Srg Feb2017 Comprehensive Exam 3: Cardiac Anatomy, Physiology, Conditions, Assessment And Management

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Anatomy Quizzes & Trivia

Questions and Answers
  • 1. 

    Which of these descriptions of the heart's location is correct? 


    • A.

      The heart lies obliquely in the mediastinum.

    • B.

      Its base is directed anteriorly and slightly superiorly. 


    • C.

      Its apex is directed posteriorly and slightly inferiorly. 


    • D.

      Two-thirds of the heart's mass lies to the right of the midline of the sternum.

    Correct Answer
    A. The heart lies obliquely in the mediastinum.
    Explanation
    The heart lies obliquely in the mediastinum, which is the space between the lungs in the chest. Its base is directed anteriorly and slightly superiorly, while its apex is directed posteriorly and slightly inferiorly. Additionally, two-thirds of the heart's mass lies to the right of the midline of the sternum.

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  • 2. 

    True of the pericardium except: 

    • A.

      Both the fibrous and parietal serous pericardium are supplied by phrenic

    • B.

      It is attached to the sternum, respiratory diaphragm and great vessels of the heart

    • C.

      Its parietal and visceral serous layers form the pericardial cavity

    • D.

      Both the parietal and visceral serous pericardium are supplied by the vagus nerve

    Correct Answer
    D. Both the parietal and visceral serous pericardium are supplied by the vagus nerve
    Explanation
    The correct answer is "Both the parietal and visceral serous pericardium are supplied by the vagus nerve." This statement is incorrect because the vagus nerve does not supply the serous pericardium. The serous pericardium is supplied by the phrenic nerves. The vagus nerve primarily supplies parasympathetic innervation to the heart.

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  • 3. 

    The epicardium: 

    • A.

      Is the pacemaker of the heart

    • B.

      Is known as the parietal pericardium

    • C.

      Is the visceral pericardium

    • D.

      Lines the heart chambers

    Correct Answer
    C. Is the visceral pericardium
    Explanation
    The epicardium is the outermost layer of the heart wall and is also known as the visceral pericardium. It is a thin, protective layer that covers the heart and helps to reduce friction as the heart beats. It is not the pacemaker of the heart, which is the sinoatrial (SA) node. The parietal pericardium is a different layer that lines the pericardial sac, not the heart chambers. Therefore, the correct answer is that the epicardium is the visceral pericardium.

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  • 4. 

    The heart valves have a double layer of __________ with a layer of __________ in between.

    • A.

      Epicardium, myocardium

    • B.

      Epicardium, endocardium

    • C.

      Myocardium, endocardium


    • D.

      Endocardium, connective tissue

    Correct Answer
    D. Endocardium, connective tissue
    Explanation
    The heart valves have a double layer of endocardium with a layer of connective tissue in between. The endocardium is the innermost layer of the heart, which lines the chambers and covers the valves. It is composed of a thin layer of endothelial cells and connective tissue. The connective tissue layer provides support and strength to the valves, allowing them to open and close efficiently to regulate blood flow.

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  • 5. 

    Which of the following does not contribute to its diaphragmatic or inferior surface?

    • A.

      Area on the 6th ICS

    • B.

      L atrium

    • C.

      Mitral pulse

    • D.

      L ventricle

    Correct Answer
    B. L atrium
    Explanation
    The left atrium is not part of the diaphragmatic or inferior surface of the heart. The diaphragmatic surface refers to the part of the heart that is in contact with the diaphragm, while the inferior surface refers to the lower part of the heart. The left atrium is located posteriorly and superiorly in the heart, and it does not contribute to the diaphragmatic or inferior surface.

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  • 6. 

    Which of these structures deliver(s) blood to the left atrium? 


    • A.

      Coronary sinus


    • B.

      Superior vena cava

    • C.

      Inferior vena cava

    • D.

      Pulmonary veins

    Correct Answer
    D. Pulmonary veins
    Explanation
    The pulmonary veins deliver blood to the left atrium. The coronary sinus drains blood from the heart muscle itself and delivers it to the right atrium. The superior vena cava carries deoxygenated blood from the upper body to the right atrium, while the inferior vena cava carries deoxygenated blood from the lower body to the right atrium. Therefore, only the pulmonary veins deliver blood to the left atrium.

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  • 7. 

    What is the origin of the L coronary artery?

    • A.

      R aortic sinus at the base of ascending aorta

    • B.

      L aortic sinus at the base of ascending aorta

    • C.

      R aortic sinus at the base of the arch of aorta

    • D.

      L aortic sinus at the base of the arch of aorta

    Correct Answer
    B. L aortic sinus at the base of ascending aorta
    Explanation
    The left coronary artery originates from the left aortic sinus at the base of the ascending aorta. This is where the artery branches off and supplies blood to the left side of the heart.

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  • 8. 

    Strong connective tissue strings that are attached to papillary muscles and to the cusps of the atrioventricular valves are:

    • A.

      Musculi pectinati

    • B.

      Chordae tendinae

    • C.

      Trabeculae carneae

    • D.

      The skeleton of the heart

    Correct Answer
    B. Chordae tendinae
    Explanation
    Chordae tendinae are strong connective tissue strings that are attached to papillary muscles and to the cusps of the atrioventricular valves. They help to anchor the valves and prevent them from inverting into the atria during ventricular contraction. This allows for proper blood flow through the heart and prevents backflow of blood. Musculi pectinati are ridges of muscle in the atria, trabeculae carneae are muscular projections in the ventricles, and the skeleton of the heart refers to the fibrous tissue that provides structural support to the heart.

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  • 9. 

    The low resistance pathways between myocardial cells that allow the spread of action potentials:

    • A.

      Gap junctions

    • B.

      Transverse tubules

    • C.

      Sarcoplasmic reticulum

    • D.

      Intercalated discs

    Correct Answer
    A. Gap junctions
    Explanation
    Gap junctions are the correct answer because they are specialized channels that allow for direct electrical communication between adjacent cardiac muscle cells. These channels facilitate the spread of action potentials, allowing for coordinated contraction of the myocardium. Transverse tubules are invaginations of the cell membrane that help transmit action potentials into the interior of the muscle cell. Sarcoplasmic reticulum is a network of membranous sacs that stores and releases calcium ions, which are necessary for muscle contraction. Intercalated discs are specialized regions where adjacent cardiac muscle cells are connected, but they do not directly facilitate the spread of action potentials.

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  • 10. 

    The portion of the intrinsic conduction system located in the interventricular septum is the: 

    • A.

      SA node

    • B.

      Bundle of His and its branches

    • C.

      Purkinje fibers

    • D.

      AV node

    Correct Answer
    B. Bundle of His and its branches
    Explanation
    The portion of the intrinsic conduction system located in the interventricular septum is the bundle of His and its branches. The bundle of His is a collection of specialized cardiac muscle fibers that transmit electrical impulses from the atrioventricular (AV) node to the Purkinje fibers, which then distribute the electrical signals to the ventricles. This pathway ensures coordinated and efficient contraction of the ventricles, allowing for effective pumping of blood throughout the body. The SA node, AV node, and Purkinje fibers are also part of the intrinsic conduction system, but they are not located specifically in the interventricular septum.

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  • 11. 

    Stimulation of this nerve will result to decreased heart rate.

    • A.

      CN XII

    • B.

      CN XI

    • C.

      CN X

    • D.

      NOTA

    Correct Answer
    C. CN X
    Explanation
    Stimulation of the CN X (vagus nerve) will result in decreased heart rate. The vagus nerve is responsible for parasympathetic innervation of the heart, which means it helps to slow down the heart rate. When the vagus nerve is stimulated, it releases neurotransmitters that inhibit the electrical activity of the heart, leading to a decrease in heart rate. This can be useful in certain situations, such as when the heart rate is too fast and needs to be slowed down.

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  • 12. 

    In a fetus, this structure temporarily shunts blood from the pulmonary trunk into the aorta. 

    • A.

      Foramen ovale

    • B.

      Fossa ovalis

    • C.

      Annulus ovalis

    • D.

      Ductus arteriosus

    Correct Answer
    D. Ductus arteriosus
    Explanation
    The correct answer is ductus arteriosus. In a fetus, the ductus arteriosus is a temporary blood vessel that allows blood to bypass the lungs. It connects the pulmonary trunk to the aorta, allowing oxygenated blood to be shunted directly to the body. After birth, the ductus arteriosus typically closes, redirecting blood flow to the lungs for oxygenation.

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  • 13. 

    Where would you listen for the sound of the aortic valve?

    • A.

      5th left ICS near sternal border

    • B.

      Right lower end of the sternum

    • C.

      2nd L ICS near sternal border

    • D.

      2nd R ICS near medial end of the costal cartilage

    Correct Answer
    D. 2nd R ICS near medial end of the costal cartilage
    Explanation
    The aortic valve is located in the 2nd right intercostal space (ICS) near the medial end of the costal cartilage. This is the correct answer because the aortic valve is best heard in this area during auscultation. The 2nd left ICS near the sternal border is where the pulmonic valve is heard. The 5th left ICS near the sternal border is where the tricuspid valve is heard. The right lower end of the sternum is where the mitral valve is heard.

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  • 14. 

    After isovolumetric contraction, the proper sequence during a cardiac cycle:1. reduced ventricular filling2. atrial systole3. rapid ejection4. isovolumetric relaxation 

    • A.

      1,2,3,4

    • B.

      2,3,1,4

    • C.

      3,1,2,4

    • D.

      3,4,1,2

    Correct Answer
    D. 3,4,1,2
    Explanation
    The correct sequence during a cardiac cycle is as follows:
    1. Atrial systole: This is when the atria contract, pushing blood into the ventricles.
    2. Rapid ejection: This is when the ventricles contract and blood is rapidly ejected into the aorta and pulmonary artery.
    3. Reduced ventricular filling: This is when the ventricles start to relax and the pressure in the ventricles decreases, causing a decrease in blood flow into the ventricles.
    4. Isovolumetric relaxation: This is when the ventricles fully relax and all heart valves are closed, preventing any blood flow into or out of the ventricles.

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  • 15. 

    If the SA node becomes damaged and nonfunctional, which of these is the most likely to occur?

    • A.

      The heart will stop. 


    • B.

      The ventricles will contract, but the atria will stop.

    • C.

      Another part of the heart, possibly the AV node, will become the 
pacemaker.

    • D.

      The heart will beat faster. 


    Correct Answer
    C. Another part of the heart, possibly the AV node, will become the 
pacemaker.
    Explanation
    If the SA node becomes damaged and nonfunctional, another part of the heart, possibly the AV node, will become the pacemaker. The SA node is responsible for initiating the electrical impulses that regulate the heart's rhythm. However, if it is unable to function properly, the AV node, which is located in the atria, can take over the role of pacemaker and generate the electrical signals to stimulate the contraction of the ventricles. This allows the heart to continue beating, although the rhythm may be slower or irregular compared to when the SA node is functioning properly.

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  • 16. 

    Which of these statements concerning cardiac muscle is correct?

    • A.

      Cardiac muscle has more sarcoplasmic reticulum than skeletal muscle. 


    • B.

      Cardiac muscle has a prolonged period of slow repolarization called the plateau phase. 


    • C.

      Cardiac muscle has a shorter refractory period than skeletal muscle. 


    • D.

      Depolarization of cardiac muscle occurs when K+ and Na+ diffuse 
into the cell.

    Correct Answer
    B. Cardiac muscle has a prolonged period of slow repolarization called the plateau phase. 

    Explanation
    Cardiac muscle has a prolonged period of slow repolarization called the plateau phase. During this phase, the action potential is sustained, allowing the heart to contract and pump blood efficiently. This prolonged repolarization period helps to prevent tetanic contractions and allows the heart to relax and fill with blood before the next contraction. This characteristic of cardiac muscle is important for maintaining the coordinated and rhythmic contractions of the heart, ensuring proper blood flow throughout the body.

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  • 17. 

    Early repolarization of cardiac muscle cells occurs when:

    • A.

      Voltage-gated Ca2+ ion channels open

    • B.

      Voltage-gated K+ ion channels open

    • C.

      Voltage-gated Na+ ion channels close

    • D.

      Both B and C

    Correct Answer
    D. Both B and C
    Explanation
    Early repolarization of cardiac muscle cells occurs when voltage-gated K+ ion channels open and voltage-gated Na+ ion channels close. This is because during the repolarization phase, the cell membrane potential is restored to its resting state by the efflux of K+ ions out of the cell and the closure of Na+ ion channels, which stops the influx of Na+ ions. Therefore, both options B and C are correct.

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  • 18. 

    Unlike other fast response type of cardiac muscle cells, the movement of __________ into the pacemaker cells is primarily responsible for the depolarization phase of the action potential. 
 

    • A.

      Ca2+ ions

    • B.

      K+ ions

    • C.

      Na+ ions

    • D.

      Cl- ions

    Correct Answer
    A. Ca2+ ions
    Explanation
    Ca2+ ions are primarily responsible for the depolarization phase of the action potential in pacemaker cells. During this phase, Ca2+ ions enter the cells, causing the membrane potential to become more positive. This influx of Ca2+ ions triggers the opening of voltage-gated ion channels, leading to the generation of an action potential. The movement of K+ ions, Na+ ions, and Cl- ions also play a role in the action potential, but Ca2+ ions have the most significant contribution to the depolarization phase.

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  • 19. 

    In an ECG, the P wave represents:

    • A.

      Depolarization of the atria

    • B.

      Repolarization of the atria

    • C.

      Depolarization of the ventricles

    • D.

      Repolarization of the ventricles

    Correct Answer
    A. Depolarization of the atria
    Explanation
    The P wave in an ECG represents the depolarization of the atria. Depolarization is the process by which the cardiac muscle cells lose their electrical charge, allowing them to contract and pump blood. In the case of the P wave, it specifically represents the depolarization of the atrial muscle cells, which initiates the contraction of the atria and the subsequent filling of the ventricles. This electrical activity can be detected and recorded by the ECG, providing valuable information about the functioning of the heart.

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  • 20. 

    Which of these conditions is most likely to cause bradycardia? 
 

    • A.

      Ectopic action potentials in the atria

    • B.

      Damage to the tricuspid valve

    • C.

      Excessive sympathetic stimulation

    • D.

      Excessive parasympathetic stimulation

    Correct Answer
    D. Excessive parasympathetic stimulation
    Explanation
    Excessive parasympathetic stimulation is most likely to cause bradycardia. The parasympathetic nervous system is responsible for slowing down the heart rate, and when it is overstimulated, it can cause the heart to beat at a slower rate than normal. This can be due to various factors such as certain medications, vagal maneuvers, or medical conditions like hypothyroidism.

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  • 21. 

    During the period of ejection in the cardiac cycle, the atrioventricular valves are __________ and the semilunar valves are __________. 
 

    • A.

      Closed, closed

    • B.

      Closed, open

    • C.

      Open, closed

    • D.

      Open, open

    Correct Answer
    B. Closed, open
    Explanation
    During the period of ejection in the cardiac cycle, the atrioventricular valves are closed to prevent the backflow of blood from the ventricles to the atria. At the same time, the semilunar valves are open to allow the blood to be ejected from the ventricles into the arteries. This ensures that blood flows in the correct direction, from the heart to the rest of the body.

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  • 22. 

    A patient has a blood pressure of 90/60 mm Hg. Compute for the patient’s mean arterial pressure. 

    • A.

      65 mmHg

    • B.

      70 mm Hg

    • C.

      75 mmHg

    • D.

      80 mm Hg

    Correct Answer
    B. 70 mm Hg
    Explanation
    The mean arterial pressure (MAP) is calculated by adding one-third of the difference between the systolic and diastolic blood pressure to the diastolic blood pressure. In this case, the difference between the systolic and diastolic blood pressure is 30 mmHg (90 - 60 = 30). One-third of this difference is 10 mmHg (30 / 3 = 10). Adding this to the diastolic blood pressure of 60 mmHg gives us a MAP of 70 mmHg.

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  • 23. 

    During the period of ejection, the left ventricular pressure reaches a high point of approximately:

    • A.

      120 mm Hg

    • B.

      100 mm Hg

    • C.

      80 mm Hg

    • D.

      60 mm Hg

    Correct Answer
    A. 120 mm Hg
    Explanation
    During the period of ejection, the left ventricular pressure reaches a high point of approximately 120 mm Hg. This is because the left ventricle contracts forcefully to pump blood out to the rest of the body. The contraction of the left ventricle creates pressure that pushes the blood through the aortic valve and into the aorta. This pressure is necessary to overcome the resistance in the systemic circulation and ensure adequate blood flow to the organs and tissues. Therefore, a high pressure of approximately 120 mm Hg is required during ejection.

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  • 24. 

    Increased venous return in the heart causes increased

    • A.

      Stroke volume

    • B.

      Preload

    • C.

      Cardiac output

    • D.

      Force of contraction

    • E.

      AOTA

    Correct Answer
    E. AOTA
    Explanation
    Increased venous return in the heart refers to an increase in the amount of blood returning to the heart from the body. This increased volume of blood stretches the walls of the heart, leading to an increase in the preload, which is the amount of blood in the ventricles just before contraction. As a result, the heart is able to contract more forcefully, leading to an increased force of contraction. This increased force, along with the increased preload, ultimately leads to an increase in stroke volume, which is the amount of blood pumped out of the heart with each beat. Therefore, the correct answer is AOTA, as all of these factors are interrelated and increase in response to increased venous return.

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  • 25. 

    Which one do you like?

    • A.

      Option 1

    • B.

      Option 2

    • C.

      Option 3

    • D.

      Option 4

    Correct Answer
    A. Option 1
  • 26. 

    Atherosclerosis impedes coronary blood flow by which of the following mechanisms?

    • A.

      Plaques obstruct the vein

    • B.

      Plaques obstruct the artery

    • C.

      Blood clots form outside the vessel wall

    • D.

      Hardened vessels dilate to allow the blood to flow through

    Correct Answer
    B. Plaques obstruct the artery
    Explanation
    Atherosclerosis is a condition characterized by the buildup of plaques inside the arteries. These plaques are made up of cholesterol, fat, calcium, and other substances. Over time, these plaques can become hardened and narrow the arteries, obstructing the flow of blood. This can lead to reduced blood flow to the coronary arteries, which supply the heart muscle with oxygen and nutrients. As a result, atherosclerosis can cause chest pain (angina), heart attack, or other cardiovascular complications. Therefore, the correct answer is "Plaques obstruct the artery."

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  • 27. 

    What is the most common complication of a myocardial infarction?

    • A.

      Cardiogenic shock

    • B.

      Heart failure

    • C.

      Arrhythmias

    • D.

      Pericarditis

    Correct Answer
    C. Arrhythmias
    Explanation
    Arrhythmias are the most common complication of a myocardial infarction. During a heart attack, the blood supply to a part of the heart muscle is blocked, leading to damage. This damage can disrupt the normal electrical signals that control the heart's rhythm, causing abnormal heart rhythms or arrhythmias. Arrhythmias can range from mild palpitations to life-threatening conditions such as ventricular fibrillation. Prompt medical intervention is crucial to manage and treat arrhythmias after a myocardial infarction to prevent further complications and improve patient outcomes.

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  • 28. 

    Which of the following types of angina pectoris is triggered by the release of inflammatory mediators following an allergic insult leading to coronary artery spasm?

    • A.

      Prinzmetal’s angina

    • B.

      Cardiac Syndrome X

    • C.

      Kounis Angina

    • D.

      Microvascular Angina

    Correct Answer
    C. Kounis Angina
    Explanation
    Kounis Angina is triggered by the release of inflammatory mediators following an allergic insult leading to coronary artery spasm. This type of angina is characterized by chest pain and other symptoms due to the constriction of the coronary arteries, which reduces blood flow to the heart. It is often associated with allergic reactions, such as those caused by medications, insect bites, or food allergies. The release of inflammatory mediators during an allergic reaction can cause the coronary arteries to spasm, leading to reduced blood flow and the development of angina symptoms.

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  • 29. 

    Which of the following is the most common symptom of myocardial infarction?

    • A.

      Chest pain

    • B.

      Dyspnea

    • C.

      Edema

    • D.

      Palpitations

    Correct Answer
    A. Chest pain
    Explanation
    Chest pain is the most common symptom of myocardial infarction, also known as a heart attack. During a heart attack, there is a blockage in the blood vessels that supply the heart muscle with oxygen and nutrients. This lack of blood flow can cause severe chest pain, often described as a squeezing or pressure sensation. The pain may radiate to the left arm, jaw, or back. It is important to recognize and seek medical attention for chest pain, as it can be a sign of a life-threatening condition.

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  • 30. 

    Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation?

    • A.

      Beta-adrenergic blockers

    • B.

      Calcium channel blockers

    • C.

      Narcotics

    • D.

      Nitrates

    Correct Answer
    A. Beta-adrenergic blockers
    Explanation
    Beta-adrenergic blockers protect the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation. Catecholamines, such as adrenaline, increase heart rate and contractility, which can worsen ischemia. By blocking the effects of these substances, beta-adrenergic blockers reduce heart rate and contractility, thereby decreasing the oxygen demand of the myocardium and improving blood flow to the ischemic tissue. This helps to protect the heart from further damage during an ischemic event. Calcium channel blockers, narcotics, and nitrates do not have the same mechanism of action and do not specifically target catecholamines and sympathetic nerve stimulation.

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  • 31. 

    A murmur is heard at the second left intercostal space along the left sternal border. Which valve area is this?

    • A.

      Aortic

    • B.

      Mitral

    • C.

      Pulmonic

    • D.

      Tricuspid

    Correct Answer
    C. Pulmonic
    Explanation
    The second left intercostal space along the left sternal border corresponds to the area where the pulmonic valve is heard. This valve is located between the right ventricle and the pulmonary artery, and its function is to prevent the backflow of blood from the pulmonary artery into the right ventricle. Therefore, if a murmur is heard in this specific area, it is likely due to an abnormality or dysfunction of the pulmonic valve.

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  • 32. 

    What is the common site of aortic aneurysm?

    • A.

      Abdominal aorta

    • B.

      Ascending aorta

    • C.

      Descending thoracic aorta

    • D.

      Arch of the aorta

    Correct Answer
    A. Abdominal aorta
    Explanation
    The common site of aortic aneurysm is the abdominal aorta. Aortic aneurysm refers to the abnormal enlargement or bulging of the aorta, which is the largest artery in the body. It commonly occurs in the abdominal aorta, which is the portion of the aorta that runs through the abdomen. Aortic aneurysms can also occur in other parts of the aorta, such as the ascending aorta, descending thoracic aorta, or arch of the aorta, but the abdominal aorta is the most frequent site.

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  • 33. 

    Which of the following groups of symptoms indicated a ruptured abdominal aneurysm?

    • A.

      Lower back pain, increased BP, decreased RBC, increased WBC

    • B.

      Severe lower back pain, decreased BP, decreased RBC, increased WBC

    • C.

      Severe lower back pain, decreased BP, decreased RBC, decreased WBC

    • D.

      Intermittent lower back pain, decreased BP, decreased RBC, increased WBC

    Correct Answer
    B. Severe lower back pain, decreased BP, decreased RBC, increased WBC
    Explanation
    The group of symptoms that indicate a ruptured abdominal aneurysm includes severe lower back pain, decreased blood pressure (BP), decreased red blood cell (RBC) count, and increased white blood cell (WBC) count. Severe lower back pain is a common symptom of a ruptured abdominal aneurysm. Decreased BP can occur due to internal bleeding caused by the rupture. Decreased RBC count indicates blood loss, while an increased WBC count suggests an inflammatory response to the rupture.

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  • 34. 

    Rheumatic fever which causes rheumatic heart disease is preceded by?

    • A.

      Group A streptococcal infection

    • B.

      Group B staphylococcal infection

    • C.

      Actinobacteria

    • D.

      Entameba Histolytica

    Correct Answer
    A. Group A streptococcal infection
    Explanation
    Rheumatic fever, which leads to rheumatic heart disease, is caused by an autoimmune response to a Group A streptococcal infection. When the body is infected with Group A streptococcus bacteria, the immune system produces antibodies to fight off the infection. However, in some cases, these antibodies mistakenly attack the body's own tissues, particularly the heart, joints, and other organs, leading to rheumatic fever. This condition can cause inflammation and damage to the heart valves, leading to rheumatic heart disease. Therefore, the correct answer is Group A streptococcal infection.

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  • 35. 

    A complex of clinical syndrome that can result from any structural or functional cardiac disorders that impairs the ability of the ventricles to fill or eject blood.

    • A.

      Rheumatic Heart Disease

    • B.

      Patent Ductus Arteriosus

    • C.

      Tetralogy of Fallot

    • D.

      Congestive Heart Failure

    Correct Answer
    D. Congestive Heart Failure
    Explanation
    Congestive Heart Failure is a complex of clinical syndrome that can result from any structural or functional cardiac disorders that impairs the ability of the ventricles to fill or eject blood. This condition occurs when the heart is unable to pump enough blood to meet the body's needs. It can be caused by conditions such as coronary artery disease, high blood pressure, or heart valve disease. Symptoms of congestive heart failure include shortness of breath, fatigue, and swelling in the legs and ankles. Treatment may involve lifestyle changes, medication, or surgery depending on the underlying cause.

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  • 36. 

    Which of the following is NOT associated with a LEFT sided heart failure?

    • A.

      Exertional Dyspnea

    • B.

      Orthopnea

    • C.

      Cyanosis

    • D.

      Distended jugular veins

    Correct Answer
    D. Distended jugular veins
    Explanation
    Distended jugular veins are not associated with left-sided heart failure. Left-sided heart failure typically leads to fluid accumulation in the lungs, causing symptoms such as exertional dyspnea (shortness of breath during physical activity) and orthopnea (shortness of breath when lying flat). Cyanosis, a bluish discoloration of the skin and mucous membranes, may also be present due to inadequate oxygenation. However, distended jugular veins are more commonly associated with right-sided heart failure, where fluid backs up into the systemic venous circulation, leading to jugular vein distension.

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  • 37. 

    Which of the following conditions is not classified under ACYANOTIC congenital heart disease (CHD)?

    • A.

      Transposition of Great Vessels

    • B.

      Coarctation of the aorta

    • C.

      Total Anomalous PVR

    • D.

      Both A and C

    Correct Answer
    D. Both A and C
    Explanation
    Both transposition of the great vessels and total anomalous pulmonary venous return are classified under CYANOTIC congenital heart disease (CHD), not ACYANOTIC congenital heart disease (CHD). ACYANOTIC CHD refers to heart conditions that do not cause cyanosis (bluish discoloration of the skin due to low oxygen levels in the blood), whereas CYANOTIC CHD causes cyanosis. Coarctation of the aorta, on the other hand, is classified under ACYANOTIC CHD.

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  • 38. 

    What is the most common form of blue baby syndrome?

    • A.

      Transposition of Great Vessels

    • B.

      Tetralogy of Fallot

    • C.

      Total Anomalous PVR

    • D.

      Truncus Arteriosus

    Correct Answer
    B. Tetralogy of Fallot
    Explanation
    Tetralogy of Fallot is the most common form of blue baby syndrome. This condition is characterized by four heart defects that affect the flow of oxygenated blood to the body. These defects include a ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy. As a result, inadequate amounts of oxygenated blood are circulated to the body, leading to cyanosis or a bluish discoloration of the skin. This condition typically requires surgical intervention to correct the heart defects and improve blood flow.

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  • 39. 

    Which of the following is a characteristic feature of INCOMPLETE PRIMARY AV heart block?

    • A.

      Prolonged P-R interval

    • B.

      Inverted T wave

    • C.

      Absent QRS complex

    • D.

      All of the above

    Correct Answer
    A. Prolonged P-R interval
    Explanation
    A prolonged P-R interval is a characteristic feature of incomplete primary AV heart block. In this condition, there is a delay in the conduction of electrical impulses from the atria to the ventricles, resulting in a longer than normal P-R interval on an electrocardiogram (ECG). This delay can cause symptoms such as dizziness, fainting, and palpitations. Incomplete AV block means that not all of the electrical impulses are blocked, allowing some to still reach the ventricles and produce a QRS complex. Inverted T waves and absent QRS complexes are not characteristic features of incomplete primary AV heart block.

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  • 40. 

    Which of the following conditions will NOT increase the resting heart rate?

    • A.

      Increase body temperature

    • B.

      Adrenergic stimulation of the heart

    • C.

      Sympathetic stimulation of the heart

    • D.

      Cholinergic stimulation of the heart

    Correct Answer
    D. Cholinergic stimulation of the heart
    Explanation
    Cholinergic stimulation of the heart will not increase the resting heart rate. Cholinergic stimulation refers to the activation of the parasympathetic nervous system, which is responsible for slowing down the heart rate. Therefore, instead of increasing the heart rate, cholinergic stimulation will have the opposite effect and decrease the resting heart rate.

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  • 41. 

    This is the neurotransmitter released during vagal stimulation of the heart resulting to decreased HR.

    • A.

      Ach

    • B.

      N.Epinephrine

    • C.

      Dopamine

    • D.

      Glycine

    Correct Answer
    A. Ach
    Explanation
    Ach refers to acetylcholine, which is the neurotransmitter released during vagal stimulation of the heart. Acetylcholine binds to muscarinic receptors in the heart, leading to a decrease in heart rate. This is because activation of the parasympathetic nervous system, which is mediated by acetylcholine, opposes the sympathetic nervous system's effects on the heart, resulting in a decrease in heart rate.

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  • 42. 

    Which of the following ECG tracing suddenly ceases in the presence of SA block?

    • A.

      P wave

    • B.

      QRS complex

    • C.

      Q wave

    • D.

      T wave

    Correct Answer
    A. P wave
    Explanation
    In the presence of SA block, the electrical signals from the sinoatrial (SA) node are not transmitted properly to the atria. This results in a delay or absence of the P wave on the ECG tracing. The P wave represents atrial depolarization, which is the contraction of the atria. Therefore, in the presence of SA block, the P wave suddenly ceases or is not visible on the ECG tracing.

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  • 43. 

    This is characterized by a poor conduction in AV node or AV bundle wherein there is a complete block of impulse from atria to the ventricles leading to ventricles establishing their own signal.

    • A.

      1st degree AV Heart Block

    • B.

      2nd degree AV Heart Block

    • C.

      3rd degree AV Heart Block

    • D.

      4th degree AV Heart Block

    Correct Answer
    C. 3rd degree AV Heart Block
    Explanation
    A 3rd degree AV Heart Block is characterized by a complete block of the electrical impulses from the atria to the ventricles. This means that the atria and ventricles are not synchronized in their contractions. Instead, the ventricles establish their own signal to maintain a regular heartbeat. This can lead to a slow heart rate and symptoms such as dizziness, fainting, and fatigue. Treatment may involve the use of a pacemaker to regulate the heart rhythm.

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  • 44. 

    Which of the following are you allowed to do during cardiac rehabilitation?

    • A.

      Resistance training 1 day after PTCA

    • B.

      UE ergometer 5 days after sternotomy

    • C.

      Resistance training 1 month after CABG

    • D.

      Mild stretching of pectorals 2 days after CABG

    Correct Answer
    C. Resistance training 1 month after CABG
    Explanation
    Resistance training is allowed 1 month after CABG (Coronary Artery Bypass Grafting) because it allows enough time for the sternum to heal and the patient to recover from the surgery. PTCA (Percutaneous Transluminal Coronary Angioplasty) is a less invasive procedure compared to CABG, so resistance training is allowed 1 day after PTCA. UE ergometer (Upper Extremity Ergometer) is a low-intensity exercise that can be started 5 days after sternotomy, which is a surgical incision made during CABG. Mild stretching of pectorals is allowed 2 days after CABG to promote flexibility and prevent muscle tightness.

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  • 45. 

    John has a SV=72mL/beat and his EDV=140mL.

    • A.

      Ejection fraction is typical of a heart failure.

    • B.

      Ejection fraction is normal

    • C.

      Cardiac output is higher than normal

    • D.

      Cardiac ouput is normal

    Correct Answer
    A. Ejection fraction is typical of a heart failure.
    Explanation
    The ejection fraction is a measure of the percentage of blood pumped out of the heart with each heartbeat. It is calculated by dividing the stroke volume (SV) by the end-diastolic volume (EDV). In this case, John has a SV of 72mL/beat and an EDV of 140mL. The ejection fraction can be calculated as (72/140) x 100 = 51.4%. A normal ejection fraction typically ranges from 50% to 70%. Since John's ejection fraction falls within the normal range, it suggests that his heart is functioning normally and not indicative of heart failure.

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  • 46. 

    Upon reading the chart of your patient who undergone sternotomy a month ago, you noticed the following blood values: Hgb=15mg/dL, Hematocrit=45mg/dL, WBC=900mg/dL, platelets=300,000mg/dL.

    • A.

      Defer. Low Hgb.

    • B.

      Defer. Low Hct.

    • C.

      Defer. Low WBC.

    • D.

      Defer. Low platelets.

    Correct Answer
    C. Defer. Low WBC.
    Explanation
    The correct answer is "Defer. Low WBC." This is because a low white blood cell count (WBC) can indicate a weakened immune system, which may put the patient at risk for infection. In the context of a patient who underwent sternotomy, it is important to ensure that their immune system is functioning properly before proceeding with any further medical interventions. Therefore, it would be appropriate to defer any additional procedures or treatments until the WBC count improves.

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  • 47. 

    You can initiate the aerobic exercise protocols in what phase of cardiac rehabilitation?

    • A.

      I

    • B.

      II

    • C.

      III

    • D.

      IV

    Correct Answer
    B. II
    Explanation
    In phase II of cardiac rehabilitation, patients are ready to start aerobic exercise protocols. This phase typically begins a few weeks after a cardiac event or surgery, when the patient's condition has stabilized. During phase II, patients are closely monitored by healthcare professionals as they gradually increase their exercise intensity and duration. This phase aims to improve cardiovascular fitness, reduce the risk of future cardiac events, and enhance overall physical well-being.

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  • 48. 

    Erica is currently undergoing Phase III cardiac rehabilitation for myocardial infarction. Your goal is to strengthen her UEs via resistance exercises. You instructed the patient to count every repetition. However, Eca told you that she does not like counting because it sounds awkward for her. However you explained that by counting, myocardial oxygen demand is decreased by:

    • A.

      Increasing both preload and SV

    • B.

      Decreasing both preload and SV

    • C.

      Increasing preload, decreasing SV

    • D.

      Decreasing preload, increasing SV

    Correct Answer
    B. Decreasing both preload and SV
    Explanation
    Counting repetitions during resistance exercises can help decrease myocardial oxygen demand by decreasing both preload and stroke volume (SV). Preload refers to the amount of blood returning to the heart, and counting repetitions can help maintain a steady flow of blood back to the heart, reducing the strain on the heart. Additionally, counting repetitions can help regulate breathing and prevent breath-holding, which can further decrease preload and SV. Therefore, by counting, Erica can help decrease the workload on her heart during cardiac rehabilitation.

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  • 49. 

    Which of the following is observed in chronic stage MI or the “infarction stage”?

    • A.

      ST elevation

    • B.

      T –wave inversion

    • C.

      Decreased J-point

    • D.

      ST depression

    Correct Answer
    A. ST elevation
    Explanation
    ST elevation is observed in the chronic stage of myocardial infarction (MI) or the "infarction stage". This is because during an MI, there is an obstruction in the blood flow to the heart muscle, leading to the death of the affected tissue. As the tissue heals, scar tissue forms, causing the ST segment to elevate on an electrocardiogram (ECG). This ST elevation is a characteristic finding in the chronic stage of MI and helps in diagnosing and monitoring the condition.

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  • 50. 

    This periodic fainting occurs in most patients after few seconds of complete AV block. What do you call this condition?

    • A.

      Overdrive Suppression

    • B.

      Stokes-Adams Syndrome

    • C.

      Ventricular Escape

    • D.

      Incomplete AV Heart Block

    Correct Answer
    B. Stokes-Adams Syndrome
    Explanation
    Stokes-Adams Syndrome refers to a condition where patients experience periodic fainting after a few seconds of complete AV block. This syndrome is characterized by a sudden loss of consciousness due to a temporary interruption in the electrical signals that control the heart's rhythm. During a complete AV block, the electrical signals that normally travel from the atria to the ventricles are blocked, leading to a pause in the heart's activity. This pause can cause a drop in blood pressure and inadequate blood flow to the brain, resulting in fainting episodes. Therefore, Stokes-Adams Syndrome is the appropriate term to describe this condition.

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