Question 1

A patient complains of sudden onset of severe chest pain that radiates to the back and worsens with respiratory movement and when lying down.These clinical manifestations describe:

Accepted Answer

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 confused initially with the pain of acute myocardial infarction. Individuals with acute pericarditis also may report dysphagia, restlessness, irritability, anxiety, and weakness.

Question 2

Angiotensin II increases the workload of the heart after a myocardial infarction by:

Accepted Answer

Angiotensin II also causes structural changes in blood vessels (remodeling) that contribute to permanent increases in peripheral resistance and make vessels more vulnerable to endothelial dysfunction and platelet aggregation.

Question 3

Infective endocarditis is most often caused by:

Accepted Answer

Infective endocarditis is a general term used to describe infection and inflammation of the endocardium-especially the cardiac valves. Bacteria are the most common cause of infective endocarditis, especially streptococci, staphylococci, or enterococci.

Question 4

Which form of cardiomyopathy is usually caused by an infiltrative disease of the myocardium, such as amyloidosis, hemochromatosis, or glycogen storage disease?

Accepted Answer

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.

Question 5

Aortic and mitral regurgitation as well as mitral stenosis are caused by:

Accepted Answer

Mitral stenosis is most commonly caused by acute rheumatic fever and is two to three times more common in women than in men. Acquired aortic regurgitation can be caused by rheumatic heart disease, bacterial endocarditis, syphilis, hypertension, connective tissue disorders (e.g., Marfan syndrome and ankylosing spondylitis), appetite suppressing medications, trauma, or atherosclerosis.

Question 6

Match the descriptions with the corresponding terms.
-Aortic stenosis

Accepted Answer

Aortic stenosis impairs the flow from the left ventricle to the aorta, not the left atrium.

Question 7

Which of the following is a clinical manifestation of aortic stenosis?

Accepted Answer

The classic manifestations of aortic stenosis are angina, syncope, and heart failure.

Question 8

An individual who is demonstrating elevated levels of troponin, creatine kinase (CK), and lactic dehydrogenase (LDH) is exhibiting indicators associated with:

Accepted Answer

Cardiac troponins (troponin I and troponin T) are the most specific indicators of MI. Other biomarkers released by myocardial cells include CK-MB (creatine kinase-MB) and LDH.

Question 9

The pulsus paradoxus that occurs as a result of pericardial effusion is significant because it reflects the impairment of the:

Accepted Answer

Pulsus paradoxus means that the arterial blood pressure during expiration exceeds arterial pressure during inspiration by more than 10 mmHg. This clinical finding reflects impairment of diastolic filling of the left ventricle plus reduction of blood volume within all four cardiac chambers.

Question 10

Biventricular dilation is the result of which form of cardiomyopathy?

Accepted Answer

Dilated cardiomyopathy causes decreased ejection fraction, increased end-diastolic and residual volumes, decreased ventricular stroke volume, and biventricular failure.

Question 11

What is the most common cardiac disorder associated with acquired immunodeficiency syndrome (AIDS) resulting from myocarditis and infective endocarditis?

Accepted Answer

Individuals infected with HIV and resultant acquired immunodeficiency syndrome (AIDS) are at risk for numerous cardiac complications. Pericardial effusion and left heart failure are the most common complications of HIV infection. Other conditions include cardiomyopathy, myocarditis, tuberculous pericarditis, infective and nonbacterial endocarditis, heart block, pulmonary hypertension, and non-antiretroviral drug-related cardiotoxicity.

Question 12

In systolic heart failure, what effect does angiotensin II have on stroke volume?

Accepted Answer

Activation of the renin-angiotensin-aldosterone system (RAAS) causes not only increases in preload and afterload but also direct toxicity to the myocardium.

Question 13

Genitourinary instrumentation, male gender, and intravenous drug use are risk factors for which of the following?

Accepted Answer

Risk factors for infective endocarditis include acquired valvular heart disease, male gender, intravenous drug abuse, long-term indwelling catheterization (e.g., for pressure monitoring, hyperalimentation, or hemodialysis), and recent cardiac surgery.

Question 14

Ventricular remodeling is a result of:

Accepted Answer

Secondary causes of decreased contractility, such as myocardial ischemia and increased myocardial workload, contribute to inflammatory, immune, and neurohumoral changes that mediate a process called ventricular remodeling.

Question 15

A patient is diagnosed with pulmonary disease and elevated pulmonary vascular resistance.Which of the following heart failures may result from this condition?

Accepted Answer

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. It most often results from left heart failure when the increase in left ventricular filling pressure that is reflected back into the pulmonary circulation is severe enough. As pressure in the pulmonary circulation rises, the resistance to right ventricular emptying increases.

Question 16

Which form of cardiomyopathy is characterized by ventricular dilation and grossly impaired systolic function, leading to dilated heart failure?

Accepted Answer

Dilated cardiomyopathy (congestive cardiomyopathy) is characterized by ventricular dilation and grossly impaired systolic function, leading to dilated heart failure.

Question 17

What is the expected electrocardiogram pattern for a person when a thrombus in a coronary artery lodges permanently in the vessel and the infarction extends through the myocardium from the endocardium to the epicardium?

Accepted Answer

These individuals usually have marked elevations in the ST segments on electrocardiogram (ECG) and are categorized as having STEMI.

Question 18

Which predominantly female valvular disorder is thought to have an autosomal dominant inheritance pattern, as well as being associated with connective tissue disease?

Accepted Answer

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.

Question 19

The hallmark of which form of cardiomyopathy is a disproportionate thickening of the interventricular septum?

Accepted Answer

It is characterized by thickening of the septal wall, which may cause outflow obstruction to the left ventricle outflow tract.

Question 20

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?

Accepted Answer

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.

Quiz 30: Alterations of Cardiovascular Function