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Cardiovascular

Terms in this set (48)

What is the initiating event that leads to the development of atherosclerosis?
a. Release of the inflammatory cytokines
b. Macrophages adhere to vessel walls.
c. Injury to the endothelial cells that line the artery walls
d. Release of the platelet-deprived growth factor
ANS: C
Atherosclerosis begins with an injury to the endothelial cells that line the arterial walls. Possible causes of endothelial injury include the common risk factors for atherosclerosis, such as smoking, hypertension, diabetes, increased levels of low-density lipoprotein, decreased levels of high-density lipoprotein, and autoimmunity. The remaining options occur only after the endothelial cells are injured.
What is the effect of oxidized low-density lipoproteins (LDLs) in atherosclerosis?
a. LDLs cause smooth muscle proliferation.
b. LDLs cause regression of atherosclerotic plaques.
c. LDLs increase levels of inflammatory cytokines.
d. LDLs direct macrophages to the site in the endothelium
ANS: A
LDLs are toxic to endothelial cells' cause smooth muscle proliferation' and activate further immune and inflammatory responses. This selection is the only option that accurately identifies the effects of LDLs.
Which inflammatory cytokines are released when endothelial cells are injured?
a. Granulocyte-macrophage colony-stimulating factor (GM-CFS)
b. Interferon-beta (IFN-β), interleukin 6 (IL-6) and granulocyte colony-stimulating factor (G-CFS)
c. Tumor necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ), and interleukin 1 (IL-1)
d. Interferon-alpha (IFN-α), interleukin-12 (IL-12), and macrophage colony-stimulating factor (M-CSF)
ANS: C
Numerous inflammatory cytokines are released, including TNF-α, IFN-γ, IL-1, toxic oxygen radicals, and heat shock proteins. This selection is the only option that accurately identifies which inflammatory cytokines are associated with endothelial cell injury.
When endothelial cells are injured, what alteration contributes to atherosclerosis?
a. The release of toxic oxygen radicals that oxidize low-density lipoproteins (LDLs).
b. Cells are unable to make the normal amount of vasodilating cytokines.
c. Cells produce an increased amount of antithrombotic cytokines.
d. Cells develop a hypersensitivity to homocysteine and lipids.
ANS: B
Injured endothelial cells become inflamed and cannot make normal amounts of antithromboticand vasodilating cytokines. This selection is the only option that accurately identifies the factor that contributes to atherosclerosis.
Which factor is responsible for the hypertrophy of the myocardium associated with hypertension?
a. Increased norepinephrine
b. Adducin
c. Angiotensin II
d. Insulin resistance
ANS: C
Of the available options' only angiotensin II is responsible for the hypertrophy of the myocardium and much of the renal damage associated with hypertension.
What pathologic change occurs to the kidney's glomeruli as a result of hypertension?
a. Compression of the renal tubules
b. Ischemia of the tubule
c. Increased pressure from within the tubule
d. Obstruction of the renal tubule
ANS: B
In the kidney, vasoconstriction and resultant decreased renal perfusion cause tubular ischemia and preglomerular arteriopathy. This selection is the only option that accurately identifies the pathologic change to the kidney that occurs as a result of hypertension.
What effect does atherosclerosis have on the development of an aneurysm?
a. Atherosclerosis causes ischemia of the intima.
b. It increases nitric oxide.
c. Atherosclerosis erodes the vessel wall.
d. It obstructs the vessel.
ANS: C
Atherosclerosis is a common cause of aneurysms because pla5ue formation erodes the vessel wall. This selection is the only option that accurately identifies the effect that atherosclerosis has on aneurysm development.
Regarding the endothelium, what is the difference between healthy vessel walls and those that promote clot formation?
a. Inflammation and roughening of the endothelium of the artery are present.
b. Hypertrophy and vasoconstriction of the endothelium of the artery are present
c. Excessive clot formation and lipid accumulation in the endothelium of the artery are present.
d. Evidence of age-related changes that weaken the endothelium of the artery are present.
ANS: A
Invasion of the tunica intima by an infectious agent also roughens the normally smooth lining of the artery, causing platelets to adhere readily. This selection is the only option that accurately describes the mechanism that supports abnormal clot formation.
What is the usual source of pulmonary emboli?
a. Deep venous thrombosis
b. Endocarditis
c. Valvular disease
d. Left heart failure
ANS: A
Pulmonary emboli originate in the venous circulation (mostly from the deep veins of the legs) or in the right heart. This selection is the only option that accurately identifies the usual source of pulmonary emboli.
Which factor can trigger an immune response in the bloodstream that may result in an embolus?
a. Amniotic fluid
b. Fat
c. Bacteria
d. Air
Ans: A
Of the options available, only amniotic fluid displaces blood, thereby reducing oxygen, nutrients, and waste exchange; however, it also introduces antigens, cells, and protein aggregates that trigger inflammation, coagulation, and the immune response in the bloodstream.
Which statement best describes thromboangiitis obliterans (Buerger disease)?
a. Inflammatory disorder of small and medium-size arteries in the feet and sometimes in the hands
b. Vasospastic disorder of the small arteries and arterioles of the fingers and, less commonly, of the toes
c. Autoimmune disorder of the large arteries and veins of the upper and lower extremities
d. Neoplastic disorder of the lining of the arteries and veins of the upper extremities
ANS: A
Buerger disease is an inflammatory disease of the peripheral arteries. Inflammation' thrombus formation, and vasospasm can eventually occlude and obliterate portions of small and medium-size arteries. The digital, tibial, and plantar arteries of the feet and the digital, palmar, and ulnar arteries of the hands are typically affected. This selection is the only option that accurately describes Buerger disease.
Which statement best describes Raynaud disease?
a. Inflammatory disorder of small and medium-size arteries in the feet and sometimes in the hands
b. Neoplastic disorder of the lining of the arteries and veins of the upper extremities
c. Vasospastic disorder of the small arteries and arterioles of the fingers and, less commonly, of the toes
d. Autoimmune disorder of the large arteries and veins of the upper and lower extremities
ANS: C
Attacks of vasospasm in the small arteries and arterioles of the fingers and, less commonly, of the toes characterize Raynaud phenomenon and Raynaud disease and is the only option that accurately describes this disease.
What change in a vein supports the development of varicose veins?
a. Increase in osmotic pressure
b. Damage to the valves in veins
c. Damage to the venous endothelium
d. Increase in hydrostatic pressure
ANS: B
If a valve is damaged, permitting backflow, then a section of the vein is subjected to the pressure exerted by a larger volume of blood under the influence of gravity. The vein swells as it becomes engorged, and the surrounding tissue becomes edematous because increased hydrostatic pressure pushes plasma through the stretched vessel wall.
Superior vena cava syndrome is a result of a progressive increase of which process?
a. Inflammation
b. Occlusion
c. Distention
d. Sclerosis
ANS: B
Superior vena cava syndrome (SVCS) is a progressive occlusion of the superior vena cava that leads to venous distention in the upper extremities and head. The remaining options are not associated with this disorder.
What term is used to identify when a cell is temporarily deprived of blood supply?
a. Infarction
b. Ischemia
c. Necrosis
d. Inflammation
ANS: B
Coronary artery disease (CAD) can diminish the myocardial blood supply until deprivation impairs myocardial metabolism enough to cause ischemia, a local state in which the cells are temporarily deprived of blood supply. This term is the only option that is used to identify a temporarily deprived blood supply.
The risk of developing coronary artery disease is increased up to threefold by which factor?
a. Diabetes mellitus
b. Hypertension
c. Obesity
d. High alcohol consumption
ANS: B
Hypertension is the only factor responsible for a twofold-to-threefold increased risk of atherosclerotic cardiovascular disease.
Which risk factor is associated with coronary artery disease (CAD) because of its relationship with the alteration of hepatic lipoprotein?
a. Diabetes mellitus
b. Hypertension
c. Obesity
d. High alcohol consumption
ANS: A
Of the available options, only diabetes mellitus is associated with CAD because of the resulting alteration of hepatic lipoprotein synthesis; it increases triglyceride levels and is involved in low-density lipoprotein oxidation
Nicotine increases atherosclerosis by the release of which neurotransmitter?
a. Histamine
b. Nitric oxide
c. Angiotensin II
d. Epinephrine
ANS: D
Nicotine stimulates the release of catecholamines (e.g., epinephrine, norepinephrine), which increases the heart rate and causes peripheral vascular constriction. As a result, blood pressure increases, as do both cardiac workload and oxygen demand. None of the other options are associated with this mechanism.
Which substance is manufactured by the liver and primarily contains cholesterol and protein?
a. Very low:density lipoproteins (VLDLs)
b. Low-density lipoproteins (LDLs)
c. High-density lipoproteins (HDLs)
d. Triglycerides
ANS: B
A series of chemical reactions in the liver results in the production of several lipoproteins that vary in density and function. These include VLDLs, primarily triglycerides and protein; LDLs, mostly cholesterol and protein; and HDLs, mainly phospholipids and protein. LDLs are the only lipoproteins that are manufactured by the liver and primarily contain cholesterol and protein.
Which elevated value may be protective of the development of atherosclerosis?
a. Very low:density lipoproteins (VLDLs)
b. Low-density lipoproteins (LDLs)
c. High-density lipoproteins (HDLs)
d. Triglycerides
ANS: C
Low levels of HDL cholesterol are also a strong indicator of coronary risk, whereas high levels of HDLs may be more protective for the development of atherosclerosis than low levels of LDLs. Neither VLDLs nor elevated triglycerides are associated with a protective mechanism.
Which laboratory test is an indirect measure of atherosclerotic plaque?
a. Homocysteine
b. Low-density lipoprotein
c. Erythrocyte sedimentation rate (ESR)
d. C-reactive protein (CRP)
ANS: D
Highly sensitive CRP (hs-CRP) is an acute phase reactant or protein mostly synthesized in the liver and, of the available options, is an indirect measure of atherosclerotic plaque-related inflammation.
Cardiac cells can withstand ischemic conditions and still return to a viable state for how many minutes?
a. 10
b. 15
c. 20
d. 25
ANS: C
Cardiac cells remain viable for approximately 20 minutes under ischemic conditions. If blood flow is restored, then aerobic metabolism resumes, contractility is restored, and cellular repair begins. If the coronary artery occlusion persists beyond 20 minutes, then myocardial infarction (MI) occurs.
Which form of angina occurs most often during sleep as a result of vasospasms of one or more coronary arteries?
a. Unstable
b. Stable
c. Silent
d. Prinzmetal
ANS: D
Of the options available, only Prinzmetal angina (also called variant angina) is chest pain attributable to transient ischemia of the myocardium that occurs unpredictably and almost exclusively at rest.
When is the scar tissue that is formed after a myocardial infarction (MI+ most vulnerable to injury?
a. Between 5 and 9 days
b. Between 10 and 14 days
c. Between 15 and 20 days
d. Between 20 and 30 days
ANS: B
During the recovery period (10 to 14 days after infarction), individuals feel more capable of increasing activities and thus may stress the newly formed scar tissue. After 6 weeks, the necrotic area is completely replaced by scar tissue, which is strong but unable to contract and relax like healthy myocardial tissue.
An individual who is demonstrating elevated levels of troponin, creatine kinase-isoenzyme MB (CK-MB) and lactic dehydrogenase (LDH) is exhibiting indicators associated with which condition?
a. Myocardial ischemia
b. Hypertension
c. Myocardial infarction (MI)
d. Coronary artery disease (CAD)
ANS: C
Cardiac troponins (troponin I and troponin T) are the most specific indicators of MI. Other biomarkers released by myocardial cells include CK-MB and LDH but they are not associated with the other options.
What is the expected electrocardiogram (ECG) pattern when a thrombus in a coronary artery permanently lodges in the vessel and the infarction extends through the myocardium from the endocardium to the epicardium?
a. Prolonged QT interval
b. ST elevation myocardial infarction (STEMI)
c. ST depression myocardial infarction (STDMI)
d. Non-ST elevation myocardial infarction (non-STEMI)
ANS: B
Individuals with this pattern on an ECG usually have significant elevations in the ST segments and are categorized as having STEMI.
How does angiotensin II increase the workload of the heart after a myocardial infarction (MI)?
a. By increasing the peripheral vasoconstriction
b. By causing dysrhythmias as a result of hyperkalemia
c. By reducing the contractility of the myocardium
d. By stimulating the sympathetic nervous system
ANS: A
Angiotensin II is released during myocardial ischemia and contributes to the pathogenesis of a myocardial infarction (MI) in several ways. First, it results in the systemic effects of peripheral vasoconstriction and fluid retention. These homeostatic responses are counterproductive in that they increase myocardial work and thus exacerbate the effects of the loss of myocyte contractility. Angiotensin II is also locally released, where it is a growth factor for vascular smooth muscle cells, myocytes, and cardiac fibroblasts; promotes catecholamine release; and causes coronary artery spasm.
The pulsus paradoxus that occurs as a result of pericardial effusion is caused by a dysfunction in which mechanism?
a. Diastolic filling pressures of the right ventricle and reduction of blood volume in both ventricles
b. Blood ejected from the right atrium and reduction of blood volume in the right ventricle
c. Blood ejected from the left atrium and reduction of blood volume in the left ventricle
d. Diastolic filling pressures of the left ventricle and reduction of blood volume in all four heart chambers.
ANS: D
Pulsus paradoxus means that the arterial blood pressure during expiration exceeds arterial pressure during inspiration by more than 10 mm Hg. This clinical finding reflects impairment of diastolic filling of the left ventricle plus a reduction of blood volume within all four cardiac chambers.
A patient reports sudden onset of severe chest pain that radiates to the back and worsens with respiratory movement and when lying down. These clinical manifestations describe:
a. Myocardial infarction (MI)
b. Pericardial effusion
c. Restrictive pericarditis
d. Acute pericarditis
ANS: D
Most individuals with acute pericarditis describe several days of fever, myalgias, and malaise, followed by the sudden onset of severe chest pain that worsens with respiratory movements and with lying down. Although the pain may radiate to the back, it is generally felt in the anterior chest and may be initially confused with the pain of an acute MI. Individuals with acute pericarditis also may report dysphagia, restlessness, irritability, anxiety, and weakness.
Ventricular dilation and grossly impaired systolic function, leading to dilated heart failure, characterize which form of cardiomyopathy?
a. Congestive
b. Hypertrophic
c. Septal
d. Dystrophic
ANS: A
Only dilated cardiomyopathy (congestive cardiomyopathy) is characterized by ventricular dilation and grossly impaired systolic function, leading to dilated heart failure.
A disproportionate thickening of the interventricular septum is the hallmark of which form of cardiomyopathy?
a. Dystrophic
b. Hypertrophic
c. Restrictive
d. Dilated
ANS: B
Only hypertrophic cardiomyopathy is characterized by a thickening of the septal wall, which may cause outflow obstruction to the left ventricle outflow tract.
Amyloidosis, hemochromatosis, or glycogen storage disease usually causes which form of cardiomyopathy?
a. Infiltrative
b. Restrictive
c. Septal
d. Hypertrophic
ANS: B
Restrictive cardiomyopathy may occur idiopathically or as a cardiac manifestation of systemic diseases, such as scleroderma, amyloidosis, sarcoidosis, lymphoma, and hemochromatosis, or a number of inherited storage diseases. This characterization is not true of the other forms of cardiomyopathy.
Which condition is a cause of acquired aortic regurgitation?
a. Congenital malformation
b. Cardiac failure
c. Rheumatic fever
d. Coronary artery disease (CAD)
ANS: C
Rheumatic heart disease, bacterial endocarditis, syphilis, hypertension, connective tissue disorders (e.g., Marfan syndrome, ankylosing spondylitis), appetite suppressing medications, trauma, or atherosclerosis can cause acquired aortic regurgitation. This selection is the only available option that is known to cause acquired aortic regurgitation.
Which predominantly female valvular disorder is thought to have an autosomal dominant inheritance pattern, as well as being associated with connective tissue disease?
a. Mitral valve prolapse
b. Tricuspid stenosis
c. Tricuspid valve prolapse
d. Aortic insufficiency
ANS: A
Mitral valve prolapse tends to be most prevalent in young women. Studies suggest an autosomal dominant and X-linked inheritance pattern. Because mitral valve prolapse often is associated with other inherited connective tissue disorders (e.g., Marfan syndrome, Ehlers-Danlos syndrome, osteogenesis imperfecta), it is thought to result from a genetic or environmental disruption of valvular development during the fifth or sixth week of gestation.
Which disorder causes a transitory truncal rash that is nonpruritic and pink with erythematous macules that may fade in the center' making them appear as a ringworm?
a. Fat emboli
b. Rheumatic fever
c. Bacterial endocarditis
d. Myocarditis of acquired immunodeficiency syndrome
ANS: B
Erythema marginatum is a distinctive truncal rash that often accompanies acute rheumatic fever. It consists of nonpruritic, pink erythematous macules that never occur on the face or hands.
What is the most common cause of infective endocarditis?
a. Virus
b. Fungus
c. Bacterium
d. Rickettsiae
ANS: C
Infective endocarditis is a general term used to describe infection and inflammation of the endocardiumGespecially the cardiac valves. Bacteria are the most common cause of infective endocarditis, especially streptococci, staphylococci, or enterococci.
What is the most common cardiac disorder associated with acquired immunodeficiency syndrome (AIDS)?
a. Cardiomyopathy
b. Myocarditis
c. Left heart failure
d. Heart block
ANS: C
Pericardial effusion and left heart failure are the most common complications of human immunodeficiency virus (HIV) infection. Other conditions include cardiomyopathy, myocarditis, tuberculous pericarditis, infective and nonbacterial endocarditis, heart block, pulmonary hypertension, and nonantiretroviral drug-related cardiotoxicity.
A patient is diagnosed with pulmonary disease and elevated pulmonary vascular resistance. Which form of heart failure may result from pulmonary disease and elevated pulmonary vascular resistance?
a. Right heart failure
b. Left heart failure
c. Low-output failure
d. High-output failure
ANS: A
Right heart failure is defined as the inability of the right ventricle to provide adequate blood flow into the pulmonary circulation at a normal central venous pressure. This condition is often a result of pulmonary disease and the resulting elevated pulmonary vascular resistance.
What cardiac pathologic condition contributes to ventricular remodeling?
a. Left ventricular hypertrophy
b. Right ventricular failure
c. Myocardial ischemia
d. Contractile dysfunction
ANS: C
Of the options available, myocardial ischemia contributes to inflammatory, immune, and neurohumoral changes that mediate a process called ventricular remodeling.
In systolic heart failure, what effect does the renin-angiotensin-aldosterone system (RAAS) have on stroke volume?
a. Increases preload and decreases afterload.
b. Increases preload and increases afterload.
c. Decreases preload and increases afterload.
d. Decreases preload and decreases afterload.
ANS: B
Activation of the RAAS not only causes an increase in preload and afterload, but it also causes direct toxicity to the myocardium. This selection is the only option that accurately identifies the effect that the RAAS has on stroke volume in this situation.
What is the cause of the dyspnea resulting from a thoracic aneurysm?
a. Pressure on surrounding organs
b. Poor oxygenation
c. Formation of atherosclerotic lesions
d. Impaired blood flow
ANS: A
Clinical manifestations depend on the location of the aneurysm. Pressure of a thoracic aneurysm on surrounding organs cause symptoms of dysphagia (difficulty in swallowing) and dyspnea (breathlessness).
Which statement is true concerning the cells' ability to synthesize cholesterol?
a. Cell production of cholesterol is affected by the aging process.
b. Cells produce cholesterol only when dietary fat intake is low.
c. Most body cells are capable of producing cholesterol.
d. Most cholesterol produced by the cells is converted to the low-density form.
ANS: C
Although cholesterol can easily be obtained from dietary fat intake, most body cells can also manufacture cholesterol.
What is the trigger for angina pectoris?
a. Atherosclerotic lesions
b. Hyperlipidemia
c. Myocardial necrosis
d. Myocardial ischemia
ANS: D
Angina pectoris is chest pain caused by myocardial ischemia. None of the other options are considered triggers for angina pectoris
Individuals being effectively managed for type 2 diabetes mellitus often experience a healthy decline in blood pressure as a result of what intervention?
a. Managed carbohydrate intake
b. Appropriate exercise
c. Insulin-sensitivity medication therapy
d. Introduction of minimal doses of insulin
ANS: C
Many people with type 2 diabetes mellitus, who are treated with drugs that increase insulin sensitivity, experience a decline in their blood pressure without taking antihypertensive drugs. Although the other medications may be included in the management plan, the other options are not associated with a decrease in hypertension.
Which statements are true regarding fatty streaks?
(Select all that apply.)
a. Fatty streaks progressively damage vessel walls.
b. Fatty streaks are capable of producing toxic oxygen radials.
c. When present, inflammatory changes occur to the vessel walls.
d. Oxidized low-density lipoproteins (LDLs) are involved in their formation.
e. Fatty streaks are formed by killer T cells filled with oxidized LDLs
ANS: A, B, C, D
The oxidized LDLs penetrate the intima of the arterial wall and are engulfed by macrophages. Macrophages filled with oxidized LDLs are called foam cells. Once these lipid-laden foam cells accumulate in significant amounts, they form a lesion called a fatty streak. Once formed, fatty streaks produce more toxic oxygen radicals and cause immunologic and inflammatory changes, resulting in progressive damage to the vessel wall.
What factors contribute to the development of orthostatic hypotension? (Select all that apply.)
a. Altered body chemistry
b. Drug action of certain antihypertensive agents
c. Prolonged immobility
d. Effects of aging on postural refle3es
e. Any condition that produces volume overload
ANS: A, B, C, D
Orthostatic hypotension may be acute or chronic. Acute orthostatic hypotension (temporary type) may result from (1) altered body chemistry, (2) drug action (e.g., antihypertensives, antidepressants), (3) prolonged immobility caused by illness, (4) starvation, (5) physical exhaustion, (6) any condition that produces volume depletion (e.g., massive diuresis, potassium or sodium depletion), and (7) venous pooling (e.g., pregnancy, extensive varicosities of the lower extremities). Older adults are susceptible to this type of orthostatic hypotension, in which postural reflexes are slowed as part of the aging process
Which assessment findings are clinical manifestations of aortic stenosis? (Select all that apply.)
a. Jugular vein distention
b. Bounding pulses
c. Hypotension
d. Angina
e. Syncope
ANS: D, E
The classic manifestations of aortic stenosis are angina, syncope, and heart failure. None of the other options are associated with aortic stenosis.
Which risk factors are associated with infective endocarditis? (Select all that apply.)
a. Rheumatic fever
b. Intravenous drug use
c. Long-term indwelling catheterization
d. Aortic regurgitation
e. Heart valve disease
ANS: B, C, E
Risk factors for infective endocarditis include acquired valvular heart disease, intravenous drug abuse, long-term indwelling catheterization (e.g., for pressure monitoring, hyperalimentation, or hemodialysis), and recent cardiac surgery. Neither rheumatic fever nor aortic regurgitation is considered a risk factor for infective endocarditis.
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