Question 1

A patient presents with complaints of shortness of breath, palpitations, and pink, frothy sputum. The chest x-ray suggests pulmonary edema. What are the characteristic features of pulmonary edema?

Accepted Answer

Decreased cardiac output, inadequate tissue perfusion, and acute pulmonary congestion are characteristic of pulmonary edema.

Question 2

Which of the following are non-cardiac causes of pulmonary edema?

Accepted Answer

Non-cardiac causes and risk factors for pulmonary edema include lung infections, exposure to certain toxins such as chlorine, ammonia and nitrogen dioxide, adverse reaction to chemotherapy drugs, and high altitude. Other causes include kidney disease, smoke inhalation, adverse reaction to illicit drugs, and acute respiratory syndrome.

Question 3

A patient presents with shortness of breath, rapid heart rate, and cyanosis. On auscultation, pulmonary crackles were heard. Which of the following invasive methods may be used to confirm a diagnosis of pulmonary edema?

Accepted Answer

Pulmonary artery catheterization is an invasive approach that can be used to diagnose pulmonary edema. It measures the pressure in the pulmonary vasculature.

Question 4

Which heart block may be an incidental finding in asymptomatic individuals and is not associated with an increase in mortality and morbidity?

Accepted Answer

First-degree heart block is not associated with an increase in morbidity and mortality; the other heart blocks are. First-degree heart block is defined as a delay in conduction of impulses from the sinoatrial (SA) node to the atrioventricular (AV) node. The condition is typically asymptomatic and undiagnosed. It can occur in individuals of all ages.

Question 5

A patient who has hypertension is noted to have developed first degree heart block; the PR interval is 22 milliseconds. Which of the following drugs would be most likely to cause this EKG finding?

Accepted Answer

Beta blockers can cause first-degree heart block. Other drugs that can cause first AV block include digoxin, and calcium channel blockers such as nifedipine, amlodipine, verapamil, and diltiazem.

Question 6

A healthy person comes for a routine checkup. The nurse records an EKG, and the patient asks if the EKG is normal. Which of the following EKG findings would be considered a normal variant?

Accepted Answer

First-degree heart block is characterized by prolonged PR interval (greater than 20 milliseconds), but this can be a normal variant in some individuals. The other EKG findings indicate a serious cardiac condition.

Question 7

A patient presents with complaints of dizziness, lightheadedness and a syncopal episode. The nurse record his pulse rate as 40/minute and blood pressure as 90/70 mm Hg. His EKG findings are suggestive of second-degree, type II AV block. What should be the goal of treatment in this patient?

Accepted Answer

Treatment of second-degree atrioventricular block type II varies on the extent and degree of the condition and the presence of other comorbid cardiovascular conditions, but the basic goal of treatment is to restore sinus rhythm and maintain cardiac output.

Question 8

Which of the following treatments is considered the standard for care of a patient who has second-degree AV block type II?

Accepted Answer

Atropine sulphate may be used to treat second-degree AV block type II until a pacemaker is available, but pacemaker placement is considered standard care. If the patient is hemodynamically unstable, , isoproterenol and dopamine may be used until a pacemaker is placed.

Question 9

Which of the following statements correctly describes the conduction defect that causes third-degree AV block?

Accepted Answer

Third-degree atrioventricular block, also known as complete heart block, involves complete dissociation of impulses between atria and ventricles.

Question 10

Which of the following sentences is not true about first-degree heart block?

Accepted Answer

Individuals with first-degree AV block seldom have symptoms. Diagnosis is typically made during routine physical examination or when being examined for another complaint. First- degree AV block is rare in young adults, but relatively common in athletes. The condition is more prevalent in African Americans than in Caucasian Americans, and the incidence of the condition increases with advancing age and among people who have cardiovascular disease.

Question 11

Which of the following sentences correctly describes the EKG findings of second-degree AV block, Wenckebach?

Accepted Answer

Second-degree atrioventricular block type I, also known as Wenckebach or Mobitz I, is characterized by progressive lengthening of the PR interval followed by a P wave without an associated QRS complex.

Question 12

Which of the following is the most common cause of mortality in patients who have had a myocardial infarction?

Accepted Answer

Cardiogenic shock is the most common cause of mortality in patients who have had a myocardial infarction.

Question 13

Which of the following would be considered to be inotropic drugs?

Accepted Answer

Digoxin, dopamine, and milrinone are inotropic drugs. Inotropic drugs increase the force of cardiac contraction and increase cardiac output. Other inotropic drugs are cardiac glycosides such as digitalis and digitoxin, phosphodiesterase inhibitors such as amrinone and milrinone, and sympathomimetics such as dobutamine, isoproterenol, metaraminol, epinephrine, and norepinephrine.

Question 14

Which of the following diuretics is not correctly matched with its drug classification?

Accepted Answer

Loop diuretics inhibit sodium and chloride reabsorption in the loop of Henle. The loop diuretics include furosemide, ethacrynic acid, and bumetanide. There are also osmotic diuretics (e.g., mannitol), potassium-sparing diuretics (e.g., spironolactone, triamterene), and thiazide diuretics (e.g., hydrochlorothiazide, chlorothiazide).

Question 15

Which of the following is not an inotropic drug?

Accepted Answer

Calcium channel blockers are not inotropic drugs. They inhibit the movement of calcium into the myocardial cells. This results in decreased force of cardiac contraction and decreased cardiac conduction. Inotropic drugs increase the force of cardiac contraction. Inotropic drugs include cardiac glycosides, phosphodiesterase inhibitors, and sympathomimetics.

Question 16

Which of the following statements correctly describes the mechanism of action of diuretics?

Accepted Answer

Diuretics prevent reabsorption of sodium in the kidneys. Each class of diuretic has a different mechanism of action and works on a different part of the nephron.

Question 17

Alpha-adrenergic antagonists are used in the treatment of which of the following conditions?

Accepted Answer

Alpha-adrenergic antagonists are used to treat hypertension, pheochromocytoma, and extravasation of tissue-toxic drugs. Alpha-adrenergic antagonists decrease vascular tone, cause vasodilation, and decrease blood pressure.

Question 18

Surgical procedures involving division of common atrioventricular valve + closure of ASD and VSD + creation of separate tricuspid and mitral valve are performed for which of the following congenital heart diseases?

Accepted Answer

Endocardial cushion defects (AV canal)
• Defects resulting from deficiency of atrioventricular septum (common in Trisomy 21)
• Indications for surgery: should be repaired by age 6 months to prevent development of pulmonary hypertension
Surgical procedures: division of common atrioventricular valve + closure of ASD and VSD + creation of separate tricuspid and mitral valve

Question 19

Which of the following defects are present in tetralogy of Fallot?

Accepted Answer

The defects of tetralogy of Fallot are hypoplasia of the right ventricular infundibulum producing a large VSD, overriding aorta, pulmonary stenosis, and RVH

Question 20

Which of the following surgical corrections is not part of corrective surgery done for tetralogy of Fallot?

Accepted Answer

Aortic valve repair is not part of the surgical correction of tetralogy of Fallot. Surgical procedures done for tetralogy of Fallot include pulmonary valvotomy or pericardial patch enlargement of RV outflow tract, RV-PA valve homograft conduit, and closure of VSD with Dacron patch.

Quiz 2: Problems