patho Ch. 12 part B
105. Septic shock is frequently caused by infections involving: a. gram-negative endotoxin-producing bacteria. b. spore-forming saprophytic fungi. c. free-swimming, motile parasitic protozoa. d. parasitic nematodes.
ANS: A
52. Common signs of rheumatic fever include all of the following EXCEPT: a. arthritis, causing deformity of the small joints in the hands and feet. b. erythematous skin rash and subcutaneous nodules. c. epistaxis, tachycardia, and fever. d. elevated ASO titer and leukocytosis.
ANS: A
54. Septic emboli, a common complication of infective endocarditis, are a result of the fact that: a. vegetations are loosely attached and fragile. b. the valves are no longer competent. c. cardiac output is reduced. d. heart contractions are irregular.
ANS: A
55. Which of the following applies to subacute infective endocarditis? a. A microbe of low virulence attacks abnormal or damaged heart valves. b. Virulent microbes invade normal heart valves. c. No permanent damage occurs to the valves. d. Prophylactic medication does not prevent infection.
ANS: A
60. Uncontrolled hypertension is most likely to cause ischemia and loss of function in the: a. kidneys, brain, and retinas of the eye. b. peripheral arteries in the legs. c. aorta and coronary arteries. d. liver, spleen, and stomach.
ANS: A
61. When is a diagnosis of essential hypertension likely to be considered in young or middle-aged individuals? a. Blood pressure remains consistently above 140/90 b. Blood pressure fluctuates between 130/85 and 180/105 c. Blood pressure increases rapidly and is unresponsive to medication d. Chronic kidney disease leads to consistently elevated blood pressure
ANS: A
69. Which factor predisposes to varicose veins during pregnancy? a. Compressed pelvic veins b. Stenotic valves in leg veins c. Thrombus formation d. Insufficient muscle support for veins
ANS: A
77. A prolonged period of shock is likely to cause: a. damage to, and increased permeability of, pulmonary capillaries. b. increased permeability of the glomerular capillaries of the kidneys. c. increased pH of blood and body fluids. d. increased systemic vasoconstriction.
ANS: A
82. A common adverse effect of many antihypertensive medications is: a. orthostatic hypotension. b. bradycardia. c. altered blood coagulation. d. peripheral edema.
ANS: A
90. In the period immediately following a myocardial infarction, the manifestations of pallor and diaphoresis, rapid pulse, and anxiety result from: a. onset of circulatory shock. b. the inflammatory response. c. release of enzymes from necrotic tissue. d. heart failure.
ANS: A
91. Septic shock differs from hypovolemic shock in that it is frequently manifested by: a. fever and flushed face. b. elevated blood pressure. c. increased urinary output. d. slow bounding pulse.
ANS: A
98. In patients with congestive heart failure, ACE inhibitor drugs are useful because they: a. reduce renin and aldosterone secretion. b. slow the heart rate. c. strengthen myocardial contraction. d. block arrhythmias.
ANS: A
74. A compensation for shock would include: a. increased heart rate and oliguria. b. lethargy and decreased responsiveness. c. warm, dry, flushed skin. d. weak, thready pulse.
ANS: A REF: 267
00. In a child with acute rheumatic fever, arrhythmias may develop due to the presence of: a. endocarditis. b. myocarditis. c. pericarditis. d. congestive heart failure.
ANS: B
101. Prophylactic antibacterial drugs such as amoxicillin are given to patients with certain congenital heart defects or damaged heart valves immediately before invasive procedures to prevent: a. formation of septic thrombi. b. infectious endocarditis. c. abscess formation. d. myocarditis.
ANS: B
102. Varicose ulcers may develop and be slow to heal because: a. leg muscles are painful, restricting movement. b. edema reduces arterial blood supply to the area. c. emboli form in damaged veins, leading to local ischemia. d. valves in veins restrict blood flow.
ANS: B
104. Aortic stenosis means the aortic valve: a. allows blood to leak back into the left ventricle during diastole. b. cannot fully open during systole. c. functions to increase stroke volume. d. does not respond to the cardiac cycle.
ANS: B
53. Rheumatic heart disease usually manifests in later years as: a. swollen heart valves and fever. b. cardiac arrhythmias and heart murmurs. c. thrombus formation and septic emboli. d. petechial hemorrhages of the skin and mucosa.
ANS: B
62. Atherosclerosis in the iliac or femoral arteries is likely to cause which of the following? 1. Gangrenous ulcers in the legs 2. Strong rapid pulses in the legs 3. Intermittent claudication 4. Red, swollen legs a. 1, 2 b. 1, 3 c. 2, 3 d. 2, 4
ANS: B
65. An echocardiogram is used to demonstrate any abnormal: a. activity in the conduction system. b. movement of the heart valves. c. change in central venous pressure. d. blood flow in coronary arteries.
ANS: B
75. Why does anaphylactic shock cause severe hypoxia very quickly? a. Generalized vasoconstriction reduces venous return. b. Bronchoconstriction and bronchial edema reduce airflow. c. Heart rate and contractility are reduced. d. Metabolic rate is greatly increased.
ANS: B
79. With shock, anaerobic cell metabolism and decreased renal blood flow cause: a. metabolic alkalosis. b. metabolic acidosis. c. decreased serum potassium. d. increased serum bicarbonate.
ANS: B
80. Shock develops in patients with severe burns as a result of: a. extensive hemorrhage. b. pain and loss of plasma. c. direct damage to the heart. d. extensive hemolysis of erythrocytes.
ANS: B
84. A cardiac pacemaker would most likely be inserted in cases of: a. angina pectoris. b. heart block. c. congestive heart failure. d. ventricular fibrillation.
ANS: B
87. Confirmation of the diagnosis of a myocardial infarction would include: 1. specific changes in the ECG. 2. marked leukocytosis and increased erythrocyte sedimentation rate (ESR). 3. elevation of cardiac isoenzymes in serum. 4. a pattern of pain. a. 1, 2 b. 1, 3 c. 2, 4 d. 3, 4
ANS: B
92. Heart block, in which a conduction delay at the AV node results in intermittent missed ventricular contractions, is called: a. first-degree block. b. second-degree block. c. bundle-branch block. d. total heart block.
ANS: B
93. More extensive permanent damage is likely when a myocardial infarction is caused by: a. a hemorrhage. b. an embolus. c. a thrombus. d. an arrhythmia.
ANS: B
70. Phlebothrombosis is more likely to cause pulmonary emboli than is thrombophlebitis because: a. platelets attach to the inflamed wall. b. thrombus forms in a vein and is less firmly attached. c. leg cramps require massage. d. systemic signs of inflammation require treatment.
ANS: B REF: 264
73. What are the early signs of circulatory shock? 1. Pale moist skin 2. Loss of consciousness 3. Anxiety and restlessness 4. Rapid strong pulse a. 1, 2 b. 1, 3 c. 1, 4 d. 3, 4
ANS: B REF: 267
103. Excessive fluid in the pericardial space causes: a. increased cardiac output. b. myocardial infarction. c. reduced venous return. d. friction rub.
ANS: C
56. Pericarditis causes a reduction in cardiac output as a result of which of the following? a. Delays in the conduction system, interfering with cardiac rhythm b. Weak myocardial contractions due to friction rub c. Excess fluid in the pericardial cavity, which decreases ventricular filling d. Incompetent valves, which allow regurgitation of blood
ANS: C
58. A source of an embolus causing an obstruction in the brain could be the: a. femoral vein. b. pulmonary vein. c. carotid artery. d. coronary artery.
ANS: C
64. What is the primary reason for amputation of gangrenous toes or feet in patients with peripheral vascular disease? a. It promotes more rapid healing of ulcerated areas. b. It improves circulation to other areas. c. It prevents spread of infection and reduces pain. d. It reduces swelling in the peripheral areas.
ANS: C
66. A friction rub is associated with: a. infectious endocarditis. b. arrhythmias. c. pericarditis. d. an incompetent aortic valve.
ANS: C
71. Shock is defined as: a. failure of the heart to supply sufficient blood to body cells. b. general hypoxia, causing damage to various organs. c. decreased circulating blood and tissue perfusion. d. loss of blood, causing severe hypoxia.
ANS: C
78. What would indicate decompensated acidosis related to shock? a. Serum bicarbonate level below normal b. PCO2 above normal c. Serum pH below normal range d. Urine pH of 4.5
ANS: C
85. Which of the following is considered to be the most dangerous arrhythmia? a. Tachycardia b. Bradycardia c. Ventricular fibrillation d. Second-degree heart block
ANS: C
97. Which statement applies to paroxysmal nocturnal dyspnea? a. It indicates decreased CO2 diffusion in the lungs. b. It indicates swelling in the bronchioles and bronchi. c. It is caused by increased blood in the lungs when lying in a supine position. d. It results from pleural effusion.
ANS: C
81. The classic early manifestation(s) of left-sided congestive heart failure is/are ____, whereas the early indicator(s) of right-sided failure is/are _______. a. palpitations and periodic chest pain; shortness of breath on exertion b. swelling of the ankles and abdomen; chest pain c. shortness of breath on exertion or lying down; swelling of the ankles d. coughing up frothy sputum; hepatomegaly and splenomegaly
ANS: C REF: 249-250
63. The term intermittent claudication refers to: a. sensory deficit in the legs due to damage to nerves. b. chest pain related to ischemia. c. ischemic muscle pain in the legs, particularly with exercise. d. dry, cyanotic skin with superficial ulcers.
ANS: C REF: 261
68. The outcome for many aortic aneurysms is: a. early diagnosis and repair. b. thrombus formation and pulmonary embolus. c. rupture and hemorrhage. d. pressure on adjacent organs or structures.
ANS: C REF: 262
88. Which of the following statements regarding aneurysms is true? a. Aneurysms are always caused by congenital malformations. b. The greatest danger with aneurysms is thrombus formation. c. Manifestations of aneurysms result from compression of adjacent structures. d. Aneurysms involve a defect in the tunica media of veins.
ANS: C REF: 263
51. The initial effect on the heart in cases of rheumatic fever is: a. infection in the heart by hemolytic streptococci. b. highly virulent microbes causing vegetations on the heart valves. c. septic emboli obstructing coronary arteries. d. acute inflammation in all layers of the heart due to abnormal immune response.
ANS: D
59. The basic pathophysiological change associated with essential hypertension is: a. development of lipid plaques in large arteries. b. recurrent inflammation and fibrosis in peripheral arteries. c. degeneration and loss of elasticity in arteries. d. increased systemic vasoconstriction.
ANS: D
67. A dissecting aortic aneurysm develops as: a. a dilation or bulge that develops at one point on the aortic wall. b. a thrombus that accumulates at a point in the aortic wall. c. a section of the aorta that weakens and dilates in all directions. d. a tear in the intimal lining, which allows blood flow between layers of the aortic wall.
ANS: D
72. Shock follows a myocardial infarction when: a. the stress response causes general vasodilation. b. fluid is lost into ischemic tissues. c. heart valves are damaged. d. a large portion of the myocardium is damaged.
ANS: D
76. Neurogenic (vasogenic) shock results from systemic vasodilation due to: a. increased peripheral resistance and less blood in the microcirculation. b. increased permeability of all the blood vessels, leading to hypovolemia. c. slower, less forceful cardiac contractions. d. increased capacity of the vascular system and reduced venous return.
ANS: D
83. The cause of essential hypertension is considered to be: a. chronic renal disease. b. excessive intake of saturated fats and salt. c. sedentary lifestyle. d. idiopathic.
ANS: D
86. Which of the following is NOT true of the drug nitroglycerin? a. It decreases myocardial workload by causing systemic vasodilation. b. It may be administered sublingually, transdermally, or by oral spray. c. Dizziness or syncope may follow a sublingual dose. d. It strengthens the myocardial contraction.
ANS: D
95. The right side of the heart would fail first in the case of: 1. severe mitral valve stenosis. 2. uncontrolled essential hypertension. 3. large infarction in the right ventricle. 4. advanced chronic obstructive pulmonary disease (COPD). a. 1, 2 b. 2, 3 c. 1, 4 d. 3, 4
ANS: D
99. In a child with ventricular septal defect, altered blood flow: a. leads to increased stroke volume from the left ventricle. b. results in unoxygenated blood in the systemic circulation. c. is called a right-to-left shunt. d. is called a left-to-right shunt.
ANS: D
94. A very rapid heart rate reduces cardiac output because: a. venous return is increased. b. ventricular fibrillation develops immediately. c. conduction through the AV node is impaired. d. ventricular filling is reduced. ANS: D REF: 243
ANS: D REF: 243
57. Pericarditis may be caused by: 1. infection. 2. abnormal immune responses. 3. injury. 4. malignant neoplasm. a. 1, 2 b. 3, 4 c. 1, 3, 4 d. 1, 2, 3, 4
ANS: D REF: 258
89. The most common factor predisposing to the development of varicose veins is: a. trauma. b. congenital valve defect in the abdominal veins. c. infection. d. increased venous pressure.
ANS: D REF: 263
96. Which of the following compensations that develop in patients with congestive heart failure eventually increase the workload of the heart? a. Faster heart rate and cardiomegaly b. Peripheral vasoconstriction c. Increased secretion of renin d. A and C e. A, B, and C
ANS: E REF: 246
