Module 4 Exam 2

1. Explain how ventricular hypertrophy is an adaptive mechanism: 2. What happens during exercise in someone with coronary artery disease?

1. An increase in wall stress can be caused by an increase in preload or afterload. Ventricular hypertrophy is an adaptive mechanism by which the ventricle can offset the increase in wall stress. OR Blood pressure elevation increases the workload of the left ventricle by increasing the pressure against which the heart must pump as it ejects blood into the systemic circulation. Over time, the left ventricle hypertrophies to compensate for the increased pressure and work. 2. During exertion, the heart beats harder and faster to supply oxygen to the muscles. The coronary vessels vasodilate and increase blood flow to the cardiac muscle to meet its increased demand for oxygen. With atherosclerotic disease, the coronary vessel lumens are narrowed and blood supply to the heart is diminished. With exertion, the vessels cannot adequately vasodilate. This can manifest as chest pain or tightness and/or shortness of breath.

A 45-year-old man has a blood pressure at a screening program of 142/90. His father has a history of hypertension and heart attack. His grandfather died of a stroke. He is 20 lbs overweight, likes eating salty foods, and enjoys drinking beer. He states he is too tired and busy to exercise. 1. According to JNC 8 guidelines, what category does this patient's blood pressure fall into? 2. What is hypertension a risk factor for? 3. What lifestyle modifications would you suggest for them? 4. Name one medication therapy for hypertension and its mechanism of action.

1. Hypertension stage 2 2. Atherosclerosis, CAD (MI), heart failure, stroke, peripheral artery disease 3. Lose weight, exercise, decrease salt intake, decrease alcohol intake 4. Diuretics, like thiazides, lower blood pressure by decreasing vascular volume ACE inhibitors inhibit the conversion of angiotensin I to angiotensin II, thereby reducing vasoconstriction, aldosterone levels Calcium channel receptor blockers inhibit the movement of calcium into cardiac and vascular smooth muscle. They reduce vascular smooth muscle tone (vasodilation); reduce cardiac contractility and heart rate, and decrease cardiac output

Match the cardiac procedures to their description and what they are best used for. 2 answers per question (1 from Set 1, and 1 from Set 2).1. Cardiac catheterization2. Exercise stress testing3. Electrocardiography4. Echocardiography Set 1: a. Records electrical potential differences during the cardiac cycle b. Observes cardiac function under stress c. Checks for structure and function of the heart d. Catheter is inserted into the great vessels and chambers of the heart Set 2: a. Best to assess ventricular function and heart failure b. Best to assess for arrhythmias and myocardial infarction c. Best to assess need for coronary artery bypass graft and stenting d. Best to assess suspected ischemic heart disease

1. Set 1: d, Set 2: c 2. Set 1: b, Set 2: d 3. Set 1: a, Set 2: b 4 . Set 1: c, Set 2: a

1. Hypertension is often called "the silent killer." By the time symptoms of hypertension occur, the complications can affect the kidneys, heart, eyes, and blood vessels. What is this term called? 2. Left ventricular hypertrophy is a major risk factor for what other diseases? Name at least 2.

1. Target-organ damage 2. coronary heart disease, cardiac dysrhythmias, congestive heart failure, and sudden death.

Antiphospholipid syndrome is NOT associated with which of the following? Select all that apply. Bleeding risk Thrombus risk Recurrent fetal loss Thrombocytopenia Can be seen with SLE

Bleeding risk

Treatment of or prevention of sickling crisis in sickle cell disease include each of the following except: Hydroxyurea Blood transfusions Immunizations Treating infections

Blood transfusions

Which is NOT included in the three principles of blood flow? Compliance Flow Pressure Resistance

Compliance

Which of the following is a hypercoagulable state? Select all that apply. Hemophilia A Congestive heart failure Smoking Thrombocytopenia Postsurgical state

Congestive heart failure Smoking Postsurgical state

Which of the following is true of fatty streaks of atherosclerotic lesions? Present in adults only Can be symptomatic Form scar tissue and calcifications Consist of macrophages and smooth muscle cells

Consist of macrophages and smooth muscle cells

Upon autopsy, this patient's heart revealed which disease process? Hypertrophic cardiomyopathy Restrictive cardiomyopathy Dilated cardiomyopathy Inflammatory cardiomyopathy

Dilated cardiomyopathy

Which pharmacologic treatment of heart failure has a mechanism of action characterized by excretion of fluid, reducing preload: ACE inhibitor Beta-blocker Diuretic Vasodilators

Diuretic

Which of the following medications would decrease a person's risk for clotting? Select all that apply. Heparin Warfarin Vitamin K Lovenox

Heparin Warfarin Lovenox

Which cardiomyopathy is the most common cause of sudden cardiac death in young athletes due to ventricular arrhythmias? Dilated Restrictive Inflammatory Hypertrophic

Hypertrophic

Lifestyle changes to treat hyperlipidemia include each of the following except: Increase physical activity Increase red meat consumption Smoking cessation Weight reduction

Increase red meat consumption

Which of the following increases the strength of the muscular contraction? Wall tension Inotropic influence Peripheral vascular resistance Hypoxia

Inotropic influence

What are the two major causes of microcytic anemias? Iron deficiency anemia, Vitamin B12 deficiency Vitamin B12, Folate deficiency Iron deficiency anemia, Thalassemias Thalassemias, Folate deficiency

Iron deficiency anemia, Thalassemias

Which of the following is FALSE of disseminated intravascular coagulation (DIC)? Select all that apply. Microthrombi cause vessel occlusion and tissue ischemia It can cause multiple organ failure Severe hemorrhage results Obstetric disorders are the main cause of DIC Lab results show a decreased PT, PTT

Lab results show a decreased PT, PTT

Which of the following is NOT true of vitamin B12 deficiency anemia? Dietary deficiencies are not common Peripheral neuropathy can be a result of deficiency Vitamin B12 is bound to intrinsic factor MCV is decreased

MCV is decreased

Which of the following symptoms is NOT associated with iron deficiency anemia? Pica Fatigue Neurologic changes Brittle hair and nails

Neurologic changes

A decrease in this type of cell can lead to an increased risk of bacterial infections: Red blood cell Neutrophil Platelets Monocyte

Neutrophil

Which of the following is NOT a regulator of blood pressure? Baroreceptors Renin-angiotensin-aldosterone system Vasopressin Parasympathetic nervous system activation

Parasympathetic nervous system activation

Which of the following increases the chance of clotting? Select all that apply. Vitamin K deficiency Von Willebrand factor deficiency Protein C deficiency Thrombocytopenia

Protein C deficiency

Right ventricular failure is commonly characterized by each of the following changes except: Distended neck veins Hepatomegaly Ankle edema Sodium and water retention Pulmonary edema

Pulmonary edema

A 23-year-old African-American man with a history of severe lifelong anemia requiring many transfusions has nonhealing leg ulcers and recurrent periods of abdominal and chest pain. These signs and symptoms are most likely to be associated with which one of the following laboratory abnormalities? Sickle cells on peripheral blood smear Loss of intrinsic factor Decreased erythropoietin Decreased ferritin

Sickle cells on peripheral blood smear

With atherosclerotic disease, the coronary vessel lumens are narrowed and blood supply to the heart is diminished. With exertion, the vessels cannot adequately vasodilate. This can manifest as chest pain or tightness and/or shortness of breath. What is this referred to as? Stable angina Unstable angina Myocardial infarction

Stable angina

_____ are a group of inherited disorders of hemoglobin synthesis common among Mediterranean populations.

Thalassemias

With increasing occlusion of the coronary vessel(s), the demands of the resting heart may become too great. When the patient experiences angina without exertion, or when the level of exertion necessary to cause anginal symptoms decreases, this is called what? Stable angina Unstable angina Myocardial infarction

Unstable angina

The laboratory test that measures the volume of red cells in 100 mL of blood is _____.

hematocrit