Question 1

Nurse is explaining a patient about the various manifestations of atherosclerosis. Which of the following statement is not true regarding this disease?

Accepted Answer

The statement not true about manifestations of atherosclerosis is "Atherosclerosis leads to altered vascular function which affects all the arteries except the renal artery and aorta". Atherosclerosis leads to altered vascular function including coronary heart disease, myocardial ischemia and myocardial infarction, cerebrovascular insufficiency, stroke, peripheral vascular disease, limb ischemia, renal disease, aortic aneurysm, and vasculitis. The final mechanism of the above complications usually occurs via plaque rupture or severe vessel narrowing and blood clotting.

Question 2

Which of the following is a correctly matched correlation of jugular venous pulse?

Accepted Answer

The correct match is loss of "a" wave: atrial fibrillation.
Pathological waveforms of JVP:
•Loss of "a" wave: A fib, atrial standstill
•Absent venous pulse: RHF/CHF, SVC obstruction, cardiac tamponade
•Giant "a" waves: contraction of atrium against increased resistance (RVH, PS, TS, pulmonary HTN)
•Cannon "a" waves: contraction of atrium against closed TV as in AV dissociation (AV dissociation, PVC)
•Systolic venous pulsation (c-v waves): regurgitation of blood into venous system with ventricular contraction as in TR (rapid "y")
•Sharp "y" descent: increased venous pressure as in constrictive pericarditis ("y">"x" phenomenon)

Question 3

After recording the ECG of a patient the nurse observes that QRS complex is wider. Which of the following is unlikely to be the cause of this finding?

Accepted Answer

Paroxysmal ventricular tachycardia is unlikely diagnosis if the ECG shows wide QRS. The differential Diagnosis of Wide QRS Complexes includes:
•Aberrant ventricular conduction
•Preexisting left or right bundle branch block
•Preexisting nonspecific IVCD
•Antegrade conduction through the bypass tract in patients with WPW

Question 4

An 80-year old male is having end-stage aortic stenosis. Definitive treatment for his condition is aortic valve replacement but he is critically ill and surgery cannot be performed at the moment. Which surgical procedure can be used as a bridge to aortic valve replacement surgery in this patient?

Accepted Answer

Balloon valvuloplasty is done for critically ill patients with end-stage aortic stenosis as a "bridge" to aortic valve replacement. Decalcification/debridement is considered in patients with mild to moderate AS in whom the primary indication for surgery is coronary artery disease. Commissurotomy is useful in a small percentage of patients with aortic rheumatic valve disease with a trileaflet valve and minimal to no calcification.

Question 5

Coronary angiogram of a 75-year old male patient shows 30 % blockage in right coronary artery. All other coronary arteries are normal. Which set of medications is recommended for treatment of atherosclerotic disease in this patient?

Accepted Answer

Statin, aspirin, clopidogrel are recommended for treatment of atherosclerotic disease in this patient of coronary artery disease. Pharmacologic agents used for the treatment of atherosclerotic disease include cholesterol-lowering medications such as statins. Anti-platelet medications are also used such as aspirin, ticlopidine, and clopidogrel. In situations where the atherosclerotic plaque is unstable, anticoagulants like heparin and warfarin are used.

Question 6

A 65-year hypertensive non-smoker male patient has an abnormal lipid profile. What lifestyle modification should the nurse advise to this patient?

Accepted Answer

The nurse should advise physical exercise, healthy diet, control of blood pressure as lifestyle modifications. Lifestyle modification for a patient of atherosclerotic disease include physical exercise, healthy diet, dietary supplementation, smoking cession and treatment of comorbid conditions like diabetes and hypertension.

Question 7

The nurse receives the blood test reports for a patient who was admitted to hospital with complaints of chest pain. The report shows an elevated level of Troponin I. What does this test signify in this patient?

Accepted Answer

Cardiac enzymes get elevated in conditions of damage to myocardium. Troponin I is one of the important cardiac enzyme used to assess the damage to myocardium. Other enzymes used for assessment of myocardial damage are troponin T and CKMB.

Question 8

A patient presenting to emergency room with severe dyspnea is diagnosed to have pulmonary edema. Which of the following drugs should the nurse immediately prepare to give this patient?

Accepted Answer

The nurse should immediately prepare intravenous furosemide at a higher dose to give this patient. In case of acute pulmonary edema, treatment with intravenous nitrates (glyceryl trinitrate), and high ceiling diuretics, such as furosemide or bumetanide, is the mainstay of therapy. These improve preload and afterload and help to improve cardiac function.

Question 9

The nurse is explaining to a 54-year smoker male patient about prognosis of intermittent claudication. Which of the following statements is true about his condition?

Accepted Answer

The true statement about his condition is "The patients who continue to smoke usually deteriorate". The prognosis of individuals diagnosed with intermittent claudication is good because the condition typically stabilizes or improves over time. Typically, approximately 1/3rd of patients with intermittent claudication tend to improve over time, while 1/3rd remains stable and another 1/3rd deteriorate, mainly due to continued smoking.

Question 10

Pericardial fluid has been aspirated and examined from a patient presenting with pericardial effusion. The fluid examination report shows a transudative fluid. Which of the following is unlikely to be the cause of this pericardial effusion?

Accepted Answer

Aortic dissection is unlikely to be the cause of transudative pericardial fluid.
There are two types of effusions:
•Transudative (serous): CHF, hypoalbuminemia/hypoproteinemia, hypothyroidism
•Exudative (serosanguinous or bloody): Causes similar to the causes of acute pericarditis, may develop acute effusion secondary to hemopericardium (trauma, post MI myocardial rupture, aortic dissection)

Question 11

The nurse is examining a patient of pericardial effusion. Which of following signs are unlikely to be present?

Accepted Answer

Bounding pulse is unlikely to be present in a patient of pericardial effusion.
Signs of pericardial effusion are:
•JVP: increased with dominant "x" descent
•Arterial pulse: normal to decreased volume, decreased PP
•Auscultation: distant heart sounds +/- rub

Question 12

Holter monitoring of a 65-year old female patient having cervical carcinoma stage 3 shows ventricular tachycardia resulting in syncope. The condition is treatable by implantable cardio-defibrillator. Which of the following is a contraindication of use of ICD in this patient?

Accepted Answer

Cervical carcinoma stage 3 is a contraindication of use of ICD in this patient. Contraindications associated with implantable cardiac defibrillators include myocardial ischemia, electrolyte abnormalities, terminal illness with short life expectancy, and ventricular tachycardia or ventricular fibrillation due to dysrhythmia.

Question 13

Which of the following statements is true about atrial septal defect?

Accepted Answer

The statement "Increased pulmonary blood flow and leads to recurrent respiratory infections" is true about atrial septal defect (ASD)
Atrial septal defect (ASD):
•Results in increased pulmonary blood flow and leads to pulmonary vascular congestion and recurrent respiratory infections
•Indications for surgery: should be closed by age 5 to avoid pulmonary hypertension; in adults with evidence of left-to-right shunt
•Surgical procedures: transcatheter closure, direct suture, use of pericardial or Dacron patch

Question 14

Choose the correct statement about ventricular septal defect (VSD).

Accepted Answer

The correct statement about VSD is transcatheter closure can be performed for muscular defects only.
Ventricular septal defect (VSD):
•Occur most frequently in the membranous septum (80%)
•The child will present with pulmonary vascular congestion and recurrent respiratory infections due to excessive pulmonary blood flow
•Indications for surgery: repair should be performed by age 1 in all patients with a significant shunt or LV volume overload
•Surgical procedures: pulmonary artery banding (to reduce pulmonary blood flow if other associated complex lesions), direct suture, patch closure, transcatheter closure (for muscular defects only)

Question 15

Which of the following is not a correct pair of the signs of chronic aortic regurgitation and the organ where it is demonstrated?

Accepted Answer

Mueller sign - liver is not a correct match.
Signs of chronic AR:
•Quincke's sign - pulsatile blushing of nail beds
•Corrigan's pulse - visible carotid pulse
•Hill's test:- femoral-brachial SBP difference > 20 (greater differences correlate with more severe AR)
•Duroziez's test: light proximal compression of femoral artery produces systolic-diastolic murmur over femoral artery
•Other - pulsating uvula (Mueller), liver (Rosenbach), pupil (Gandolfi), or spleen (Gerhard)

Question 16

A child has a patent ductus arteriosus (PDA). Which of the following statements is true regarding this condition?

Accepted Answer

The true statement regarding this condition is if PDA persists beyond third month of life, it is an indication of surgery.
Patent ductus arteriosus (PDA):
•Can increase pulmonary blood flow and produce pulmonary vascular congestion and LV volume overload
•Patency may be critical to survival in neonates with complex heart disease by providing pulmonary or systemic blood flow
•Indications for surgery: PDA contributing to respiratory compromise or persisting beyond 3rd month of life
•Surgical procedures: transcatheter closure using intravascular coils, simple ligation, surgical division

Question 17

Which of the following descriptions of the various procedures used for valvular repair is correctly matched with its name?

Accepted Answer

"Annuloplasty - repairs the junction between the cardiac valve leaflet and cardiac muscle" represents the correct match. Annuloplasty is a procedure that repairs the junction between the cardiac valve leaflet and cardiac muscle. Two different approaches can be used to perform annuloplasty including the use of ring prosthesis and/or sutures. Chordoplasty is a procedure that involves the repair of an elongated or ruptured chordae tendinea.

Question 18

Which of the following sets of drugs might slow the conduction through AV node and cause second degree heart block?

Accepted Answer

Digoxin, beta-blockers, and calcium channel blockers might slow the conduction through AV node and cause second degree heart block. Pharmacologic agents that slow conduction through the atrioventricular node have been shown to cause second-degree atrioventricular block type I. These agents include cardioactive drugs such as digoxin, beta-blockers, calcium channel blockers, and certain antiarrhythmia drugs such as sodium channel blockers (procainamide).

Question 19

Which of the following sets represent the group of vascular diseases that lead to second degree atrioventricular block?

Accepted Answer

Vascular diseases such as ankylosing spondylitis, dermatomyositis, rheumatoid arthritis, scleroderma, lupus, and Reiter syndrome are associated with second degree atrioventricular block type I. All other sets do not represent vascular diseases.

Question 20

Which of the following surgical methods are not used for treatment of hypertrophic cardiomyopathy?

Accepted Answer

Surgical Maze procedure is not used for the treatment of hypertrophic cardiomyopathy. Pharmacologic agents used for treatment of hypertrophic cardiomyopathy including beta-blockers and calcium channel blockers. Surgical options include implantation of ICDs or pacemakers and septal myectomy. Alcohol abstinence is another option for patients not candidates for surgery.

Quiz 1: Cardiac Medicine