Question 1

Which of the following set of diseases represent the co-morbid conditions associated with metabolic syndrome?

Accepted Answer

Co-morbid conditions associated with metabolic syndrome include elevated uric acid levels, fatty liver disease, polycystic ovary syndrome, and hemochromatosis and acanthosis nigricans.

Question 2

A 32- year old male patient has been diagnosed with dyslipidemia. He is curious to know about the underlying metabolic disorder. What is the correct answer the nurse should give this patient?

Accepted Answer

Dyslipidemia is a disorder of lipoprotein metabolism, including hyperlipidemia and hypolipidemia. Dyslipidemia can be classified as primary dyslipidemia or as result of a comorbid condition and referred to as secondary dyslipidemia. The condition is typically characterized by elevations in total cholesterol, low-density lipoprotein cholesterol, triglyceride levels, and a decrease in high-density cholesterol levels.

Question 3

Which of the following is not a feature of dyslipidemia?

Accepted Answer

Dyslipidemia does have an elevation in high-density cholesterol levels. Dyslipidemia is typically characterized by elevations in total cholesterol, low-density lipoprotein cholesterol, triglyceride levels, and a decrease in high-density cholesterol levels.

Question 4

Which of the following approaches are not used for reducing triglyceride levels?

Accepted Answer

Antiplatelets are not used for reducing triglyceride levels. The approaches demonstrated to be effective in lowering triglyceride levels includes fibrates, statins, nicotinic acid, and omega-3 fatty acids.

Question 5

A non-diabetic non-hypertensive male presents with symptoms of discoloration of fingers and toes when exposed to cold. Which of the diagnostic tools are useful to distinguish between primary and secondary Raynaud's phenomena?

Accepted Answer

The tools used to distinguish between primary and secondary Raynaud's disease are: nail fold capillaroscopy, diagnostic measurement of hand temperature gradients, digital artery pressure measurements, and doppler ultrasound. Blood counts and measurement of urea and electrolyte levels are other tools used to distinguish between primary and secondary forms of the phenomenon.

Question 6

The nurse records the ECG of a patient presenting with dizziness, light headedness and palpitations. The ECG shows absent p-waves and fibrillatory waves. Which of the following invasive approaches are not beneficial in treating this patient's arrhythmia?

Accepted Answer

A dual chamber pacemaker is not beneficial for treatment of atrial fibrillation. Invasive approaches for treatment of atrial fibrillation include AV node ablation, radiofrequency catheter ablation, and surgical maze procedure.

Question 7

Which of the following statements is not true regarding cardiac arrhythmias?

Accepted Answer

The statement "Supraventricular arrhythmias originate in the ventricle". Supraventricular arrhythmias originate in the atria and include atrial fibrillation, atrial flutter, and Wolf-Parkinson-White syndrome.

Question 8

A child having aortic regurgitation has been advised for valve replacement surgery. The parents are concerned to know about the type of aortic valve prosthesis which is suitable for their child. What is the correct answer given by nurse?

Accepted Answer

The nurse should tell them that pulmonary autograft is suitable for their child. Pulmonary autograft valves are ideal for children and young adults to avoid anticoagulation. Ross procedure: replace the diseased aortic valve with the patient's own pulmonary valve and implant a semilunar valve homograft (e.g. pulmonary valve homograft) in the pulmonary position.

Question 9

A patient with atrial fibrillation is presents with acute pain in left lower limb which progressed to loss of sensation and feeling of cold and numbness over few hours. What is the first treatment the nurse should start?

Accepted Answer

The first treatment the nurse should start is immediate heparinization with 5000 IU bolus and continuous infusion to maintain PTT > 60. The symptoms of this patient are highly suggestive of acute arterial occlusion.
Management of acute arterial occlusion:
•Immediate heparinization at 5000 IU bolus and continuous infusion to maintain PTT > 60
•In the absence of power and sensation - need emergent re-vascularization: for embolus - embolectomy; (ii) for thrombus - bypass
•In the presence of power and sensation - need work-up - including angiogram: for embolus - embolectomy; (ii) for thrombus - bypass
•Embolectomy: Fogarty catheter tied to fish embolus out of artery
•Bypass: bypass occlusion allowing blood flow to resume to distal site
•Identify and treat underlying cause
•Continue heparin post-op, start warfarin post-op day 1 for 3 months
•Re-perfusion phenomenon
•Toxic metabolites from ischemic muscle --> renal failure and multi-organ system failure

Question 10

Which of the following drugs is liable to cause dilated cardiomyopathy?

Accepted Answer

Adriamycin is liable to cause dilated cardiomyopathy. Amiodarone, atenolol and ampicillin do not cause cardiomyopathy. Cardiomyopathy is the enlargement of the heart and is to be monitored in patients receiving Adriamycin.

Question 11

Dilated cardiomyopathy is not a manifestation of which of the following?

Accepted Answer

Dilated cardiomyopathy is not a manifestation of amyloidosis. Amyloidosis is a cause of restrictive cardiomyopathy. Coronary artery disease and alcohol cause dilated cardiomyopathy.

Question 12

The antibiotic used for treatment of acute streptococcal infection in patients of acute rheumatic fever is:

Accepted Answer

Benzathine penicillin (benzathine penicillin G 1.2 MU IM x 1 dose) is used for treatment of acute streptococcal infection in patients of acute rheumatic fever.

Question 13

Which of the following set of symptoms constitute the triad of aortic stenosis?

Accepted Answer

Triad of symptoms of aortic stenosis consists of angina, syncope, and dyspnea.
•Angina (exertional): due to concentric LVH and subendocardial ischemia (decreased subendocardial flow and increased myocardial O2 demand), may have limitation of normal activity or resting angina in tight AS (associated with <5 year survival)
•Syncope: due to fixed CO or arrhythmia (<3 year survival)
•Dyspnea (LV failure): systolic +/- diastolic dysfunction, pulmonary edema, may have orthopnea, if secondary RHF may have ascites, peripheral edema, congestive hepatomegaly (<2 years)

Question 14

Which of the following criteria is not used to diagnose Buerger's disease?

Accepted Answer

Pain in muscles on walking is not a criterion for diagnosis of Buerger's disease. The most commonly used criteria used for the diagnosis of Buerger's disease: individuals younger than 45 years of age, past or present tobacco use, presence of distal extremity ischemia (ischemic ulcers and gangrene), exclusion of autoimmune disorders, and consistent angiographic findings in extremities.

Question 15

A 40-year old male patient has been diagnosed to have Buerger's disease. The nurse is explaining this patient about the available treatment options for his condition. Which of the following treatment methods should the nurse not mention to the patient?

Accepted Answer

The nurse should not mention lipid-lowering agents like statins as a treatment method in this patient. The main treatment of Buerger's disease is smoking cessation which will halt progression of the disease. Other options for the treatment of Buerger's disease include anti-coagulation agents or anti-platelet agents to improve blood flow, surgery to cut nerves in infected painful areas, as well as digit amputation due to extensive infection or gangrene.

Question 16

A 45-year old female patient is on warfarin therapy for atrial fibrillation. She has planned to undergo mitral valve replacement surgery for mitral stenosis and mitral regurgitation. What advice should be given by the nurse regarding the anticoagulant medication?

Accepted Answer

The advice for patients taking anticoagulants like warfarin is to stop 4-5 days prior to surgery; admit and start on IV heparin if high risk of thrombosis (large left atrium, atrial fibrillation, mitral valve prosthesis). IV heparin should be stopped 2-3 hours preoperation (unless on intra-aortic balloon pump (IABP) support).

Question 17

A 65-year old male had undergone percutaneous transluminal coronary angioplasty. What tests should the nurse order to evaluate this patient of post percutaneous transluminal coronary angioplasty?

Accepted Answer

The nurse should order electrocardiogram, echocardiogram, physical assessment, and monitoring of peripheral blood flow to evaluate this patient. Post percutaneous transluminal coronary angioplasty patients should be evaluated by performing electrocardiogram, echocardiogram, physical assessment, monitoring of peripheral blood flow, any swelling and evaluation of cardiac pain.

Question 18

A 72-year old male patient has been diagnosed to have peripheral arterial disease. What are the contraindications of percutaneous transluminal angioplasty of the lower extremity in this patient?

Accepted Answer

Contraindications of percutaneous transluminal angioplasty of the lower extremity are:
•Medically unstable patients
•Patients having long arterial occlusions
•Patients having poor distal run off
•Diabetic patients

Question 19

The nurse is taking care of a patient who has percutaneous transluminal angioplasty of the lower extremity. What are the possible complications the nurse should be watchful in this patient?

Accepted Answer

The possible complications the nurse should be watchful in this patient are vasospasm, thrombus formation, arterial dissection, vessel perforation, compartment syndrome and arterial dissection. The complications associated with post percutaneous transluminal angioplasty of the lower extremity are vasospasm, thrombus formation, arterial dissection, vessel perforation, compartment syndrome, arterial dissection, restenosis, and sudden death. Other complications may occur due to the patient's overall health, allergies, and other comorbid conditions.

Question 20

Which of the following statement is correct about relationship between smoking and atherosclerosis?

Accepted Answer

The correct statement about smoking and atherosclerosis is "smoking not only predisposes individuals to atherosclerosis, but it increases the progression of the disease". This is by the constricting effects on the arteries that smoking has.

Quiz 1: Cardiac Medicine