Pathophysiology/Risk Factors Quiz
Which of the following statements concerning the surgical treatment of coronary artery disease is true? A. A coronary artery stent carries a lower rate of revascularization than does percutaneous transluminal coronary angioplasty. B. Atherectomy is a prerequisite requirement for percutaneous transluminal coronary angioplasty. C. Venous grafts are significantly superior to arterial grafts in terms of patency. D. Long-term outcome of laser angioplasty is unknown and, thus, rarely used.
A. A coronary artery stent carries a lower rate of revascularization than does percutaneous transluminal coronary angioplasty. Restenosis occurs within 6 months in approximately 30-50% of patients who have had a PTCA, whereas a stent has about a 25% failure rate and the drug-eluting stent having a restenosis rate in the low single digits. Atherectomy can be used along with PTCA and is useful when the PTCA catheter cannot pass through the artery, but atherectomy is not a prerequisite for PTCA. Internal mammary artery grafts are preferred over saphenous venous grafts because of superior patency (90% versus <50% at 10 years). About 25-50% of patients will experience a restenosis within 6 months of laser angioplasty.
All of the following risk factors for coronary artery disease can be modified by a regular and appropriate exercise training program except _____________. A. Advancing Age B. Diabetes Mellitus C. Hypertension D. High-Density Lipoprotein Cholesterol
A. Advancing Age A modifiable risk factor is one that be influenced by either surgical, pharmacologic, or behavioral intervention. Scientific studies have shown that a regular and appropriate exercise program can reduce the risk of developing DM, hypertension, and unfavorable HDL levels or it can be used as an adjunct treatment.
The primary effects of chronic exercise training on blood lipids include ___________. A. Decreased triglycerides and increased high-density lipoproteins B. Decreased total cholesterol and low-density lipoproteins C. Decreased high-density lipoprotein and increased low-density lipoproteins D. Decreased total cholesterol and increased high-density lipoproteins
A. Decreased triglycerides and increased high-density lipoproteins Chronic exercise training has its greatest benefit on lowering triglycerides (TGs) and increasing high-density lipoproteins (HDL). Changes in total cholesterol or low-density lipoprotein (LDL) cholesterol are influenced more by dietary habits and body weight than by exercise training.
A sedentary lifestyle ________________. A. Has a risk similar to that of hypertension, high cholesterol, and cigarette smoking. B. Increases high-density lipoprotein (HDL) cholesterol C. Increases the sensitivity to insulin D. Has little influence on mortality rates after an MI
A. Has a risk similar to that of hypertension, high cholesterol, and cigarette smoking. The risk ratios of hypertension (2.1), high cholesterol (2.4), cigarette smoking (2.5), and physical inactivity (1.9) are similar. A sedentary lifestyle is associated with low HDL cholesterol and sensitivity to insulin (higher plasma glucose values). Studies have shown that, after an MI, a regular exercise training program can significantly reduce mortality rates in these patients as compared with those who are less active after an MI.
Which answer below best describes the condition of asthma? A. Narrowing of the bronchial airways B. Alveolar destruction C. Ventilatory dead space D. Respiratory muscular atrophy
A. Narrowing of the bronchial airways Asthma is a narrowing or vasoconstriction of the bronchial airways that is initiated by some trigger such as, for example, dust or cigarette smoke. Destruction of the alveoli and impaired ventilation (dead space) is the pathophysiology of emphysema. When the muscles of respiration are comprised (e.g., muscular dystrophy), then restrictive lung disease can occur.
What is the current state of knowledge on progression or regression of atherosclerosis in human coronary arteries? A. Regression of atherosclerosis has been observed in clinical studies. B. Regression of atherosclerosis has yet to observed in clinical studies. C. Progression of atherosclerosis begins at puberty. D. There is no difference in the rate of progression or regression between those who undergo usual medical care and those who aggressively control risk factors.
A. Regression of atherosclerosis has been observed in clinical studies. Clinical studies of cardiac patients have shown that long-term aggressive control of CAD risk factors can reduce or halt the rate of disease progression and may actually result in regression of atherosclerotic plaque. Individuals who aggressively attack, reduce, and control risk factors are more likely to see favorable results than individuals who undergo usual medical care. The process of atherosclerosis begins at birth.
A classic sign of subendocardial ischemia is ________. A. Angina B. AT segment depression C. ST segment elevation D. A pathologic Q wave
B. AT segment depression A classic sign of MI ischemia is ST segment alteration. ST segment depression suggests subendocardial ischemia, whereas ST segment elevation indicates transmural ischemia, whereas ST segment elevation indicates transmural ischemia or acute MI. Pathologic Q waves point to transmural MI. Angina is a classic symptom, not a sign, of ischemia.
A cardiac patient is taking a B-blocker medication. During an exercise test, you would expect _______________. A. ST segment depression because B-blockers depress ST segment on the resting ECG B. An increase in the anginal threshold compared with a test without the medication C. No change in heart rate or blood pressure compared with a test without the medication D. A slight decrease or no effect on blood pressure compared with a test without the medication
B. An increase in the anginal threshold compared with a test without the medication B-blockers increase the angina threshold by reducing myocardial oxygen demand at rest and during exercise. This occurs through a reduction in chronotropic (heart rate) and inotropic (strength of contraction) responses. Blood pressure is also reduced at rest and during exercise by a reduction in cardiac output (reduced chronotropic and inotropic response) and a reduction in total peripheral resistance. B-blockers do not produce ST segment changes on the resting ECG.
What is the correct term and definition to describe a potential complication that may occur after an acute myocardial infarction (MI)? A. Expansion - another MI B. Aneurysm - bulging of the ventricular wall C. Extension - left ventricular dilation D. Rupture - coronary artery breaks open
B. Aneurysm - bulging of the ventricular wall A ventricular aneurysm is a bulging of the ventricular wall. Expansion is dilation of the left ventricle while extension is another MI. Rupture is an aneurysm that breaks open in the ventricular wall not the coronary artery.
The loss of elasticity (or "hardening") of the arteries is known as ________. A. Atherosclerosis B. Arteriosclerosis C. Atheroma D. Adventitia
B. Arteriosclerosis Arteriosclerosis, also called "hardening" of the arteries, is a loss of arterial elasticity and is associated with aging. Atherosclerosis is a form of arteriosclerosis characterized by an accumulation of obstructive lesions within the arterial wall. The adventitia, the outermost layer of the artery wall, provides the media and intima with oxygen and other nutrients.
All of the following are suggestive of cardiovascular and pulmonary disease except _________. A. A sharp, jabbing pain in the side when running B. Dyspnea during strenuous exertion C. Syncope during moderate-intensity exercise training D. Substernal burning that occurs during exertion and dissipates with the rest
B. Dyspnea during strenuous exertion Your response was incorrect. The correct response is Dyspnea during strenuous exertion. Dyspnea (shortness of breath) commonly occurs during strenuous exertion in healthy, well-trained persons and during moderate exertion in healthy, untrained persons. It should be regarded as abnormal, however, when it occurs at a level of exertion that is not expected to evoke this symptom in a given individual. Underlying cardiac arrhythmias can cause palpitations, even at rest. Syncope is loss of consciousness ans is abnormal at rest or during any level of exertion. The location (substernal), character (burning), and provoking factor (exertion that dissipates with rest) of substernal burning are features of classic ischemia.
The relationship between heart rate (HR) and oxygen consumption in pulmonary cases is ________. A. Nonlinear B. Linear C. Exponential D. No relationship
B. Linear Patients with pulmonary disease and apparently healthy individuals have a linear increase in heart rate to oxygen consumption. With pulmonary disease, the patient will be limited by some mechanism that ultimately results in inefficient pulmonary gas exchange. An attempt to correct for this factor will be shown by a high ventilation per unit of oxygen consumed (VE/VO2), a high percentage of pulmonary ventilation to maximal voluntary ventilation (VE/MVV), and a high respiratory rate.
Which of the following drugs is used during acute MI to dissolve blood clots, restore blood flow, and limit myocardial necrosis? A. B-blockers B. Thrombolytic agent's therapy C. Sestamibi D. Coronary artery bypass graft surgery
B. Thrombolytic agent's therapy Administration of streptokinase or t-PA (recombinant tissue plasminogen activator) within the first 1-2 hours after an MI may dissolve the clot causing the injury. This type of therapy, called thrombolytic therapy, is designed to restore blood flow and limit myocardial necrosis.
A possible mechanism by which chronic exercise training may reduce resting blood pressure in a person with hypertension is ________. A. An increase in plasma renin B. A higher cardiac output C. A reduced heart rate D. A lower stroke volume
C. A reduced heart rate Blood pressure is the product of cardiac output and total peripheral resistance. A benefit of exercise training is a reduction in cardiac output and total peripheral resistance at any given workload, including rest. A lower dardiac output is probably owing to a reduction in heart rate as a result of an increased stroke volume and arteriovenous oxygen difference. Plasma renin is a catalyst for vasoconstriction. It is reduced, not increased, with exercise training.
Body fat appears to be most dangerous when _________. A. Weight for height exceeds 20% above recommended B. Body fat exceeds 25% for males and 30% for females C. Central (android) obesity is present D. Body mass index exceeds 25 kg/m2
C. Central (android) obesity is present The distribution of body fat, rather than the overall quantity of fat, appears to be the most important predictor of the health risks associated with obesity. Individuals with abdominal fat (central obesity or android) are especially at increased risk for a variety of cardiovascular conditions than individuals with similar body fat levels but with more of their fat on the extremities. A waist-to-hip, or waist alone circumference can be used to assess risk of central obesity. Weight for height tables, body composition assessment, and body mass index provide indices of total excess weight or total fat weight, but do not provide a distribution of body fat.
Which physiologic responses would be expected to occur under conditions of high ambient temperature? A. Increased maximal oxygen B. Decreased hear rate at rest C. Increased heart rate at submaximal workload D. Decreased maximal heart rate
C. Increased heart rate at submaximal workload Compared with a cool and dry environment, a higher metabolic cost exists at submaximal workloads when exercising in the heat and humidity. Thus, the exercise prescription should be altered by lowering the work intensity. Evaporation of sweat cools the skin; therefore, wiping away sweat would decrease evaporative cooling and heat loss. Heat loss by convection, such as that which occurs when a breeze is created by running can be beneficial but not unless the workload of activity is reduced. It is necessary to exercise in the heat and humidity to become acclimated to the environment; it will not occur by being sedentary.
A transient deficiency of blood flow to the myocardium resulting from an imbalance between oxygen demand and oxygen supply is know as _________. A. Infarction B. Angina C. Ischemia D. Thrombosis
C. Ischemia Myocardial ischemia occurs when the oxygen supply does not meet oxygen demand resulting from decreased blood flow to the myocardium. This is usually owing to atherosclerotic lesions reducing blood flow or coronary artery spasm, both of which are the result of atherosclerosis. This process often leads to angina (symptoms) or myocardial infarction caused by a thrombosis.
Modifiable primary risk factors for coronary artery disease include __________. A. Hypertension, dyslipidemia, advancing age, and tobacco smoking B. Homocysteine, lipoprotein (a), C-reactive protein, and gender C. Obesity, diabetes mellitus, tobacco smoking, and sedentary lifestyle D. Tobacco smoking, dyslipidemia, hypertension, and homocysteine
C. Obesity, diabetes mellitus, tobacco smoking, and sedentary lifestyle The primary modifiable risk factors for CAD are tobacco smoking, dyslipidemia, hypertension, sedentary lifestyle, obesity, and DM. The primary nonmodifiable risk factors for CAD are advance age, male gender, and family history. Emerging risk factors for CAD are numerous and include, for example, homocysteine, fibrinogen tissue plasminogen activator, lipoprotein (a), and C-reactive protein.
Which term is used to describe angina pectoris that occurs at rest without a precipitating event? A. Silent B. Stable C. Variant D. Typical
C. Variant Variant, or Prinzmetal's, angina is a form of unstable angina that occurs without provocation at rest owing to coronary vasospasm. Typical, or classic, angina is usually provoked by physical activity or other stressor and is relieved by rest or nitroglycerin. Stable angina is a form of typical angina that is predictable in onset, severity, and means of relief. Silent angina is not a medical term used to describe chest pain, because pain cannot be silent.
Which of the following statements is true concerning the pathophysiology of coronary artery disease? A. Injury to the artery wall begins in the media. B. Platelets and thrombi from in the adventitia. C. The endothelium takes up lipids, especially low-density lipoproteins. D. Atherosclerotic lesions are formed in the intima.
D. Atherosclerotic lesions are formed in the intima. Atherosclerotic lesions are formed in the intima. Injury to the artery wall does not begin in the media but rather in the endothelial layer with subsequent platelet and clot formation. Monocytes adhere to the endothelium, move to the intima, and take up cholesterol. The adventitia, the outermost layer of the artery wall, is not involved in the development of atherosclerosis.
The criteria for the diagnosis of metabolic syndrome includes the following _____________. A. Elevated total cholesterol, obesity, diabetes, and physical inactivity. B. Central obesity, elevated low-density lipoprotein cholesterol, diabetes, and physical inactivity C. Low high-density lipoprotein cholesterol, cigarette smoking, hypertension, and physical inativity D. Central obesity, elevated triglycerides and low high-density lipoprotein cholesterol, hypertension, and insulin resistance
D. Central obesity, elevated triglycerides and low high-density lipoprotein cholesterol, hypertension, and insulin resistance The metabolic syndrome is a cluster of lipid and nonlipid risk factors of metabolic origin. Excess body fat, particularly abdominal obesity, raised blood pressure, insulin resistance (with or without glucose intolerance), and dyslipidemia (elevated TG, and low HDL cholesterol) comprise this deadly quartet. The metabolic syndrome enhances the risk for heart disease exponentially.
What term is used to refer to a group of pulmonary disorders characterized by limitations in airflow that are not fully reversible? A. Bronchitis B. Asthma C. Emphysema D. Chronic obstructive pulmonary disease
D. Chronic obstructive pulmonary disease Bronchitis and emphysema are all forms of chronic obstructive pulmonary disease (COPD). Asthma is a separate category of pulmonary disease.
All of the following are possible causes of restrictive lung disease except ___________. A. Scoliosis B. Obesity C. Muscular Dystrophy D. Cigarette Smoke
D. Cigarette Smoke Restrictive lung disease can be caused by a variety of factors that compromise the ability of the lungs and rib cage to expand outward and upward including, for example, scoliosis, muscular dystrophy, and obesity. Cigarette smoke is risk factor for chronic obstructive lung disease, a condition characterized by inflammation of the airways and impaired gas exchange.
Emerging risk factors for coronary artery disease include _____________. A. Advancing age, family history, and male gender B. Impaired fasting glucose, obesity, and hypertension C. Lipoprotein (a), advancing age, and male gender D. Homocysteine, lipoprotein (a), and fibrinogen
D. Homocysteine, lipoprotein (a), and fibrinogen Primary risk factors are those that have shown a consistent casual link over time and have been proved with much certainty (e.g., advancing age, obesity, hypertension). Emerging risk factors are those that have been shown to be related to an increased risk, but their link has not been causal or consistent in nature. Although such factors (e.g., homocysteine, lipoprotein (a), figrinogen) show promise as independent causes of CAD, additional studies are warranted to assess their complete significance to CAD.
The goal of risk stratification is to _________. A. Determine prognosis B. Assess disease severity C. Confirm diagnosis D. Increase the safety of exercise participation
D. Increase the safety of exercise participation The goal of risk stratification is to increase the safety of exercise training in adult fitness and exercise-based cardiac rehabilitation programs. Initial risk stratification tables are available from the American College of Sports Medicine. Cardiac patients may be further stratified using tables available from the American Heart Association, and American Association of Cardiovascular and Pulmonary Rehabilitation. Although risk stratification is based on the likelihood of experiencing an untoward cardiac event, it does not attempt to diagnose disease, predict prognosis, or determine disease severity. Different nomograms and tables are available for such information.