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PCCN Cardiac Questions

Terms in this set (117)

Which of the following is the outermost lining of the heart?
A. Endocardium
B. Myocardium
C. Transcardium
D. Pericardium
D. Pericardium
"Endo" meaning "within" is associated with the innermost lining of the heart, so eliminate A. The myocardium is associated with the heart's middle layer, so eliminate option B. The "transcardium" is somewhat of a contrived term, so eliminate C as well. The prefix in pericardium, "peri" means "outside". Option D is the best answer.
Which of the following statements regarding the coronary sinus is correct?
A. It provides arterial blood flow to the lateral LV wall
B. It provides arterial blood flow to the sinus node
C. It is the main venous drainage vessel of the heart
D. It stimulates secretion of the atrial natriuretic factor
C. It is the main venous drainage vessel of the heart
The lateral LV wall is supplied by the circumflex and the sinus node is supplied by the RCA, so eliminate options A and B. It is atrial distension that stimulates the secretion of atrial natriuretic factor, so eliminate D as well. The coronary sinus is best known as the main venous drainage vessel of the heart. C is the best answer.
Of the following four factors, three determine stroke volume. Identify the factor that does NOT affect stroke volume.
A. Preload
B. Afterload
C. Contractility
D. Capillary permeability
D. Capillary permeability
Options A, B. and C all influence stroke volume (i.e. the mLs of blood the LV ejects with each beat). Preload reflects the filling of the LV, afterload is associated with the resistance of LV ejection, and contractility impacts the strength of which that volume is ejected. Secondarily, capillary permeability may ultimately affect the mLs pumped by the LV with each beat, but the impact will be indirect. Choose D.
Which of the following are atrioventricular (AV) valves?
A. Mitral and tricuspid
B. Pulmonic and aortic
C. Mitral and aortic
D. Tricuspid and pulmonic
A. Mitral and tricuspid
This is a straight knowledge question. The mitral and tricuspid valves (Choice A) are called the AV valves because they separate the atriums and the ventricles. An easy way to remember these is to remember that L (left) and M (mitral) are close to one another in the alphabet and are on the left side of the heart. R (right) and T (tricuspid) are also close in the alphabet and are on the right side of the heart. The aortic and pulmonic valves (all mentioned in B, C, and D) are called the semilunar valves. Choose A.
Two circumstances may produce a systolic murmur. One exists when backward flow of blood (regurgitant flow) occurs through a valve that is normal closed during systole. The second exists when blood has difficulty getting past a valve (stenosis) that is normally easily opened. Which two situations may produce a systolic murmur?
A. Aortic stenosis and mitral regurgitation
B. Pulmonic regurgitation and tricuspid stenosis
C. Aortic and tricuspid stenosis
D. Pulmonic and mitral regurgitation
A. Aortic stenosis and mitral regurgitation
During ventricular systole, the semilunar valves (aortic and pulmonic) should be open and the AV (mitral and tricuspid) valves should be closed. Option A provides the only scenario where this should be occurring. A quick test-taking strategy would be to identify that both options C and D identify situations where both types of valves are in stenosis or regurgitation at the same time, allowing you to rule out C and D options quickly.
All of the following but one are considered key treatments in the management of HF. Which one is NOT a key treatment in HF?
A. Angiotensin-converting enzyme (ACE) inhibitors
B. Beta blockers
C. Diuretics
D. Nitroprusside
D. Nitroprusside
Remember, in these negatively stated questions, the question is essentially asking, "These are all key treatments EXCEPT ..." ACE inhibitors and beta blockers (such as carvedilol) are standards of care in HF, so options A and B can be eliminated quickly. Although diuretics are not associated with mortality benefit in HF, they are frequently administered in HF and key to preload reduction and symptom relief in acute HF, so eliminate C. Although afterload reducers are often adjunctive treatment in HF, nitroprusside is less commonly administered compared to the other options and not considered a standard of care in HF. Choose D.
Pericardial tamponade presents with all but one of the following symptoms. Identify the symptom NOT associated with pericardial tamponade.
A. Equalization of left and right atrial pressures (CVP and PAOP)
B. LV failure without RV involvement
C. Hypotension
D. Distended neck veins
B. LV failure without RV involvement
In this negatively stated question, it suggests that all options are characteristics of pericardial tamponade EXCEPT one option. An equalization of all cardiac filling pressures, option A, is a classic finding due to circumferential external pressure on the myocardium. Due to the fact that the pressure distribution is circumferential, both ventricles WOULD BE involved, making option B the best answer. Hypotension (option C) is a classic finding due to decreased LV filling, and distended neck veins (option D) is a classic finding due to a compressed RA. Choose B.
Phase 0 of cellular impulse transmission refers to which phase of electrical action?
A. Depolarization
B. Early repolarization
C. End repolarization
D. Myocardial relaxation
A. Depolarization
Even if you were unsure of the correct choice initially, notice that options B, C, and D all relate to repolarization and rest. Option A is the only option that refers to depolarization as suggested by phase 0. Choose A.
Spontaneous diastolic repolarization occurs during which phase of the cardiac action potential?
A. Phase 0
B. Phase 1
C. Phase 3
D. Phase 4
D. Phase 4
Even if you are unsure of which phase of cardiac potential and ion movement were associated with each option, option D (phase 4) is the only option indicating the complete resting interval between action potentials. Think of the action potential wave as "steps" with the lowest, "bottom" step (-90 mV, electronegativity) suggesting diastole and repolarization.
Which electrolyte is responsible for initial depolarization?
A. Sodium
B. Potassium
C. Chloride
D. Calcium
A. Sodium
The electrolyte responsible is sodium (option A), which rushes into the cell to depolarize it. An easy way to remember this is to remember that sodium is the cation (positively charged) that is available in the highest extracellular quantities (135-145 mEq/L), just waiting to rush into the cell. Potassium is largely intracellular, so eliminate B. Chloride is an ion of rapid repolarization in phase 1, so eliminate C. Calcium, option D, is more involved in the slow calcium channels of phase 2, the plateau phase of repolarization. Choose A
Which cation activates the second (slow-channel) inward flow of ions during cardiac depolarization?
A. Sodium
B. Potassium
C. Chloride
D. Calcium
D. Calcium
The sodium-potassium pumps are associated with rapid channel movement, so A and B can be eliminated initially. Chloride is an anion, so eliminate C as well. Calcium is the "slow channel" cation of phase 2 (the plateau phase). It is by working on this phase that calcium chloride IVP administration can increase contractility and protect the myocardium. Choose D.
Which ion leaves the cell during depolarization to counter the inward flow of sodium?
A. Phosphate
B. Potassium
C. Chloride
D. Calcium
B. Potassium
The cell membrane will always favor exchanging a "positive for a positive" or a "negative for a negative." Since sodium is positive and phosphate (option A) and chloride (Option C) are negative, they can be eliminated quickly. The "sodium-potassium pump" suggests that sodium largely exchanges with potassium, making option B the best answer. Calcium is more associated with the slow-channel phase 2, so eliminate D.
Which of the following cardiac chambers contains deoxygenated blood?
A. Right ventricle
B. Left ventricle
C. Pulmonary veins
D. Left atrium
A. Right ventricle
Left-sided cardiac chambers carry oxygenated blood, so options B and D can be eliminated quickly. The only right-sided chamber mentioned here is A, making option A the best answer. Even though the word "veins" is mentioned in option C, the pulmonary veins carry oxygenated blood to the right atrium from the lungs, thus eliminating option C as well.
Where is the sinoatrial (SA) node located?
A. Right atrium
B. Left atrium
C. Right ventricle
D. Superior vena cava
A. Right atrium
The conduction pathway begins in the right atrium, travels through the bundle of His in the septum, then the apex of the LV and throughout the His-Purkinje system. The conduction impulse also begins with the sinoatrial (SA) node, so choose A. The superior vena cava, option D, is not even a cardiac chamber and can be eliminated quickly. Options B and C refer to either the incorrect side or the cardiac chamber in order to confuse the reader.
Which component of blood pressure regulation has the strongest effect on controlling the blood pressure?
A. Stroke volume
B. Cardiac output
C. SVR
D. Mean arterial pressure
C. SVR
Cardiac output and stroke volume relate more to blood flow than blood pressure, so option A and B can be eliminated quickly. Mean arterial pressure is just another way to measure blood pressure, so D can be eliminated as well. Consider the formula MAP = CO x SVR. SVR measures the degree of afterload that compensates for changes in cardiac output (CO). SVR is also one of the primary parameters targeted for treatment of primary systemic HTN. Choose C.
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