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Cardiovascular ARS Questions

Terms in this set (38)

Q1 slide 9
A 7-year-old girl with the flu presents with chest pain that intensifies with deep breathing and coughing. When listening to her heart, the clinician hears a pericardial rub, and all of the girl's heart sounds are muffled. She is diagnosed with cardiac tamponade as excessive fluid has accumulated in the pericardial space. Identify the most likely problem associated with this condition.
a) Diastolic Murmur with regurgitation
b) Systolic Murmur with stenosis
c) Impaired Ventricular filling during diastole
d) Systolic Murmur with Regurgitation
e) Impaired Ventricular filling during systole
c) Impaired Ventricular Filling During Diastole
A 16-year-old presents to the emergency department after having been stabbed. The penetrating wound is adjacent to the sternum in the left 4th intercostal space. Identify the structure most likely injured due to this wound.
a) Left Atrium
b) Right Ventricle
c) Left Upper lobe of Lung
d) Right Atrium
e) Left Ventricle
b) Right Ventricle
A 63-year-old man with a history of heart disease undergoes coronary catheter angiography to test the patency of his anterior interventricular artery. Into which vessel opening will the contrast most likely be injected?
a) Left circumflex artery
b) Left coronary Artery
c) Coronary Sinus
d) Right Coronary Artery
e) Right Obtuse Artery
b) Left coronary Artery
During the physical exam of a 41-year-old woman, a systolic murmur is auscultated in the left 4th intercostal space in the midclavicular line. Identify the most likely cause of her murmur.
a) Mitral Valve Murmur
b) Tricuspid Valve Murmur
c) Aortic Semilunar Valve Mumur
d) Pulmonary Semilunar Valve Mumur
e) Patent Ductus Arteriosus
a) Mitral Valve Murmur
Aortic coarctation is defined as a congenital narrowing of the aortic arch lumen that causes a variable degree of obstruction to normal blood flow. Which of the following conditions would likely occur in a patient with aortic coarctation?
a) Left atrium hypertrophies
b) Left ventricle hypertrophies
c) Right atrium hypertrophies
d) Right ventricle hypertrophies
b) Left ventricle hypertrophies
Identify the event of the cardiac cycle that most likely causes the atrioventricular (AV) valves to close.
a) Ventricular Ejection
b) Ventricular Isovolumetric Contraction
c) Atrial Systole
d) Ventriclar Isovolumetric Relaxation
b) Ventricular Isovolumetric Contraction
A 62-year-old man has a small myocardial infarction involving the septum of the right atrium inferiorly and posteriorly near the ostium of the coronary sinus. Because of the location of the infarct, this patient will most likely:
a) Be free of any conduction defects
b) Have damage to the SA node
c) Develop AV block
d) Develop Mitral Regurgitation
e) Suffer Cardiac Arrest
c) Develop AV block
A 58-year-old man complains of dysphagia (difficulty swallowing). Imaging reveals that the anterior wall of his esophagus in the midthorax region is compressed. Identify the structure most likely responsible for his dysphagia.
a) Right Atrium
b) Left Ventricle
c) Pulmonary Trunk
d) Right Ventricle
e) Left Atrium
e) Left Atrium
A 71-year-old man presents with angina and pain radiating down his left arm. Radiographic imaging reveals close to complete blockage of his left anterior descending artery (LAD). Identify the region of this patient's heart that is most likely susceptible to ischemic damage.
a) Posterior Interventricular Septum
b) Left Atrium
c) Anterior Interventricular Septum
d) Right Atrium
e) Left Marginal Artery
c) Anterior Interventricular Septum
Mönckeberg arteriolosclerosis is most likely to affect which of the following vessels?
a) Descending thoracic Aorta
b) Right main Pulmonary Artery
c) Left Femoral Artery
d) Alveolar Septal Capillaries
e) Left Anterior Descending Coronary Artery
e) Left Anterior Descending Coronary Artery
Which of the following blood vessel layers is acellular?
a) Endothelium
b) Intima
c) Media
d) External elastic Lamina
e) Adventitia
d) External elastic Lamina
Theoretically, the best approach to preventing complications of atherosclerotic disease would keep which stage of the process from progressing?
a) Fatty Streak
b) Advanced Plaque
c) Fibrofatty Plaque
d) Monckeberg Arteriolosclerosis
e) Anrurysm
a) Fatty Streak
Which of the following is NOT made by cholesterol?
a) Steroid Hormones
b) Bile Acids
c) Triglycerides
d) Vitamin D
c) Triglycerides
This layer is composed of:
a) Cholesterol
b) Bile Salts
c) Plantsterols
d) Chylomicrons
d) Chylomicrons
Chylomicrons are......
a) The smallest lipoprotein
b) Composed of dietary TG and cholesterol
c) Composed of endogenous TG and cholesterol
d) Hydrolyzed by apoB-48
b) Composed of dietary TG and cholesterol
Which of the following is true about VLDL?
a) They are the smallest lipoprotein
b) Its TG content is hydrolyzed by apoC-II
c) MTP helps package TG into its core
d) Its major apoliprotein is ApoB-48
c) MTP helps package TG into its core
What occurs when PCSK9 binds to the LDL receptor?
a) More LDL receptors get recycled to the cell surface
b) LDL receptor degradation is inhibited
c) Plasma levels of LDL are increased
d) PCSK9 does not bind the LDL receptor
c) Plasma levels of LDL are increased
What is the major apolipoprotein found on high density lipoproteins (HDL)?
a) Apolipoprotein A-I
b) Apolipoprotein A-II
c) Apolipoprotein B-100
d) Apolipoprotein E
a) Apolipoprotein A-I
Which of the following happens when cellular cholesterol levels are high?
a) Increased HMG-CoA reductase activity
b) Migration of SREBP to the nucleus
c) Increased LDL receptor expression at the cell surface
d) Increased ACAT activity
d) Increased ACAT activity
What is the major way that explains how statins decrease plasma cholesterol?
a) Decrease synthesis of LDL receptors
b) Increase synthesis of LDL receptors
c) Decrease synthesis of cholesterol
d) Inhibit HMG CoA Reductase
b) Increase synthesis of LDL receptors
Which of the following is not part of the pathway that explains how inhibition of HMG CoA reductase increases LDL receptor number?
a) Sterol Regulatory Element Binding Protein (SREBP)
b) Cholesterol-Sensing Protein- SREBP cleavage activating protein (SCAP)
c) Cholesterol Ester Transfer Protein (CETP)_
d) Site-1 Protease (S1P) and site-2 protease (S2P)
c) Cholesterol Ester Transfer Protein (CETP)
T/F: Blocking cholesterol synthesis in the liver with statins is likely to produce major adverse effects due to inhibition of cholesterol synthesis throughout the body
a) True
b) False
b) False
Which of the following is associated with an increased risk of myopathy in patient taking atorvastatin to lower cholesterol?
a) Co-administration with CYP-450 inhibitor
b) Female Sex
c) Advanced age
d) Genetic variation in transporter for hepatic uptake of statins
e) Increased dosage
f) Co-administration of fibrate, niacin
g) Taking drug with large amounts of grapefruit juice
h) All of the above
h) All of the above
Which compound listed is absolutely necessary for synthesis of bile acids?
a) Vitamin D
b) Pregnenolone
c) Cholesterol
d) Deoxycholic Acid
e) All of the above
c) Cholesterol
How does blockade of cholesterol absorption decrease plasma LDL cholesterol?
a) LDL receptor numbers increase resulting in increased uptake of LDL from circulation
b) Compensatory increase in hepatic lipase
c) Chylomicrons means less circulating LDL because chylomicrons are converted into VLDL
a) LDL receptor numbers increase resulting in increased uptake of LDL from circulation
All of the following are true about niacin except:
a) Dose used for lipid-lowering is similar to dose used as vitamin
b) Prostaglandins likely contribute to adverse effect of flushing
c) Mechanism unclear but acts to lower TG and LDL
d) Increase in HDL is an added benefit
e) Decrease in Lp(a) is added benefit
a) Dose used for lipid-lowering is similar to dose used as vitamin
Which drug or drugs are typically used alone for the treatment of hypercholesterolmia?
a) Cholestryramine
b) Mipomersen
c) Ezetimibe
d) Alirocumab
e) Omega 3 FAs
f) Fenofibrate
g) Simvastatin
h) Niacin
I) Lomitapide
k) Atorvastatin
g) Simvastatin
k) Atorvastatin
Name a drug that would be most effective in a patient with low HDL.
a) Simvasatin
b) Gemfibrozil
c) Niacin
d) Cholestryamine
c) Niacin
Which drug should be avoided in a patient with both elevated LDL-C and TG?
a) Simvasatin
b) Gemfibrozil
c) Niacin
d) Cholestyramine
d) Cholestyramine
Which of the following drugs may increase risk of myopathy when co-administered with a statin?
a) Ezetimibe
b) Gemfibrozil
c) Niacin
d) All of the above
d) All of the above
Which of the following profiles would you like to have?
a) LDL 220; HDL 85
b) LDL 160; HDL 65
c) LDL 100; HDL 25
a) LDL 220; HDL 85
24 y/o F with PCOS foes to an MD w/ c/o irregular menstrual cycles. The MD starts her on combined estrogen - progesterone OCP to help normalize her cycles. Which of the components in her lipid panel can be affected with this medication
a) HDL
b) LDL
c) TGs
d) Total Cholesterol
c) TGs
Eruptive xanthomas are seen in patients with:
a) High LDL
b) Low HDL
c) High TGs
d) High HDL cholesterol
c) High TGs
In which of the following situations will you not recommend treatment with a cholesterol medication?
a) A 40 y/o M with MI 2 years ago
b) A 60 y/o M with diabetes and LDL cholesterol of 140
c) 55 y/o healthy female with LDL cholesterol of 200 mg/dL
d) 40 y/o healthy male with LDL cholesterol of 130 mg/dL
d) 40 y/o healthy male with LDL cholesterol of 130 mg/dL
Which of the following patients has metabolic syndrome?
a) 23 y/o healthy F with waist circumference 37 in, Fasting BS 88, HDL 53, TG 130
b) 40 y/o healthy M with waist circumference 37 inches, fasting BS 110, HDL 38, TG 160
c) 65 y/o F w/ hypertension, waist circumference 35 in, fasting BS 90 HDL 60, TG 80
d) 70 y/o M w/ diabetes, waist circumference 38 in, HDL 45, TG 140
b) 40 y/o healthy M with waist circumference 37 inches, fasting BS 110, HDL 38, TG 160
High LDL, Low HDL, High Total Cholesterol and High TGs can be seen in all of the following conditions except:
a) Familial combined hyperlipidemia
b) Hypothyroidism
c) Diabetes
d) Anabolic steroids abuse
d) Anabolic steroids abuse

Anabolic steroids do not cause high TG levels
Which of the following cholesterol medications would you use for a 65 y/o M with a recent heart attack combined with the lipid panel below?
Total cholesterol: 180 HDL: 44 TG: 150 LDL: 106
a) Niacin
b) Ezetimibe
c) Statin
d) Colestipol
c) Statin
How do PCSK9 inhibitors work?
a) By competitive Inhibition of the LDL receptors
b) By preventing degradation of LDL receptors
c) By increasing uptake of cholesterol by LDL receptors
d) By inhibiting cholesterol synthesis
b) By preventing degradation of LDL receptors
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