Question 1

Which of the following tests should be part of the pre-operative examination of patients who will be undergoing cardiac surgery?

Accepted Answer

The pre-operative examination of patients who will be undergoing cardiac surgery should include potassium level, prothrombin time, hematocrit, serum creatinine level, electrocardiogram, echocardiogram, and a chest x-ray.

Question 2

Cardiac transplantation was performed in a patient who had end-stage cardiovascular disease. What is the 10-year life expectancy of this patient?

Accepted Answer

The 10-year life expectancy for cardiac transplant patients is approximately 10 years.

Question 3

Pharmacologic agents used to prevent long-term complications in a patient after cardiac transplantation include the following:

Accepted Answer

Pharmacologic agents used to prevent the long-term complications associated with cardiac transplantation include immunosuppressive agents, antihypertensives, and lipid lowering agents. Antibiotics are given as needed.

Question 4

What are the long-term complications associated with cardiac transplantation?

Accepted Answer

Long-term complications associated with cardiac transplantation include infection, rejection, and thromboembolic disease.

Question 5

A 65-year old male was diagnosed with a small aneurysm in an artery of his left lower limb. His father died of a ruptured of abdominal aneurysm. What are the treatments of choice for this patient?

Accepted Answer

The treatments of choice for this patient are risk factor modification and regular screening: treatment recommendations for aneurysms are based on the size and location of the aneurysm. Typically, aneurysms found early can be treated with aggressive risk factor modification including cessation of smoking, lowering cholesterol, treating hypertension, diet, exercise, and treatment with anti-platelet agents. However, surgery is often necessary if an aneurysm is large and at risk of rupture.

Question 6

A 40-year-old male smoker complains of pain in his feet when walking, and weakness, swelling, discoloration, and ulcers on the digits. What is the most likely diagnosis?

Accepted Answer

The most likely diagnosis in this patient is Buerger's disease. Symptoms of Buerger's disease include pain and weakness in extremities, swelling of hands and feet, and ulcers on the digits.

Question 7

A male smoker presents with pain in his extremities after exercise. Which of the following diseases need to be ruled out before considering a diagnosis of Buerger's disease?

Accepted Answer

Systemic lupus, diabetes, hypercoagulable conditions, and scleroderma can all produce the symptoms of pain in the extremities during exercise, and color changes in the digits when they are exposed to cold. Blood tests are used as screening tools to aid in diagnosis of Buerger's disease. Tests are done to rule out scleroderma, lupus, diabetes and other blood clotting conditions. The Allen test is used to assess blood flow to the hands and feet. Angiography, ultrasound, and echocardiography can be used to assess vascular flow.

Question 8

Which of the following criteria is most commonly used for diagnosis of Buerger's disease?

Accepted Answer

The most common criteria used for 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), and consistent angiographic findings in extremities.

Question 9

Which of these medications is used to treat Raynaud's disease?

Accepted Answer

Pharmacologic agents used in the treatment of Raynaud's disease include calcium channel blockers to dilate blood vessels, alpha-blockers to counteract the constriction of blood vessels, and vasodilators to dilate and relax blood vessels.

Question 10

Which of the following combinations of pharmacologic agents are used for treatment of dilated cardiomyopathy?

Accepted Answer

Pharmacologic agents used for treatment of dilated cardiomyopathy include ACE inhibitors, angiotensin-receptor blockers, and beta-blockers.

Question 11

A patient presenting with features of renal failure has amyloidosis. He is at risk of developing which type of cardiomyopathy?

Accepted Answer

Restrictive cardiomyopathy can be caused by amyloidosis. It can also be caused by hemochromatosis, sarcoidosis, and connective tissue disorders.

Question 12

Which of the following pharmacologic agents will be useful in treatment of a patient who presents with symptoms of fatigue, shortness of breath, swelling of legs, rapid weight gain over several days, and signs of fluid overload?

Accepted Answer

This patient almost certainly has heart failure, and the pharmacologic agents useful for this patient would be diuretics, ACE inhibitors, digoxin, and beta-blockers.

Question 13

A patient presenting with symptoms of shortness of breath on exertion, swelling of the abdomen and extremities, decreased appetite, and nausea was diagnosed to have congestive heart failure. What should be the goal of treatment in this patient?

Accepted Answer

The goal of treatment in patients of congestive heart failure includes controlling excess fluid accumulation, improving cardiac function, and reducing cardiac workload.

Question 14

Which of the following mechanisms are not associated with development of cor pulmonale?

Accepted Answer

Cor pulmonale is not caused by pulmonary plethora; it is caused by pulmonary vasoconstriction, anatomic changes in vascularization, increased blood viscosity, and idiopathic or primary pulmonary hypertension.

Question 15

Which of the following is synonymous with metabolic syndrome?

Accepted Answer

Metabolic syndrome is also known as syndrome X, and occasionally as cardiometabolic syndrome.

Question 16

A patient presenting with high blood glucose and high triglyceride level was diagnosed as having metabolic syndrome. Which of the following are risk factors for the development of metabolic syndrome?

Accepted Answer

The 5 risk factors associated with metabolic syndrome include a large waistline, high normal triglyceride levels, low high density lipoprotein cholesterol, hypertension, and hyperglycemia.

Question 17

A 45-year-old male patient has waist circumference of 105 cm. His blood examination shows fasting plasma glucose of 120mg/dL, triglyceride level of 180 mg/dL, and high-density lipid cholesterol 30 of mg/dL. He has been diagnosed as having metabolic syndrome. He is at risk of developing which of the following set of conditions?

Accepted Answer

This patient is at risk for 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.

Question 18

A hypertensive patient who has elevated serum cholesterol wants to get screened for endothelial dysfunction. Which of the following methods can be used for diagnostic screening of endothelial dysfunction?

Accepted Answer

Diagnostic screening for endothelial dysfunction is typically done using iontophoresis with acetylcholine, and intra-venous administration of vasoactive agents. Another more invasive approach is intracoronary catheterization, but it is not often performed due to increased risk of complications.

Question 19

An obese adult female presents to the outpatient clinic. The attending nurse records her blood pressure as 136/ 86 mm Hg. According to The 2003 National Heart, Lung, and Blood Institute (NHLBI) guidelines, this patient will fall into which of the following categories?

Accepted Answer

This patient would be considered to have prehypertension.
The 2003 National Heart, Lung, and Blood Institute (NHLBI) guidelines divide blood pressure into 4 general categories for adults that include the following:
• The first category is normal blood pressure: a blood pressure below 120/80 mmHg.
• The secondary category is called prehypertension: a systolic blood pressure ranging from 120 to 139 and diastolic blood pressure ranging from 80 to 89.
• The third category is referred to as stage 1 hypertension: a systolic blood pressure ranging from 140 to 159 and/or a diastolic blood pressure ranging from 90 to 99.
. The fourth category is stage 2 hypertension: this is called severe hypertension, a systolic blood pressure above 160 and/or a diastolic blood pressure above100.

Question 20

A patient suffers an acute myocardial infarction. Which of the following cells are not expected to be present in pathological examination of the myocardial tissue 7 days after the infarction?

Accepted Answer

Neutrophil will likely not be present in the pathological examination of the myocardial tissue.

Quiz 2: Problems