Question 1

Which of the following is not synonymous with metabolic syndrome?

Accepted Answer

Familial hypercholesterolemia is not synonymous with metabolic syndrome. Metabolic syndrome is also known as syndrome X, insulin resistance syndrome, dysmetabolic syndrome, hypertriglyceridemic waist and obesity syndrome.

Question 2

A nurse is planning to give pre-procedure teaching about the benefits of the procedure to a patient who is planned to undergo percutaneous transluminal coronary angioplasty (PTCA). What is the correct statement in this regard?

Accepted Answer

The correct statement in this regard is that the goal of percutaneous transluminal coronary angioplasty is to increase blood flow to the coronary arteries by reducing plaque build-up. The procedure involves the use of a catheter introduced through the femoral, brachial, or radial artery into the diseased coronary artery and balloon pressure is applied to the area of plaque formation to decrease plaque size and/or stretch the vessel wall. A stent is often placed after opening the vessels.

Question 3

The nurse is taking care of a 50-year old patient who has undergone mitral valve replacement surgery. Patient suffers from perioperative myocardial infarction, doctor recommends continuous intravenous infusion of nitroglycerine. About which of the following parameters should the nurse be closely watchful?

Accepted Answer

The nurse should be closely watchful about frequent monitoring of blood pressure if the patient is receiving intravenous nitroglycerine. Intravenous infusion of nitroglycerine may result in fall of blood pressure.

Question 4

A 64-year old male patient was advised to undergo coronary artery bypass surgery after coronary angiogram. What is the correct statement used by the nurse while explaining the objective of coronary artery bypass surgery?

Accepted Answer

The correct statement used by nurse while explaining the objective of coronary artery bypass surgery is "Complete revascularization of the myocardium". The objective of CABG is complete revascularization of the myocardium. Arteries with severe stenoses (> 50% diameter reduction) are bypassed, except those of small caliber (<1mm in diameter).

Question 5

Graham Steell murmur is heard in which of the valvular diseases?

Accepted Answer

Graham Steell murmur is heard in pulmonary regurgitation. Graham Steell murmur is a high pitched early diastolic murmur heard best at the left sterna edge in the 2nd and 3rd left intercostals space in full inspiration.

Question 6

A patient presents in the emergency department complaining of acute pain abdomen is having high degree of suspicion of a ruptured abdominal aortic aneurysm (RAAA). What measures should be initiated immediately?

Accepted Answer

The immediate measure to be started are immediate resuscitation after ensuring immediate vascular access. If RAAA is strongly suspected do not waste time in radiology. Start initial resuscitation including vascular access, ensure availability of blood products. Emergency laparotomy as soon as IV and cross-match sent.

Question 7

Choose the sentence which correctly defines orthostatic hypotension.

Accepted Answer

The sentence "Blood pressure drops when going from a sitting to standing position" correctly defines orthostatic hypotension. Orthostatic hypotension or postural hypotension is defined as low blood pressure upon standing. In this condition, an individual's blood pressure drops when going from a sitting to standing position, leading to dizziness, light-headedness, blurred vision, and fainting or syncope.

Question 8

A 45-year old male patient has a waist circumference of 106 cm. His blood reports show a fasting plasma glucose of 120mg/dL, triglyceride levels 170 mg/dL, high-density lipid cholesterol 30 mg/dL. He is at risk of developing which of the following set of conditions?

Accepted Answer

He is at risk of developing fatty liver, gallstones and sleep apnea. The NCEP/ATP III (National Cholesterol Education Program/Adult Treatment Panel) defines metabolic syndrome as an individual with 3 or more of the following risk factors including waist circumference equal to or greater than 102 cm in men and 88 cm in women, triglyceride levels greater than 150 mg/dL, high-density lipid cholesterol less than 40 mg/dL in men and less than 50 mg/dL in women, blood pressure greater than or equal to 130/85 mmHg and fasting plasma glucose greater than 100mg/dL. Additional conditions that have been associated with metabolic syndrome include fatty liver, polycystic ovary syndrome, gallstones and sleep apnea.

Question 9

Pharmacologic agents not used to treat inflammation are:

Accepted Answer

Atorvastatin is not used to treat inflammation. Pharmacologic agents used include analgesics, nonsteroidal anti-inflammatory agents, corticosteroids, anti-malarial agents such as hydroxychloroquine and other agents including methotrexate, sulfoalanine, leflunomide, anti-tumor necrosis factor medications, cyclophosphamide and mycophenolate.

Question 10

Which of the following conditions is not an example of acute inflammation?

Accepted Answer

Tuberculosis is not an example of acute inflammation. Tuberculosis is an example of chronic inflammation. Acute appendicitis, acute tonsillitis, and acute gout are examples of acute inflammation. Acute dermatitis and acute bacterial meningitis are also examples of acute inflammation.

Question 11

Which of the following is not an example of chronic inflammation?

Accepted Answer

Bacterial meningitis is not an example of chronic inflammation. Rheumatoid arthritis, ulcerative colitis and psoriasis are example of chronic inflammation. Other examples of chronic inflammation are: chronic persistent asthma; autoimmune disease such as lupus, psoriasis and rheumatoid arthritis; bursitis; gout; prolonged inflammation; chronic prostatitis; glomerulonephritis; hypersensitivities such as allergies; myopathies; leukocyte defects; inflammatory bowel disease such as Crohn's disease and ulcerative colitis; pelvic inflammatory disease; reperfusion injury, transplant rejection and vascuitis.

Question 12

Which of the following class of antibiotics is liable to cause pericarditis?

Accepted Answer

The tetracycline group of antibiotics are liable to cause pericarditis. Hydralazine also causes pericarditis but is not an antibiotic. Isoniazid and cyclosporine can also cause pericarditis. Quinolones and Penicillin do not cause pericarditis.

Question 13

Which of the following degree of heart block may be present in asymptomatic individuals and is not associated with an increase in mortality and morbidity?

Accepted Answer

First-degree atrioventricular block may be present in asymptomatic individuals and is not associated with an increase in mortality and morbidity. First-degree atrioventricular block is typically asymptomatic and may remain undiagnosed. It can occur in individuals of all ages. The disease is typically benign and not associated with an increase in the mortality and morbidity.

Question 14

A hypertensive patient comes for routine follow up. His EKG demonstrates a PR interval of 220 milliseconds. Which of the following drugs is most likely culprit for this EKG finding?

Accepted Answer

The most likely culprit for this EKG finding is nifedipine. Pharmacologic agents that can lead to first-degree atrioventricular block include digoxin, calcium channel blockers such as nifedipine, amlodipine, verapamil, diltiazem and beta-blockers.

Question 15

A healthy young adult male comes for a routine check-up. The nurse records an EKG. The patient is worried if there is something abnormal in his EKG. Upon getting which of the following EKG finding would the nurse convince the patient that there is nothing wrong with his EKG?

Accepted Answer

Upon getting a PR interval of 210 milliseconds, the nurse can convince the patient that there is nothing wrong with the EKG. First degree AV block is characterized by prolonged PR interval (> 200 milliseconds), which may be a normal variant in some asymptomatic individuals.

Question 16

A 75-year old diabetic, obese male patient presenting with complaints of intermittent palpitation and excessive sleepiness during daytime was advised 24-hour Holter monitoring. The nurse is explaining to the patient about the diagnostic significance of Holter monitoring. Which of the following cannot be determined by Holter monitoring?

Accepted Answer

Cause of excessive sleepiness during daytime cannot be determined by Holter monitoring. A sleep study would need to be completed to help determine the cause of excessive sleepiness during daytime.
Holter monitor can be used to determine:
•Detect intermittent arrhythmias
•Relate symptoms to dysrhythmias
•Detect myocardial ischemia

Question 17

In the adolescent age group, the commonest cause of pericarditis is:

Accepted Answer

In adolescents, pericarditis is most commonly caused by Adeno virus and Coxsackie virus. Dressler's syndrome is a complication of myocardial infarction which does not occur in adolescent age group. Hypothyroidism is not a cause of myocarditis.
Etiology of myocarditis:
•Idiopathic
•Infectious
•viral: Coxsackie virus B, Echovirus, Poliovirus, HIV, mumps
•bacterial: S. aureus, C. perfringens, C. diphtheriae, Mycoplasma, Rickettsia
•fungi
•spirochetal (Lyme disease - Borrelia burgdorferi)
•Chagas disease (Trypanosoma cruzi), toxoplasmosis
•Acute rheumatic fever (Group A ß-hemolytic Streptococcus)
•Drug-induced: emetine, doxorubicin
•Collagen vascular disease: systemic lupus erythematosus (SLE), polyarteritis nodosa (PAN), rheumatoid arthritis (RA), dermatomyositis (DMY)

Question 18

Which of the following statement is not correct about pericarditis?

Accepted Answer

The statement "Chronic pericarditis is more common than acute pericarditis" is not correct about pericarditis. Pericarditis is defined as inflammation of the pericardium, which is the thin membrane surrounding the heart muscle. Excess fluid can accumulate between the two layers of the membrane, impacting the proper function of the heart. There are two types of pericarditis including acute pericarditis and chronic pericarditis. Acute pericarditis is more prevalent than chronic pericarditis.

Question 19

The attending nurse records the ECG of a patient whose PR interval is 220 milliseconds which signifies the presence of first degree heart block. Which of the following sentences is not true about his condition?

Accepted Answer

The sentence "Prevalence is highest among residents of Asian countries" is not true about this patient's condition. Individuals who present with first-degree atrioventricular block have few or no symptoms. Diagnosis is typically made during routine physical examination or when being examined for another compliant. Higher prevalence in younger adults occurs in athletes and university students. The condition is more prevalent in African Americans than Caucasian Americans. The condition also increases with natural aging and more prevalent among elderly patients with other cardiovascular co-morbid condition.

Question 20

The nurse records the EKG of an asymptomatic patient. Which of the following EKG findings confirms the diagnosis of Wenckebach phenomena?

Accepted Answer

The EKG finding of progressive lengthening of PR interval followed by a P wave without an associated QRS complex confirms the diagnosis of Wenckebach phenomena. Second-degree atrioventricular block type I, also known as Wenckebach or Mobitz I, is an asymptomatic dysrhythmia typically diagnosed on electrocardiogram which shows progressive lengthening of PR interval followed by a P wave without an associated QRS complex.

Quiz 1: Cardiac Medicine