Pathophysiology Exam 3

Which factor predisposes to varicose veins during pregnancy? 1) Compressed pelvic veins 2) Stenotic valves in leg veins 3) Thrombus formation 4) Insufficient muscle support for veins

1) Compressed pelvic veins

Septic shock differs from hypovolemic shock in that it is frequently manifested by: 1) fever and flushed face. 2) elevated blood pressure. 3) increased urinary output. 4) slow bounding pulse.

1) fever and flushed face. SEPTIC SHOCK = WARM SHOCK hypovolemic = vasoconstriction due to reduced volume and flow

A compensation for shock would include: 1) increased heart rate and oliguria. 2) lethargy and decreased responsiveness. 3) warm, dry, flushed skin. 4) weak, thready pulse.

1) increased heart rate and oliguria.

Uncontrolled hypertension is most likely to cause ischemia and loss of function in the: 1) kidneys, brain, and retinas of the eye. 2) peripheral arteries in the legs. 3) aorta and coronary arteries. 4) liver, spleen, and stomach.

1) kidneys, brain, and retinas of the eye.

In the period immediately following a myocardial infarction, the manifestations of pallor and diaphoresis, rapid pulse, and anxiety result from: 1) onset of circulatory shock. 2) the inflammatory response. 3) release of enzymes from necrotic tissue. 4) heart failure.

1) onset of circulatory shock.

In patients with congestive heart failure, ACE inhibitor drugs are useful because they: 1) reduce renin and aldosterone secretion. 2) slow the heart rate. 3) strengthen myocardial contraction. 4) block arrhythmias.

1) reduce renin and aldosterone secretion.

Septic emboli, a common complication of infective endocarditis, are a result of the fact that: 1) vegetations are loosely attached and fragile. 2) the valves are no longer competent. 3) cardiac output is reduced. 4) heart contractions are irregular.

1) vegetations are loosely attached and fragile.

A partial obstruction in a coronary artery will likely cause: 1) pulmonary embolus. 2) hypertension. 3) angina attacks. 4) myocardial infarction.

3) angina attacks. partial = angina, complete = MI

The first arteries to branch off the aorta are the: 1) common carotid arteries. 2) pulmonary arteries. 3) coronary arteries. 4) subclavian arteries.

3) coronary arteries. R and L

Shock is defined as: 1) failure of the heart to supply sufficient blood to body cells. 2) general hypoxia, causing damage to various organs. 3) decreased circulating blood and tissue perfusion. 4) loss of blood, causing severe hypoxia.

3) decreased circulating blood and tissue perfusion.

Excessive fluid in the pericardial space causes: 1) increased cardiac output. 2) myocardial infarction. 3) reduced venous return. 4) friction rub.

3) reduced venous return. Friction rub is less fluid, fluid constricting heart so low CO

Calcium-channel blocking drugs are effective in: 1) reducing the risk of blood clotting. 2) decreasing the attraction of cholesterol into lipid plaques. 3) reducing cardiac and smooth muscle contractions. 4) decreasing all types of cardiac arrhythmias.

3) reducing cardiac and smooth muscle contractions.

The cardiac reserve is: 1) afterload. 2) the difference between the apical and radial pulses. 3) the ability of the heart to increase cardiac output when needed. 4) the extra blood remaining in the heart after it contracts.

3) the ability of the heart to increase cardiac output when needed.

Why does anaphylactic shock cause severe hypoxia very quickly? 1) Generalized vasoconstriction reduces venous return. 2) Bronchoconstriction and bronchial edema reduce airflow. 3) Heart rate and contractility are reduced. 4) Metabolic rate is greatly increased.

2) Bronchoconstriction and bronchial edema reduce airflow.

Which of the following describes the pericardial cavity? 1) It contains sufficient fluid to provide a protective cushion for the heart. 2) It is a potential space containing a very small amount of serous fluid. 3) It is lined by the endocardium. 4) It is located between the double-walled pericardium and the epicardium.

2) It is a potential space containing a very small amount of serous fluid.

In an infant, the initial indication of congestive heart failure is often: 1) distended neck veins. 2) feeding problems. 3) low-grade fever and lethargy. 4) frequent vomiting.

2) feeding problems.

A cardiac pacemaker would most likely be inserted in cases of: 1) angina pectoris. 2) heart block. 3) congestive heart failure. 4) ventricular fibrillation.

2) heart block. Pacemaker for hear block or SA/AV node problems Defibrillator for Vfib

The endothelial cells of the vasculature have a(n) ______ action and conrol the nearby smooth muscle cells and local environs. 1) endocrine 2) paracrine 3) autocrine 4) coagulative

2) paracrine autocrine - controls itself paracrine - controls things around it

Unoxygenated blood enters the systemic circulation in children with tetralogy of Fallot because: 1) the aorta and pulmonary artery have exchanged positions. 2) pulmonary stenosis changes the ventricular pressures. 3) the left ventricular wall has hypertrophied. 4) the septal defect allows exchange of blood between the atria.

2) pulmonary stenosis changes the ventricular pressures. TOF is the most common cyanotic VSD 4 signs - VSD, RVH, overriding aorta, pulmonary stenosis

Cardiac output refers to: 1) the amount of blood passing through either of the atria. 2) the volume of blood ejected by a ventricle in one minute. 3) the volume of blood ejected by each ventricle in a single contraction. 4) the total number of heartbeats in one minute.

2) the volume of blood ejected by a ventricle in one minute. CO = /1min SV = /contraction

Pericarditis may be caused by: 1--infection. 2--abnormal immune responses. 3--injury. 4--malignant neoplasm. 1) 1, 2 2) 3, 4 3) 1, 3, 4 4) 1, 2, 3, 4

4) 1, 2, 3, 4

The term cardiac arrest refers to which of the following? 1) Condition where cardiac output is less than the demand 2) A decreased circulating blood volume 3) Missing a ventricular contraction 4) The cessation of all cardiac function

4) The cessation of all cardiac function

Which of the following is most likely to cause left-sided congestive heart failure? 1) Incompetent tricuspid heart valve 2) Chronic pulmonary disease 3) Infarction in the right atrium 4) Uncontrolled essential hypertension

4) Uncontrolled essential hypertension HTN = high systemic BP, so high aortic pressure causes LVH, causing LHF

A sign of aortic stenosis is: 1) increased cardiac output. 2) congestion in the liver, spleen, and legs. 3) flushed face and headache. 4) a heart murmur.

4) a heart murmur. MS, MR, AS, AI = the big murmurs Narrowing of aorta

A dissecting aortic aneurysm develops as: 1) a dilation or bulge that develops at one point on the aortic wall. 2) a thrombus that accumulates at a point in the aortic wall. 3) a section of the aorta that weakens and dilates in all directions. 4) a tear in the intimal lining, which allows blood flow between layers of the aortic wall

4) a tear in the intimal lining, which allows blood flow between layers of the aortic wall

The normal delay in conduction through the AV node is essential for: 1) preventing an excessively rapid heart rate. 2) limiting the time for a myocardial contraction. 3) allowing the ventricles to contract before the atria. 4) completing ventricular filling.

4) completing ventricular filling.

The most common factor predisposing to the development of varicose veins is: 1) trauma. 2) congenital valve defect in the abdominal veins. 3) infection. 4) increased venous pressure.

4) increased venous pressure.

An atheroma develops from:

Accumulated lipids, cells, and fibrin where endothelial injury has occurred

Asprin vs. Warfrin

Asprin blocks platelet comparability Warfrin blocks everything

Type of shock in which the overall capacity of the vascular system is increased, but there is not volume to support it or cardiac ability to pump it where needed, leading to all the changes of shock (reduced oxygenation of tissues, level of consciousness changes)

Neurogenic/ Vascular Hypovolemic = vasoconstriction from low blood volume and decreased flow Cardiogenic = vasoconstriction from heart damage

Which is a common adverse effect of many antihypertensive medications? a. orthostatic hypotension b. bradycardia c. altered blood coagulation d. peripheral edema

a. orthostatic hypotension

Low-density lipoproteins (LDL): a. promote atheroma development b. contain only small amounts of cholesterol c. transport cholesterol from cells to the liver for excretion d. are associated with low intake of saturated fats

a. promote atheroma development Transport to body cells (VLDL's from liver to body cells)

Modifiable factor that increase the risk for atherosclerosis include: a. sedentary life style b. female more than 40 years of age c. exclusion of saturated fats from the diet d. familial hypercholesterolemia

a. sedentary life style

What does the term preload refer to? a. volume of venous return b. peripheral resistance c. stroke volume d. cardiac output

a. volume of venous return End-diastolic-volume

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

b. 1, 3

What is atherosclerosis in the iliac or femoral arteries likely to cause? 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

b. 1, 3

Why does cyanosis occur in children with tetralogy of Fallot? a. More carbon dioxide is present in the circulating blood. b. A large amount of hemoglobin in the general circulation is unoxygenated. c. The pulmonary circulation is overloaded and congested. d. The circulation is sluggish (slow) throughout the system

b. A large amount of hemoglobin in the general circulation is unoxygenated.

Which of the following drugs improves cardiac efficiency by slowing the heart rate and increasing the force of cardiac contractions? a. Furosemide b. Digoxin c. Epinephrine d. Nifedipine

b. Digoxin

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

b. an embolus

How does rheumatic heart disease usually manifest in later years? 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

b. cardiac arrhythmias and heart murmurs

Which of the following effects may be expected from a beta-adrenergic blocking drug? a. increasing systemic vasoconstriction b. decreased sympathetic stimulation of the heart c. blockage of an angiotensin receptor site d. increased release of renin

b. decreased sympathetic stimulation of the heart

For which of the following would a cardiac pacemaker likely be inserted? a. angina pectoris b. heart block c. congestive heart failure d. ventricular fibrillation

b. heart block

Which is the best definition of congestive heart failure? a. cessation of all cardiac activity b. inability of the heart to pump enough blood to meet the metabolic needs of the body c. insufficient circulating blood in the body d. the demand for oxygen by the heart is greater than the supply

b. inability of the heart to pump enough blood to meet the metabolic needs of the body

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

b. movement of the heart valves

Why does shock develop in patients with severe burns? a. extensive hemorrhage b. pain and loss of plasma c. direct damage to the heart d. extensive hemolysis of erythrocytes

b. pain and loss of plasma

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

b. second-degree block

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 asymptomatic c. leg cramps require massage d. systemic signs of inflammation require treatment

b. thrombus forms in a vein and is asymptomatic

Each of the following compares the output of blood from the left and right ventricles with each contraction of a normal heart. Which is correct? a. Left ventricular output is slightly greater than the right ventricular output. b. Left ventricular output is approximately double that of right ventricular output. c. Left ventricular output equals the right ventricular output. d. Left ventricular output is less than right ventricular output.

c. Left ventricular output equals the right ventricular output.

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.

c. Manifestations of aneurysms result from compression of adjacent structures.

Which of the following best describes the basic pathophysiology of myocardial infarction? a. Cardiac output is insufficient to meet the needs of the heart and body. b. Temporary vasospasm occurs in a coronary artery. c. Total obstruction of a coronary artery causes myocardial necrosis. d. Heart rate and force is irregular, reducing blood supply to coronary arteries.

c. Total obstruction of a coronary artery causes myocardial necrosis.

Which statement describes a coronary artery bypass procedure? a. removing the section of an artery containing plaque and thrombus b. compressing the thrombus with an inflated balloon to provide a larger lumen c. attaching a section of vein to the coronary artery proximal and distal to the obstruction d. adding a piece of vein to the end of each coronary artery

c. attaching a section of vein to the coronary artery proximal and distal to the obstruction

Which of the following could be the source of an embolus causing an obstruction in the brain? a. femoral vein b. pulmonary vein c. carotid artery d. coronary artery

c. carotid artery

How is shock defined? 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

c. decreased circulating blood and tissue perfusion

What does the term intermittent claudication refer 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

c. ischemic muscle pain in the legs, particularly with exercise

A friction rub is associated with: a. infectious endocarditis b. arrhythmias c. pericarditis d. an incompetent aortic valve

c. pericarditis

Cigarette smoking is a risk factor in coronary artery disease because smoking: a. reduces vasoconstriction and peripheral resistance b. decreases serum lipid levels c. promotes platelet adhesion d. increases serum HDL levels

c. promotes platelet adhesion

In which blood vessels will failure of the left ventricle cause increased hydrostatic pressure? a. veins of the legs and feet b. jugular veins c. pulmonary capillaries d. blood vessels of the liver and spleen

c. pulmonary capillaries

Vasodilation in the skin and viscera results directly from: a. decreased blood pressure b. increased parasympathetic stimulation c. relaxation of smooth muscle in the arterioles d. increased stimulation of alpha-adrenergic receptors

c. relaxation of smooth muscle in the arterioles

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

c. serum pH below normal range Not PCO2 bc shock casues metabolic acidosis

Factors that may precipitate an angina attack include all of the following EXCEPT: a. eating a large meal b. an angry argument c. walking down stairs d. shovelling snow on a cold, windy day

c. walking down stairs

MI is confirmed by:

characteristic patterns of serum isoenzymes (triponin, BNP, CK) and EKG

Blood Gas

check in recent MI and shock acid/base and blood O2

Cardiac control center

controls rate and force of heart contraction through sympathetic and parasympathetic stimulation no parasympathetic in vessels

Which of the following are predisposing factors to thrombus formation in the circulation? 1. decreased viscosity of the blood 2. damaged blood vessel walls 3. immobility 4. prosthetic valves a. 1, 3 b. 2, 4 c. 1, 3, 4 d. 2, 3, 4

d. 2, 3, 4 Virchows Triad -- stasis, damaged walls, hypercoagubility Decreased viscosity = more watery, less coaguable

When does shock follow myocardial infarction? 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.

d. A large portion of the myocardium is damaged. Circulatory shock

When comparing angina with myocardial infarction (MI), which statement is true? a. Both angina and MI cause tissue necrosis. b. Angina often occurs at rest; MI occurs during a stressful time. c. Pain is more severe and lasts longer with angina than with MI. d. Angina pain is relieved by rest and intake of nitroglycerin; the pain of MI is not.

d. Angina pain is relieved by rest and intake of nitroglycerin; the pain of MI is not.

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.

d. It strengthens the myocardial contraction.

Which of the following causes increased heart rate? a. stimulation of the vagus nerve b. increased renin secretion c. administration of beta-blocking drugs d. Stimulation of the sympathetic nervous system

d. Stimulation of the sympathetic nervous system

Which of the following represent(s) the pathophysiologic changes in the heart in cases of rheumatic fever? 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. an abnormal immune response, causing acute inflammation in all layers of the heart

d. an abnormal immune response, causing acute inflammation in all layers of the heart

Which of the following drugs decrease sodium and fluid retention in the body? a. warfarin (Coumadin) b. digoxin (Lanoxin) c. nitroglycerin (Isordil) d. hydrochlorothiazide (Hydro DIURIL)

d. hydrochlorothiazide (Hydro DIURIL)

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

d. idiopathic

Why does neurogenic (vasogenic) shock result from systemic vasodilation? 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

d. increased capacity of the vascular system and reduced venous return

What is considered to be the basic pathophysiologic change in essential hypertension? 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

d. increased systemic vasoconstriction

What is the function of the baroreceptors? To: a. stimulate the parasympathetic or sympathetic nervous systems at the SA node as needed b. adjust blood pressure by changing peripheral resistance c. sense a change in blood oxygen and carbon dioxide levels d. signal the cardiovascular control center of changes in systemic blood pressure

d. signal the cardiovascular control center of changes in systemic blood pressure

Which change results from total heart block? a. a prolonged PR interval b. periodic omission of a ventricular contraction c. a wide QRS wave d. spontaneous slow ventricular contractions, not coordinated with atrial contraction

d. spontaneous slow ventricular contractions, not coordinated with atrial contraction

What does the term arteriosclerosis specifically refer to?

degeneration with loss of elasticity and obstruction in small arteries

Pulse deficit

difference from radial and apical

puse pressure

difference in systolic and diastolic

Yuong children first sign of CHF:

feeding problems

vasodilaton

headache syncope dizziness and flushing

Exercising

helps to build collateral's, when theres not enough O2 during exercise it grows collateral's

Cardiac Cath

look at Pulm Cap Wegde Pressure and Central Venous Pressure

An incompetent mistral valve will cause:

low CO from the LV

SPECT

measures ischemia at rest specialized CT scan

Tomographic Studies

nuclear imiaging test that measures level of tissue mass

Match the endocrine/paracrine molecule to its usual action in most parts of the body parasympathetic action endothelin angiotensin II nitric oxide epinephrine 1.most active vasoconstrictor released from vessel-lining cells 2.a vasoconstrictor released from adrenal cells 3.the most important vasodilator released from arterial lining cells 4.results in widespread vasodilation 5.the vasoconstrictor signalled to form by the kidney

parasympathetic action -- results in widespread vasodilation endothelin -- most active vasoconstrictor released from vessel-lining cells angiotensin II -- the vasoconstrictor signaled to form by the kidney nitric oxide -- the most important vasodilator released from arterial lining cells epinephrine -- a vasoconstrictor released from adrenal cells

typical early signs of MI:

persistent chest pain radiating to the left arm, pallor, and rapid, weak pulse

BB

prevent sympathetic stimulation

compensation for decreased CO:

reinin and aldosterone secretion

What is the outcome for many aortic aneurysms?

rupture and hemorrhage

Things that increase HR:

smoking, exercise, pregnancy

Metabolic syndrome includes

1. Changes in far distribution - APPLE (increased waist circumference) (Pear is normal) 2. Type 2 diabetes - bad atherosclerotic disease and insulin resistance 3. Lipid derangement (multiple changes in lipoprotein metabolism) 4. HTN - continued endothelial damage, low HDL, high LDL

Prophylactic for angina

CCB

VSD

L --> R blood flow

Coronaries:

Left is more important becasue it supplies the LV R coronary supplies R side of heart and inter ventricular supplies LA = circumflex RA = RV =

Which of the following apply 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.

a. A microbe of low virulence attacks abnormal or damaged heart valves.

Most dangerous arrhythmia?

Vfib

Which of the following results from increased secretion of epinephrine? a. increased heart rate and force of contraction b. decreased stimulation of the SA node and ventricles c. vasoconstriction in skeletal muscles and kidneys d. vasodilation of cutaneous blood vessels

a. increased heart rate and force of contraction

What indicates compensation for shock? a. increased heart rate and oliguria b. lethargy and decreased responsiveness c. warm, dry, flushed skin d. weak, thready pulse

a. increased heart rate and oliguria

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

a. arthritis causing deformity of the small joints in the hands and feet RHD = Polyarthritis of large joints Erythema Marginatum/ Subcutaneous nodles Sydenhams chorea Carditis

What is the most common cause of death immediately following a myocardial infarction? a. cardiac arrhythmias b. ruptured ventricle c. congestive heart failure d. cerebrovascular accident

a. cardiac arrhythmias

What is a prolonged period of shock likely to cause? a. damage 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

a. damage and increased permeability of pulmonary capillaries