survive
B) Usually arrive at the hospital awake and alert

Question 8

An individual who is suffering from orthostatic hypotension is likely to:

A) Vomit while lying down
B) Develop double vision while reading
C) Faint when standing up
D) Require therapy with a diuretic drug

Question 9

Which of the following is a coronary artery?

A) The left anterior descending artery
B) The femoral artery
C) The subclavian artery
D) The radial artery

Question 10

The heart's intrinsic pacemaker is also known as:

A) The sinoatrial node
B) The atrioventricular node
C) The foramen ovale
D) The bundle of His

Question 11

If you cross clamp the aorta, you:

A) Decrease blood flow into the right atrium
B) Block blood flow into the right ventricle
C) Block blood flow into the systemic circulation
D) Increase blood flow to the carotid arteries

Question 12

Capillaries are blood vessels that:

A) Provide oxygen to the tissues in which they are found.
B) Take up metabolic waste products and carbon dioxide from the tissues in which they are found
C) Are only one cell thick
D) All of the above
E) None of the above

Question 13

Which of the following structures normally has the highest concentration of oxygen?

A) The pulmonary veins
B) Arterioles
C) Venules
D) The vena cava

Question 14

Which of the following structures normal has the highest concentration of carbon dioxide?

A) The pulmonary veins
B) Arterioles
C) Venules

Question 15

Which of the following structures may be blocked or partially blocked by atherosclerosis?

A) The carotid arteries
B) The coronary arteries
C) The femoral arteries
D) The renal arteries
E) All of the above
F) None of the above

Question 16

In a patient with mitral valve regurgitation, blood flows abnormally from:

A) The right ventricle to the right atrium
B) The right ventricle to the left atrium
C) The right atrium to the right ventricle
D) The aorta to the left ventricle
E) All of the above
F) None of the above

Question 17

Which of the following classes of medications is most likely to slow the heart rate?

A) A diuretic
B) An alpha blocker
C) A beta blocker
D) A pressor

Question 18

The membrane that surrounds the heart is known as:

A) The pleural lining
B) The pericardium
C) The peritoneum
D) The pia mater

Question 19

Dehydration is most likely to cause:

A) Mild hypertension
B) Severe hypertension
C) Hypotension
D) Hypoglycemia

Question 20

The diastolic blood pressure:

A) Is always lower than the systolic blood pressure
B) Never exceeds 100 mm Hg
C) Is the pressure within the heart when the left ventricle is actively contracting
D) Is the pressure in the heart during pulseless electrical activity.

Question 21

The subclavian arteries carry blood to the:

A) Intestines
B) Kidneys
C) Arms
D) Legs

Question 22

Digital arteries carry blood to the:

A) Fingers and toes
B) Facial muscles
C) Eyes
D) Stomach and small intestine

Question 23

An EKG measures:

A) The electrical activity of the heart
B) The mechanical contraction of the heart
C) The volumes of blood circulated by the heart
D) All of the above
E) None of the above

Question 24

The popliteal artery pulse is most easily detected:

A) In the groin
B) Posterior to the ankle on the medial side of the leg
C) At the wrist, proximal to the thumb and thenar eminence
D) Behind the knee

Question 25

The blood vessels that feed blood into the right atrium are the:

A) Aorta
B) Pulmonary veins
C) Superior vena cava, inferior vena cava, and coronary sinus
D) The inferior vena cava only

Question 26

The septum between the right and left atria has an opening, called the _______________, which usually closes after birth, isolating the deoxygenated blood that returns to the heart from the oxygenated blood that returns from the lungs.

A) Foramen ovale
B) Foramen magnum
C) Foramen cecum
D) Foramen Magendie

Question 27

The epicardial coronary arteries are located on the surface of the heart and supply blood to the heart muscle (the myocardium). The left main coronary artery is the largest of these. It splits into:

A) The right coronary artery and the left anterior descending artery
B) The diagonal arteries
C) The left anterior descending artery and the circumflex artery
D) The right coronary artery and the circumflex artery

Question 28

The heart's pacemaker, called the sinoatrial (SA) node, is located in:

A) The apex of the left ventricle
B) The upper right-hand corner of the right atrium
C) The lower left-hand corner of the right ventricle
D) The papillary muscles

Question 29

The fibrous sac that encircles most of the heart is called the:

A) Epicardium
B) Myocardium
C) Pericardium
D) Pleura

Question 30

The thoracic aorta becomes the abdominal aorta after it passes through the:

A) Foramen magnum
B) Foramen Magendie
C) Foramen spinosum
D) Diaphragm

Question 31

Cardiac chambers empty when they contract (during systole), and fill when they relax (diastole). Which of the cardiac valves is open during diastole?

A) The pulmonary valve
B) The ileocecal valve
C) The mitral valve
D) The aortic valve
E) The valvulae connivente

Question 32

A loud murmur heard at the base of the heart which radiates to the sternal notch and the carotid arteries is most likely produced by the:

A) Aortic valve
B) Mitral valve
C) Pulmonary valve
D) Tricuspid valve

Question 33

A systolic murmur audible at the apex of the heart which radiates into the left axilla of the patient is most likely to be the murmur of:

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

Question 34

Which of the following abnormal sounds is heard during diastole?

A) A carotid bruit
B) The murmur of aortic stenosis
C) The murmur of mitral stenosis
D) The murmur of hypertrophic obstructive cardiomyopathy

Question 35

Which of the following body structures is typically damaged by injection drug use?

A) The inferior vena cava
B) The superior vena cava
C) The tricuspid valve
D) The carotid arteries

Question 36

During the assessment of a patient, a student nurse hears heart tones on the right side of the chest and notices there is a murmur that radiates from the area near the right nipple into the right axilla. She concludes:

A) That the patient has inverted internal organs ("situs inversus").
B) That her stethoscope needs to be readjusted. She was listening with the bell instead of the diaphragm.
C) That everything is ok. This is a normal finding.
D) That the patient has aortic regurgitation.

Question 37

In which of the following diseases or conditions is heart block present?

A) When the ejection fraction is less than 40%
B) When the P-R interval of the heart is >2 seconds
C) When a loud holosystolic murmur is heard at the apex
D) When a large quantity of fluid accumulates in the pericardium

Question 38

In which of the following diseases or conditions is heart failure present?

A) When the ejection fraction is less than 40%
B) When the QRS interval of the heart exceeds 0.12 seconds
C) When a loud holosystolic murmur is heard at the apex
D) When a large quantity of fluid accumulates in the pericardium

Question 39

In which of the following diseases or conditions is the activity of the heart muscle restricted by an external force?

A) When the ejection fraction exceeds 75%
B) When the T wave on the surface electrocardiogram is inverted
C) When a soft diastolic blow is heard at the base of the heart
D) When a large quantity of fluid accumulates rapidly in the pericardium

Question 40

In which of the following diseases or conditions would one likely see acute S-T segment elevation on an electrocardiogram?

A) Acute myocardial infarction
B) Mitral valve prolapse
C) Skeletal deformities of the chest wall
D) Fever of 103°F

Question 41

The atrioventricular node (AV node) of the heart:

A) Is the primary pacemaker of the heart
B) Slows the electrical activity of the heart before it reaches the ventricles
C) Fills gradually with blood during diastole
D) Is a vestigial organ. Animals can live without it.

Question 42

The sinoatrial node of the heart is:

A) The primary pacemaker of the heart
B) A vestigial organ
C) A place where blood clots frequently form, because blood eddies in this organ
D) A powerful muscle

Question 43

Which ONE of the following statements about the pulmonary veins is true?

A) There are two pulmonary veins
B) The pulmonary veins carry oxygenated blood into the left atrium from the lungs
C) The pulmonary veins dump blood into the superior vena cava
D) The pulmonary veins carry deoxygenated blood from the right ventricle to the pulmonary artery

Question 44

Which of the following events is most likely to cause a cardiac contusion?

A) Plaque rupture within a coronary artery
B) High cholesterol levels
C) Ventricular tachycardia
D) Blunt force injury to the chest

Question 45

Which of the following events is most likely to cause an aortic dissection?

A) Plaque rupture within a coronary artery
B) High levels of HDL cholesterol
C) Ventricular tachycardia
D) Blunt force injury to the chest

Question 46

Which of the following is an accepted pathological explanation for an acute myocardial infarction?

A) Plaque rupture in a coronary artery
B) High high-density lipoprotein levels
C) Pericardial effusion
D) Left ventricular hypertrophy

Question 47

The epicardial coronary arteries:

A) Are tiny blood vessels located deep inside the myocardium
B) Feed blood to major segments of myocardium
C) Are physiologically insignificant
D) Provide blood to the pericardium

Question 48

A blood clot lodged in the right ventricular outflow tract would do which of the following?

A) Diminish blood flow into the pulmonary artery
B) Increase blood flow into the left atrium
C) Decrease blood flow into the right atrium
D) Increase electrical activity in the bundle of His

Question 49

Which of the following biomarkers is used in clinical medicine to indicate that a patient has heart failure?

A) Troponin I
B) Creatinine kinase (CK)
C) Brain natriuretic peptide (BNP)
D) D-dimer

Question 50

Which of the following agents is unlikely to have a beneficial effect on patients in heart failure?

A) Furosemide
B) Dobutamine
C) Morphine
D) Atropine

Question 51

Which of the following antiarrhythmic drugs has been shown to prolong survival in patients who have suffered cardiac arrest?

A) Amiodarone
B) Lidocaine
C) Procainamide
D) None of the above.

Question 52

Acute pulmonary edema is most likely to improve when treated with:

A) Aspirin, a loop diuretic, nitrates, and ACE inhibitors
B) Beta blockade (e.g., with high doses of intravenous propranolol)
C) Calcium channel blockade (e.g., diltiazem)
D) Norepinephrine, aspirin, and heparin

Question 53

A pulseless, nonbreathing patient undergoing chest compressions and bag-valve-mask ventilation after a witnessed loss of consciousness is attached to a heart rhythm monitor and found to be in ventricular fibrillation. Two defibrillators are available for use in the Emergency Department-one is a monophasic defibrillator; the other is biphasic. The difference between these two devices is:

A) The monophasic defibrillator can deliver only a single shock to a patient; the biphasic defibrillator can deliver two shocks in rapid succession.
B) The monophasic defibrillator delivers a shock during a single phase of the cardiac cycle; the biphasic defibrillator shocks the patient during both systole and diastole.
C) The biphasic defibrillator sends electrical current through the patient in two directions (from one paddle or patch to the other, and back), while the monophasic defibrillator forces electrical current through the patient in a single direction.
D) The biphasic defibrillator uses twice the current of that used by the monophasic defibrillator.

Question 54

During cardiopulmonary resuscitation (CPR), methods that enhance the usefulness of chest compressions include one of the following. Which is an effective technique?

A) Using a mechanical piston device to substitute for manual chest compression by health care providers
B) Alternating chest compressions with abdominal compressions
C) Performing chest compressions shallowly and slowly, to make certain they are coordinated with rescue breathing
D) Timing chest compressions to make certain they match the rate of cardiac depolarizations seen on the heart monitor to which the patient is attached

Question 55

Which of the following is a shockable rhythm?

A) Asystole
B) Pulseless electrical activity
C) Pulseless ventricular tachycardia
D) Third-degree heart block

Question 56

A homeless man is found comatose in the snow after a bitterly cold night in Minneapolis in the late fall. On examination you find that he is pulseless, apneic, and has a body temperature of about 30°C. You should:

A) Call Medical Control, and ask that the patient be declared dead to avoid a futile resuscitation.
B) Begin passive rewarming measures.
C) Initiate treatment for cardiac arrest according to ACLS protocols.

Question 57

A patient with chest pain calls for assistance. You arrive at the scene to find a 66-year-old male, who says he is having a squeezing sensation in his chest that feels like someone tying a towel around him, making it hard for him to breathe. The sensation goes into his jaw and both arms. On examination he is sweating. His pulse is 110 and regular, and his blood pressure is 180/100 mm Hg (equal in both arms). You administer nitroglycerin sublingually as well as oxygen and an aspirin because you think this patient has:

A) A pulmonary embolism
B) Angina pectoris
C) Acute cholecystitis
D) A ruptured abdominal aortic aneurysm

Question 58

An elderly woman with a history of heart failure calls Emergency Medical Services the day after Thanksgiving to report that she has gradually developed worsening shortness of breath, similar to problems she has had in the past when she has eaten heavy, salty meals. Her heart rate is 110 and irregular; her blood pressure is 180/100, her oxygen saturation is 88%; and her respiratory rate is 30 and labored. Her lungs have rales and rhonchi heard throughout. Which of the following would be an inappropriate emergency treatment?

A) Sublingual nitroglycerin
B) Intravenous morphine
C) Nebulized albuterol
D) Oral aspirin
E) Oxygen by nonrebreather mask
F) Massive intravenous hydration

Question 59

Abdominal aortic aneurysm is a vascular abnormality most likely to be found in which of the following patient populations?

A) Premenopausal females with progressive systemic sclerosis
B) Postmenopausal females with high blood pressure and high cholesterol
C) Men over the age of 65 who high blood pressure and have ever smoked
D) Men in their thirties with hypertension

Question 60

Some older patients feel unsteady when they get out of bed or stand up from a seated position. This condition is often caused by a lowering of blood pressure that occurs with postural change. It is called:

A) Orthodromic conduction
B) Orthostatic hypotension
C) Diabetes insipidus
D) Diabetes mellitus

Question 61

Isolated systolic hypertension is a risk factor for stroke in older individuals. Drugs that can be safely used in the older patient to treat this condition include all of the following EXCEPT:

A) Beta blockers like atenolol
B) Diuretics, like hydrochlorothiazide
C) ACE inhibitors, like lisinopril
D) Centrally acting alpha agonists like clonidine

Question 62

Which of the following drugs is a POOR choice for a patient suffering a hypertensive emergency?

A) Epinephrine
B) Nitroglycerin
C) Labetalol
D) Nitroprusside

Question 63

When all factors are considered, including drug efficacy, drug tolerability, side effects, and the cost of drugs, the single best class of antihypertensive medications, and the class recommended by the Joint National Committee on hypertension for initial use by most patients with hypertension is:

A) Alpha blockers
B) Angiotensin-converting enzyme inhibitors
C) Beta blockers
D) Calcium channel blockers
E) Thiazide diuretics

Question 64

During a routine health care appointment, a male patient is found to have a blood pressure of 150/94 mm Hg. Which of the following courses of action is most appropriate?

A) The patient should be hospitalized.
B) The patient should be treated immediately with sublingual nifedipine.
C) The patient should be advised to recheck his blood pressure in a few days to see if it remains elevated.
D) The patient should be advised to increase his daily exercise levels and should be placed on an American Heart Association diet.

Question 65

The incidence of hypertension increases with:

A) Increasing levels of education
B) Increasing earnings
C) Increasing age
D) Decreasing body mass index

Question 66

In the United States, the incidence of hypertension is HIGHEST among which of the following ethnic groups?

A) African Americans
B) Asian Americans
C) Catholics
D) Irish Americans
E) Mormons

Question 67

A patient with hypertension comes to the office complaining of occasional palpitations. You obtain a 12-lead electrocardiogram which does not show an explanation for his palpitations, although it does reveal left ventricular hypertrophy. What can you conclude from this?

A) Nothing. You did not identify the cause of the patient's palpitations, and you identified incidentally that he has left ventricular hypertrophy.
B) You can conclude that his blood pressure has been well managed in the past.
C) You can conclude that the patient has a problem with illicit drugs
D) You can conclude that the patient has had hypertension for many years.

Question 68

Which of the following statements about chronic hypertension is TRUE?

A) It increases a person's risk of stroke
B) It increases a person's likelihood of smoking
C) It increases a person's life span
D) It increases a person's risk of cirrhosis

Question 69

In the Intensive Care Unit a patient has a blood pressure of 180/120. His mean arterial pressure is:

A) 160 mm Hg
B) 180 mm Hg
C) 120 mm Hg
D) 150 mm Hg

Question 70

The difference between the systolic blood pressure and the diastolic blood pressure is known as the:

A) Mean arterial pressure
B) Pulse pressure
C) Pulsus paradoxicus
D) Water hammer pulse

Question 71

A patient comes to the hospital after an episode of syncope. On examination her blood pressure is 160/50. She has a late peaking systolic heart murmur heard best at the base of the heart, followed by a diastolic sound heard in the same area. You suspect that this patient has:

A) Congestive heart failure
B) Mitral regurgitation
C) Aortic stenosis and aortic regurgitation
D) Tricuspid insufficiency

Question 72

A 13-year-old male has a blood pressure of 150/95. His body mass index is normal. He is a well-adjusted child who behaves appropriately and does well in school. On examination he has no abdominal bruits, but his femoral pulse arrives later than his radial pulse. Of the following conditions, which is the most likely cause of his hypertension?

A) Renal artery stenosis
B) Essential hypertension
C) Ethanol-induced hypertension
D) Coarctation of the aorta

Question 73

Malignant hypertension is:

A) Elevated blood pressure found in patients with cancer
B) Elevated blood pressure within the eye. It is a synonym for glaucoma
C) Elevated blood pressure in a family cohort
D) Elevated blood pressure that progresses rapidly to internal organ damage, such as retinopathy, renal failure, heart failure, or stroke

Question 74

Parenteral medications that lower blood pressure rapidly include all of the following, EXCEPT:

A) Labetalol
B) Nifedipine
C) Nitroglycerin
D) Nitroprusside

Question 75

Nutritional interventions can help to lower blood pressure. Which of the following interventions is LEAST likely to help to lower blood pressure in a patient who is overweight, hypercholesterolemic, and hypertensive?

A) DASH diet
B) Salt-free diet
C) Western diet
D) 1600 calorie diet

Question 76

A 75-year-old man tells you he feels a ripping chest pain that is tearing through his body from his anterior chest to his back. His blood pressure in his right arm is 165/105. His blood pressure in the left arm is 135/80. Which of the following diseases or conditions might be responsible for this presentation?

A) Acute coronary syndrome
B) Aortic dissection
C) Esophageal rupture
D) Pulmonary embolism

Question 77

Which of the following are NOT common complications of digitalis toxicity?

A) Anorexia and nausea
B) Cardiac arrhythmias
C) Confusion and dizziness
D) Rashes

Question 78

Alternative and complementary medications are used to treat many diseases and conditions, but some should be avoided because of their potential side effects. Which of the following alternative medications should not be taken by people with hypertension?

A) Ma huang
B) Ginger
C) Ginkgo biloba
D) Ginseng

Question 79

82 The most common side effect of warfari is

A) Anaphylaxis
B)Hemorrhage
C)Shock
D)Thrombocytopenia

Question 80

Agents that reverse the impact of warfarin include all of the following, EXCEPT

A) Cryoglobulins
B) Cryoprecipitate
C)Fresh frozen plasma
D)Vitamin K