Systems-Weekly.txt

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emm64
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134083
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Systems-Weekly.txt
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2012-02-09 15:42:52
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Systems Weekly assesments
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Systems Assessments 1-4
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  1. Components of normal hemostasis include:
    • A) An intact blood vessel wall
    • B) Normal platelet function
    • C) Normal coagulation system
    • D) All of the above
  2. Correct Answer(s): D
  3. Rheumatic heart disease refers to a history of rheumatic fever.
    • A) True
    • B) False
  4. Correct Answer(s): False
  5. Which of the following is not a beneficial effect of thrombosis:
    • A) Stops exsanguination from external injury
    • B) Controls local hemorrhage
    • C) Complete obstruction of a vessel shutting off the blood supply and causing ischemia
    • D) Provides growth factors which aid in healing
  6. Correct Answer(s): C
  7. Allosteric thin filament regulation of crossbridge cycling in cardiac muscle is achieved by…
    • A) … the binding and unbinding of 4 calcium ions to the troponin T complex.
    • B) … the binding and unbinding of 2 calcium and 2 magnesium ions to the regulatory light chains of tropomyosin.
    • C) … the binding and unbinding of 4 magnesium ions to Troponin C.
    • D) … the physical blocking and unblocking of the myosin binding site on actin by Ca mediated conformational changes in the Troponin-Tropomyosin complex.
    • E) … the binding of ATP to the Troponin-Tropomyosin complex.
  8. Correct Answer(s): D
  9. Virchow’s triad:
    • A) Describe factors that favor thrombus formation
    • B) Describes factors that inhibit thrombus formation
    • C) Describes 3 diseses named after Virchow
    • D) Describes 3 symptoms described by Virchow
  10. Correct Answer(s): A
  11. The following have anti-coagulation effects:
    • A) Vitamin K
    • B) Protein S
    • C) The fibrinolytic system
    • D) Prostacyclin
  12. Correct Answer(s): B
  13. The normal coagulation system consists of:
    • A) A sequence of enzymatic conversions turning pro-enzymes into activated enzymes
    • B) Involves conversion of soluble fibrinogen into insoluble fibrin
    • C) Involves calcium at multiple steps
    • D) All of the above
  14. Correct Answer(s): D
  15. Select the single INCORRECT statement or statements regarding isometric contractions in cardiac muscle cells or strips.
    • A) Crossbridges are activated and cycling.
    • B) Thick and thin myofilaments are sliding past one another to elicit sarcomere and therefore muscle shortening.
    • C) The force developed by the S1 myosin heads is stored in the S2 spring like section of the molecule during each cycle and attempted power stroke.
    • D) Multiple isometric contractions at different lengths can be used to generate force-length plots.
    • E) Both B & C are incorrect.
  16. Correct Answer(s): B
  17. The Starling Relationship refers to:
    • A) The extrinsic regulation of the cardiac output (CO) by afterload.
    • B) The modulation of the CO by the autonomic nervous system (ANS).
    • C) The modulation of stroke volume and maintenance of the CO on a beat-to-beat basis from circulating catecholamines.
    • D) The modulation of stroke volume and CO by intrinsic changes in ventricular filling (EDV & preload).
    • E) The modulation of the CO by pacemaker activity in the AV node.
  18. Correct Answer(s): D
  19. Refer to the length-tension diagram in note figure 10 (Topic 2) to answer this question. Substitute for the standard filament lengths in diagram 10a to a = 2.0 μm, b = 4.0 μm, c = 0.5 μm, and z = 0. Note that filament “a” is the length of the thick filament; filament “b” is the length of the thin filaments on both sides of the Z line; segment “c” is the length of the bare zone on the thick filament; and “z” is the width of the Z line. Using the diagrams for how the myofilaments interact and the active force-length curve, determine the sarcomere length range for the revised plateau segment, points 2 to 3.
    • A) 1.7 – 2.0 μm
    • B) 2.0 – 2.5 μm
    • C) 2.5 – 4.0 μm
    • D) 4.0 – 4.5 μm
    • E) 2.0 – 4.5 μm
  20. Correct Answer(s): D
  21. Excitation-contraction coupling in cardiac muscle is different than in skeletal muscle because ...
    • A) Tropomyosin blocks the myosin binding site on actin only in cardiac muscle.
    • B) Troponin blocks the myosin binding site on actin only in cardiac muscle.
    • C) Calcium enters the cardiac cell from both the extracellular space via the L-type calcium channels in the T-tubules and regulates the release of calcium from the SR by the ryanodine (RyR) receptor/channel.
    • D) Calcium enters and exits the cardiac myocyte only from the sodium-calcium exchanger.
    • E) No ATP is necessary to return the calcium to the SR in cardiac myocytes.
  22. Correct Answer(s): C
  23. Epinephrine can bind and elicit an adrenergic response from which receptor
    • A) Nicotinic receptors on ventricular myocytes.
    • B) Ligand-gated receptors on atrial myocytes.
    • C) Beta (β) adrenergic receptors on ventricular myocytes.
    • D) Muscarinic receptors on the SA node.
    • E) Alpha (α) receptors in the sympathetic ganglia.
    • Points Earned: 0.0/1.0
  24. Correct Answer(s): C
  25. The following terms describe different amounts of accumulation of blood within tissue:
    • A) Petechiae
    • B) Purpura
    • C) Ecchymoses
    • D) All of the above
    • Points Earned: 0.0/1.0
  26. Correct Answer(s): D
  27. All three muscle types, skeletal, cardiac and smooth, have many features in common. Select the single best answer listing a common feature or features.
    • A) striations.
    • B) actin and myosin.
    • C) excitability.
    • D) neuromuscular junctions.
    • E) Both B & C are correct.
  28. Correct Answer(s): E
  29. Select the single INCORRECT statement regarding stroke work.
    • A) Stroke work is the work performed by the ventricles during a single beat.
    • B) Stroke work is a time dependent variable like auxotonic contractions.
    • C) Stroke work index is calculated by normalizing the stroke work to body surface area.
    • D) Stroke work can be determined from the area of the Pressure-Volume loop.
    • E) Stroke work and stroke work index can be a useful tools to assess the metabolic demand of the heart.
  30. Correct Answer(s): B
  31. Select the single best statement regarding the filling phase of the cardiac cycle.
    • A) All the valves are closed.
    • B) Blood flows from the higher pressures in the atria to the lower pressures in the ventricles via the AV valves.
    • C) Blood flows from the higher pressures in the ventricles to the lower pressures in the aorta via the aortic and pulmonary valves.
    • D) The atria contract late in this phase to provide some extra filling into the ventricles.
    • E) Both B & D are correct.
  32. Correct Answer(s): E
  33. Select the single best statement regarding sarcomere structure and function.
    • A) The A-band width becomes narrower when sarcomeres shorten.
    • B) The H-zone is centered about the Z-line which binds thick filaments in register.
    • C) In cross-section, the thick and thin filaments are highly organized into a hexagonal arrangement with 6 thin filaments surrounding each thick filament.
    • D) Smooth muscle is characterized by large multinucleated fibers without striations.
    • E) Cardiac muscle sarcomeres from adjacent cells are held in register by the intermediate filament protein titin which transversely links myofibrils at the Z-line.




    Correct Answer(s): C
  34. Select the single correct statement about cardiac energetics.
    • A) The heart can store excess phosphate energy via the creatine phosphate mechanism.
    • B) The heart relies primarily upon oxidative phosphorylation to provide the constant supply of ATP for muscle contraction.
    • C) The heart relies primarily upon glycolysis to provide the constant supply of ATP for muscle contraction.
    • D) Oxygenated blood is supplied continuously from the venous return in the right ventricle.
    • E) There are few mitochondria in cardiac cells.
  35. Correct Answer(s): B
  36. Refer to the afterloaded contraction plots in note figure 15B (Topic 2) to answer the following question. In the contraction with the 0.35 mg afterload, during which time segment or segments is the contraction isotonic?
    • A) Time 0 – 0.12 sec
    • B) Time 0 – 0.12 and 0.43 – 0.6 sec
    • C) Time 0.12 – 0.43 sec
    • D) It is isotonic the entire time.
    • E) It is never isotonic.
  37. Correct Answer(s): C
  38. Which of the following statements about the crossbridge cycle in striated muscle is NOT correct?
    • A) ATP is the source of energy for the conformational changes in myosin S1 that generate force in the crossbridge cycle.
    • B) ATP binds to the S2 segment of myosin where it is hydrolyzed to “energize” the myosin.
    • C) The rigor state of strong acto-myosin binding occurs when no ATP is available.
    • D) The power stroke occurs following the release of inorganic phosphate (Pi) and ADP from the S1 myosin head.
    • E) Crossbridges will cycle repetitively as long as ATP is available and the myosin S1 head is in proximity to actin and its myosin binding site.
  39. Correct Answer(s): B
  40. In the course of their activity, platelets do the following:
    • A) Adhere to exposed collagen
    • B) Secrete products from granules that aid in thrombosis
    • C) Aggregate to form a temporary hemostatic plug
    • D) All of the above
  41. Correct Answer(s): D
  42. Treatment of severe mitral stenosis may be accomplished by:
    • A) Valvuloplasty
    • B) Mechanical heart valve replacement
    • C) Bioprosthetic heart valve replacement
    • D) All of the above
  43. Correct Answer(s): D
  44. The autonomic nervous system …..
    • A) … is part of the efferent division of the peripheral nervous system.
    • B) … has sympathetic (fight or flight) and parasympathetic (rest or digest) divisions that tend to regulate organ systems antagonistically.
    • C) … is characterized by pre- and post-ganglionic nerve fibers in both divisions.
    • D) … is involved in both excitatory and inhibitory regulation of most organ systems.
    • E) All of the above are correct.
  45. Correct Answer(s): E
  46. The intact endothelium:
    • A) Has anti-thrombotic effects
    • B) Only has pro-thrombotic effects
    • C) Attracts platelets
    • D) Separates the circulating blood from underlying collagen
  47. Correct Answer(s): A
  48. Which is a major diagnostic criteria for rheumatic fever?
    • A) Loss of appetite
    • B) Erythema marginatum
    • C) Fever
    • D) Splenomegaly
  49. Correct Answer(s): B
  50. Select the single best statement regarding ventricular cardiac myocytes.
    • A) Myocytes are organized into a syncytium (network) of cells whose layers are oriented so that the heart efficiently squeezes blood out of the ventricular chamber during contraction.
    • B) Myocytes are organized into a linear fiber organization to elicit the transmission of maximal force to eject blood from the chamber.
    • C) Myocytes have many nuclei, but no T-tubules.
    • D) Unlike smooth muscle cells, there are no electrical connections between cardiac myocytes in the heart.
    • E) The sarcomeres in cardiac myocytes typically work along the descending limb of the active force-length relationship.
  51. Correct Answer(s): A
  52. The endothelium has anti-thrombotic properties that include:
    • A) Anti-platelet effects
    • B) Anti-coagulant effects
    • C) Fibrinolytic effects
    • D) All of the above
  53. Correct Answer(s): D
  54. Select the single best answer about a feature or features of smooth muscle that are NOT also found in cardiac muscle.
    • A. Stretch activation.
    • B. Gap junctions.
    • C. Modulation of physiological effects by hormones.
    • D. Maintained muscle tone.
    • E. Both A & D are correct.



    Correct Answer: E
  55. Which of the following types of cardiac cells do NOT have any potential pacemaker activity?
    • A. SA nodal cells.
    • B. AV nodal cells.
    • C. Purkinje conducting cells.
    • D. Atrial working (contracting) cells.
    • E. Right bundle branch conducting cells.


    Correct Answer: D
  56. Cyanosis refers to:
    • A. Blue discoloration of skin
    • B. Tissue death
    • C. Anemia
    • D. Leukopenia



    Correct Answer: A
  57. Left sided heart failure may result from:
    • A. Pulmonary obstruction
    • B. Coronary heart disease
    • C. Hypertension
    • D. B and C
    • Correct Answer: D



    Your Response: B
  58. Refer to topic 7 note equations & figures #40 & #41 (top) &the corresponding topic 7 lecture slides to answer the following question. You have been chosen to be among the first astronauts to travel to the Planet Jupiter. Setting aside the obvious environmental and physical issues, you land on the “surface” of the planet. The gravity of Jupiter is about 2.4X greater than that of the earth. You have a normal peak systolic blood pressure of 120 mmHg measured at the level of the heart. After landing in the supine position, you stood up and fell over faint. Thus, what was the approximate systolic arterial pressure at the top of your head (in mmHg) and at the bottom of your feet (in mmHg) that contributed to this reaction? [Hint: use Pascal’s laws and the known hydrostatic pressures at 1G in figure 41]
    • A. 80 (head); 210 (feet).
    • B. 24 (head); 311 (feet).
    • C. 24 (head); 336 (feet).
    • D. -16 (head); 311 (feet).
    • E. -16 (head); 336 (feet).



    Correct Answer: C
  59. Which of the following statements regarding the electrocardiogram (EKG) is NOT true
    • .A. The P wave of the EKG corresponds to the time of atrial depolarization.
    • B. The QRS complex of the EKG corresponds to the time of ventricular depolarization.
    • C. The T wave of the EKG corresponds to the time of atrial repolarization.
    • D. The EKG is a 3-D representation of the sum of action potentials in the heart.
    • E. The EKG can be used to diagnose arrhythmias.
    • Correct Answer: C
  60. What is NOT a factor in resistance to blood flow in the vascular system?
    • Select the single incorrect answer.
    • A. The viscosity of the blood.
    • B. The effective turbulence of blood flow through the vessel.
    • C. Vessel radius or diameter.
    • D. Vessel compliance.
    • E. Vessel length.
    • Correct Answer: D
  61. Heart failure is associated with all of the above EXCEPT:
    • A. Increased preload
    • B. Increased renal perfusion
    • C. Increased afterload
    • D. Reduced cardiac output



    Correct Answer: B
  62. Select the best statement regarding the ramifications of regions of ischemic tissue from coronary artery disease in the ventricular myocardium..
    • A. Ischemic ventricular myocytes can have slowed conduction of action potentials leading to dysfunctional contraction
    • B. Ischemic conducting cells (e.g.: bundle branches, Purkinje fibers) can lead to first, second or third degree heart block.
    • C. Ischemia can lead to re-entry, arrhythmias and sudden death.
    • D. Large regions of ischemia can lead to myocardial infarctions and heart failure.
    • E. All of the above are correct.


    Correct Answer: E
  63. Select the single best statement about the regulation of smooth muscle contraction.
    • A. Crossbridge cycling is switched on and off by the phosphorylation of the smooth muscle troponin-tropomyosin complex.
    • B. Crossbridge cycling is switched on and off by the phosphorylation of the smooth muscle myosin.
    • C. Spontaneous action potentials are initiated at neuromuscular junctions in single unit smooth muscle cells.
    • D. Action potentials are propagated to the cell interior via t-tubules to initiate calcium release from the SR.
    • E. Both B & D are correct.



    Correct Answer: B
  64. Keeping in mind that blood is NOT a Newtonian fluid, the Fahraeus-Lindqvist phenomenon has important ramifications for capillary blood flow. It refers to ….
    • A. … the proportional relationship between apparent blood viscosity and vessel length.
    • B. … the observation that a smaller delta P (pressure difference) across the capillary bed increases the apparent blood viscosity.
    • C. … the observation that the apparent blood viscosity drops substantially and capillary blood flow improves as the vessel diameter decreases toward that of a red cell.
    • D. … the observation that apparent blood viscosity drops with increased turbulent flow in arterioles.
    • E. Both C & D are correct.



    Correct Answer: C
  65. Select the single correct statement regarding chronotropic regulation of the heart rate.
    • A. The release of nor-epinephrine from the sympathetic nerve endings on the SA node will elicit a faster heart rate by increasing the sodium funny current and T-type calcium conductances which increases the rate of spontaneous depolarization.
    • B. The release of acetylcholine from the parasympathetic nerve endings on the SA node will elicit a slower heart rate by increasing the sodium funny current conductance which slows the rate of spontaneous depolarization.
    • C. The release of acetylcholine from the parasympathetic nerve endings on the SA node will elicit a slower heart rate by increasing the opening time of the T-type calcium channel which slows the rate of spontaneous depolarization.
    • D. Chronotropic regulation is an intrinsic regulator of cardiac output.
    • E. Both B & C are correct.



    Correct Answer: A
  66. Which is TRUE about acute pericarditis?
    • A. It may be caused by the human immunodeficiency virus
    • B. It involves severe scarring of the visceral periocardium
    • C. It may be associated with a pericardial friction rub
    • D. A and C



    Correct Answer: D
  67. In the first six months after heart valve replacement, ….
    • A. the risk of infective endocarditis is greater for bioprosthetic type valves
    • B. cases of endocarditis are mostly staphylococcal in origin
    • C. cases of endocarditis are mostly streptococcal in origin
    • D. patients don not need daily anti-coagulation



    Correct Answer: C
  68. Which of the following signs is not associated with left sided heart failure:
    • A. Orthopnea
    • B. Ankle edema
    • C. Tachypnea
    • D. Gallop rhythm


    Correct Answer: B
  69. In general, the resistance to blood flow in the circulatory system is greatest in the….
    • A. … aorta.
    • B. … arterioles.
    • C. … capillaries.
    • D. … venules.
    • E. … lymphatic veins.



    Correct Answer: B
  70. Select the single incorrect answer about capillary diffusion mechanisms.
    • A. Large proteins easily move across the capillary membrane depending upon their concentration gradient.
    • B. Oxygen and CO2 are lipid soluble substances that move across the capillary membranes depending upon their concentration gradients.
    • C. Glucose moves across the membrane depending upon its concentration gradient.
    • D. Diffusion is the primary means for the net movement of nutrients across capillary walls.
    • E. Variations in the size of intracellular clefts (filled with water) account for large differences in the “leakiness” in the capillaries of different organ sysytems.
    • Correct Answer: A
  71. Which of the following is a feature of infective endocarditis?
    • A. Carditis
    • B. Osler’s nodes
    • C. Chorea
    • D. Polyarthritis



    Correct Answer: B
  72. Cardiac temponade refers to:
    • A. Severe hypertension
    • B. Reduced cardiac output
    • C. Right sided heart failure
    • D. Peripheral edema



    Correct Answer: B
  73. Which of the following increases the risk for developing infective endocarditis?
    • A. An indwelling catheter
    • B. A prosthetic heart valve
    • C. An uncorrected congenital heart defect
    • D. All of the above



    Correct Answer: D
  74. From the list below select ALL the correct matches:
    • 1. Normal 6. BP of: 120 -139 / 80 - 89 mmHg
    • 2. Prehypertension 7. BP of: less than 120 / less than 80 mmHg
    • 3. Hypertension stage 1 8. BP of: 140-159 / 90-99 mmHg
    • 4. Hypertension stage 2 9. BP of: more than 160 / greater than 100 mmHg
    • 5. Isolated systolic hypertension 10. BP of: more than 140 / less than 90 mmHg
    • A) 1 and 7
    • B) 2 and 6
    • C) 5 and 8
    • D) 3 and 9
    • E) 4 and 9
  75. Correct Answer(s): A , B , E
  76. At the end of the ejection phase of the cardiac cycle, which of the following events occur?
    • A) The QRS wave complex of the EKG occurs.
    • B) The first heart sound (“lub”) occurs.
    • C) The aortic and pulmonary valves close.
    • D) The end-diastolic volume (EDV) is reached.
    • E) Atrial contraction starts.
  77. Correct Answer(s): C
  78. Which statement is FALSE about preeclampsia?
    • A) It involves proteinuria
    • B) It is associated with severe hypotension
    • C) It may lead to neurologic abnormalities
    • D) It increases the risk of hypertension after pregnancy
  79. Correct Answer(s): B
  80. Select the single best answer regarding vascular blood flow regulation by epinephrine.
    • A) Epinephrine at physiological doses (less than nM) relaxes vascular smooth muscle via the beta 2 receptor leading to vasodilation and increased blood flow.
    • B) Epinephrine at physiological doses (less than nM) contracts vascular smooth muscle via the alpha 1 receptor leading to vasoconstriction and decreased blood flow.
    • C) Epinephrine at pharmacological doses (>mM) relaxes vascular smooth muscle via the beta 2 receptor leading to vasodilation and increased blood flow.
    • D) Epinephrine at pharmacological doses (>mM) contracts vascular smooth muscle via the alpha 1 receptor leading to vasoconstriction and decreased blood flow.
    • E) Both A & D are correct.
  81. Correct Answer(s): E
  82. Which is TRUE about a hemorrhagic stroke?
    • A) It is easily detectable by a fMRI
    • B) It may be managed by t-PA
    • C) I may require surgical clipping
    • D) It requires anticoagulation
  83. Correct Answer(s): C
  84. Numerous physiological changes occur during dynamic exercise. Select the single correct statement.
    • A) During strenuous dynamic exercise, cardiac output can increase many fold with the vast majority of the increased blood flow directed toward the brain.
    • B) Systolic blood pressure typically remains the same since there is an increase in vascular resistance.
    • C) Arterial baroreceptors are involved in maintaining a relatively constant mean arterial pressure during dynamic exercise.
    • D) The excess heat produced by skeletal muscle metabolism is removed in part via chemoreceptor stimulation of sweat glands.
    • E) All of the above are correct.
  85. Correct Answer(s): C
  86. An ischemic stroke may be associated with:
    • A) Sensory loss
    • B) Ataxia
    • C) Blindness
    • D) All of the above
  87. Correct Answer(s): D
  88. Heatstroke can seriously compromise cardiovascular function leading to life threatening situations during strenuous exercise in hot weather. Heatstroke occurs because…..
    • A) … the high cardiac output during exercise can dislodge blood clots leading to a stroke.
    • B) … the capacity of the heart to maintain cardiac output is exceeded leading to hypotension and collapse.
    • C) … you drink too much water in the hot weather and dilute your blood’s oxygen carrying capacity leading to cardiac insufficiency.
    • D) … working muscle mandates increased blood flow leading to a large increase in mean arterial pressure and afterload so that the heart can’t pump enough blood.
    • E) Both B & D are correct.
  89. Correct Answer(s): B
  90. At the end of the isovolumetric contraction phase of the cardiac cycle, you can measure which of the following values?
    • A) Diastolic arterial blood pressure.
    • B) The stroke volume.
    • C) Systolic arterial blood pressure.
    • D) The end-systolic volume (ESV).
    • E) Systemic vascular resistance.
  91. Correct Answer(s): A
  92. Which is NOT a contributing factor to essential HTN?
    • A) Sodium excretion
    • B) Vascular endothelial dysfunction
    • C) Hyperinsulinemia
    • D) Increased adrenergic activity
  93. Correct Answer(s): A
  94. Select the single best answer regarding the renin-angiotensin blood pressure regulation pathway.
    • A) Angiotensin lowers blood pressure via AT1 receptor-mediated vasodilation.
    • B) Pathological increases in renin can lead to hypertension via fluid retention in the kidney.
    • C) Renin is released by the pituitary and acts directly as a diuretic.
    • D) Renin is released by the atrial cells when stretched.
    • E) Both A & B are correct.
  95. Correct Answer(s): B
  96. Numerous local factors can modulate vascular smooth muscle to vasoconstrict or vasodilate arterioles. Which of the following factors is not involved in local regulation of vascular smooth muscle?
    • A) Angiotensin II.
    • B) Stretch
    • C) CO2
    • D) pH
    • E) NO
  97. Correct Answer(s): A
  98. The baroreceptors …..
    • A) … are sensitive to blood pH.
    • B) … respond slowly to changes in the arterial pressure.
    • C) … are sensitive to both the mean arterial pressure and the rate of pressure change.
    • D) … will elicit an increase in parasympathetic stimulation to the SA node following a decrease in arterial pressure.
    • E) … will elicit an increase in sympathetic stimulation to the heart following an increase in arterial pressure.
  99. Correct Answer(s): C
  100. You are in a physiology lab where you are able to simulate heart function and obtain values for heart rate, circulatory pressures & heart chamber volumes. At baseline, you record systolic and diastolic arterial pressures of 120/75 at a heart rate of 80. The CVP is 5 mmHg, the EDV is 140 mls and the ESV is 70 mls. After a hemodynamic perturbation of unknown origin, you record the same 6 values again and find that nothing changed except the CVP which is now 8 mmHg and the EDV which is now 160 mls. Assuming no other counteracting reflexes, what is the new cardiac output (CO), the new systemic vascular resistance (SVR) and the mechanism of the change?
    • A) 5.6 L/min; 1214 dyne-sec-cm-5; ↑ contractility.
    • B) 5.6 L/min; 15.18 dyne-sec-cm-5; ↑ preload.
    • C) 7.2 L/min; 11.39 dyne-sec-cm-5; ↑ afterload.
    • D) 7.2 L/min; 911 dyne-sec-cm-5; ↑ contractility.
    • E) 7.2 L/min; 911 dyne-sec-cm-5; ↑ preload.
  101. Correct Answer(s): E
  102. Pheochromocyoma is:
    • A) Tumor of chromaffin cells in the kidneys
    • B) A cateocholamine producing tumor in the adrenal gland
    • C) Associated with signs of parasympathetic hyperactivity
    • D) A cause of essential hypertension
  103. Correct Answer(s): B
  104. Leg claudication may be seen with:
    • A) Heart failure
    • B) Peripheral arterial disease
    • C) Coarctation of the aorta
    • D) All of the above
  105. Correct Answer(s): D
  106. Which of the following is incorrect about the tunica intima:
    • A) It is the innermost layer of the blood vessel
    • B) One of the components is endothelial cells
    • C) Another component is connective tissue
    • D) Is of uniform thickness throughout the arterial system
  107. Correct Answer(s): D
  108. A regular heart rate of 300 beats per minute, is referred to as:
    • A) Ventricular tachycardia
    • B) Atrial flutter
    • C) Paroxysmal supraventricular tachycardia
    • D) Sick sinus syndrome
  109. Correct Answer(s): B
  110. Which of the following is considered a risk factor for ischemic heart disease?
    • A) High HDL level
    • B) High CRP level
    • C) Being female
    • D) Being diabetic
    • E) B and D
  111. Correct Answer(s): E
  112. Within a couple of hours after an acute MI which enzyme is likely to be elevated?
    • A) Alkaline phosphatase
    • B) Creatine kinase MB isoenzyme
    • C) Aspartate Transferase
    • D) Alanine transferase
  113. Correct Answer(s): B
  114. Cardiovascular responses to strenuous levels of static exercise include which of the following:
    • A) Decreased SVR.
    • B) No change in MAP.
    • C) Large increases in SBP, MAP & DBP.
    • D) Large increases HR.
    • E) Both C & D.
  115. Correct Answer(s): C
  116. Which of the following is the most important type of arteriosclerosis:
    • A) Arteriolosclerosis
    • B) Monckeberg’s arteriosclerosis
    • C) Atherosclerosis
    • D) Osteosclerosis
  117. Correct Answer(s): C
  118. Which of the following is true of tunica media:
    • A) In all arterial vessels, the primary component is smooth muscle cells
    • B) In all arterial vessels, the major component is elastic tissue
    • C) There is striated muscle within the media
    • D) One of the major functions is control of vascular resistance
  119. Correct Answer(s): C
  120. Deep Vein Thrombosis (DVT) is a risk factor for:
    • A) Hemorrhagic stroke
    • B) Thrombophlebitis
    • C) Pulmonary embolism
    • D) Leg claudication
  121. Correct Answer(s): C
  122. On an ECG tracing, the PR interval reflects:
    • A) Atrial repolarization
    • B) Conduction from the SA node to the AV node
    • C) Ventricular depolarization
    • D) Ventricular repolarization
  123. Correct Answer(s): B
  124. Virchow’s triad:
    • A) Describe factors that favor thrombus formation
    • B) Describes factors that inhibit thrombus formation
    • C) Describes 3 diseses named after Virchow
    • D) Describes 3 symptoms described by Virchow
  125. Correct Answer(s): A
  126. The intact endothelium:
    • A) Has anti-thrombotic effects
    • B) Only has pro-thrombotic effects
    • C) Attracts platelets
    • D) Separates the circulating blood from underlying collagen
  127. Correct Answer(s): A
  128. Which of the following is true of hypertension:
    • A) It is more common in blacks
    • B) It increases in prevalence and incidence with age
    • C) It has been referred to as the silent killer
    • D) It always responds to medical therapy
  129. Correct Answer(s): D
  130. Which of the following is TRUE about a second degree heart block?
    • A) It represents a conduction disturbance
    • B) It may require treatment with a pacemaker
    • C) If not corrected within 3 minutes it leads to an MI
    • D) A and B
  131. Correct Answer(s): D
  132. When you are considering giving additional doses of nitroglycerine to a patient who still has anginal symptoms after the first dose, it is important to first check the vital signs, since nitroglycerine can cause a dangerous increase in blood pressure.
    • A) True
    • B) False
  133. Correct Answer(s): False
  134. Which of the following is not true of atherosclerosis:
    • A) It is the leading cause of death in industrialized nations
    • B) Death results from rupture or occlusion of arteries
    • C) The prevalence is close to 100% in adults
    • D) There is no relation to diet or cholesterol levels
  135. Correct Answer(s): D
  136. Which of the following is not a beneficial effect of thrombosis:
    • A) Stops exsanguination from external injury
    • B) Controls local hemorrhage
    • C) Complete obstruction of a vessel shutting off the blood supply and causing ischemia
    • D) Provides growth factors which aid in healing
  137. Correct Answer(s): C
  138. Treatment of atrial fibrillation may include all of the following EXCEPT:
    • A) An anti-arrhythmic drug
    • B) Electrical cardioversion
    • C) Coronary bypass surgery
    • D) Radioablation
  139. Correct Answer(s): C
  140. Which of the following statements is not true of essential hypertension:
    • A) It is the most common type of hypertension
    • B) There are definite genetic influences
    • C) There are environmental factors
    • D) It is not a common disease
  141. Correct Answer(s): D
  142. First year dental student, Carrie S. Denton, was totally panicked about her System One Midterm exam. She could not sleep and studied all night living off of Red Bull and espresso. At 5 AM she felt sick and had an episode of vomiting and diarrhea. She pulled herself together and got to the exam on time still feeling somewhat out of it. She forgot to bring anything to eat or drink. Upon reading the first question about circulatory shock, which she had not studied at all, she turned pale and passed out. After falling out of her chair onto her backpack, she quickly recovered in the supine position, had some liquids from her friend and performed well on the rest of the exam. Why did Carrie to pass out? (select the single best answer)
    • A) She suffered from cardiogenic shock since she drank so much Red Bull she had a heart attack.
    • B) She suffered from anaphylactic shock since she was allergic to tests.
    • C) She suffered from hypovolemic shock since she was very dehydrated from the vomiting, diarrhea and lack of water.
    • D) She suffered from neurogenic shock since she was suddenly stressed by seeing that the first question was on a topic she had not studied.
    • E) She suffered from the additive effects of a combination of hypovolemic and a sudden neurogenic shock – Both C & D likely contributed to Carrie passing out.
  143. Correct Answer(s): E
  144. Which of the following is untrue about sudden cardiac death:
    • A) Most cases in the Western world are due to heart disease
    • B) Accounts for hundreds of thousands of deaths per year in the United States
    • C) Is most commonly due to coronary artery anomaly
    • D) In adults is most commonly due to ischemic heart disease
  145. Correct Answer(s): C
  146. In the course of their activity, platelets do the following:
    • A) Adhere to exposed collagen
    • B) Secrete products from granules that aid in thrombosis
    • C) Aggregate to form a temporary hemostatic plug
    • D) All of the above
  147. Correct Answer(s): D
  148. Sudden death can be due to:
    • A) Diseases of the coronary arteries
    • B) Diseases of the myocardium
    • C) Diseases of the heart valves
    • D) All of the above
  149. Correct Answer(s): D
  150. Which of the following is not a complication of hypertension:
    • A) Heart failure
    • B) Accelerated atherosclerosis
    • C) Cerebral hemorrhage
    • D) Migraine headaches
  151. Correct Answer(s): D
  152. Components of normal hemostasis include:
    • A) An intact blood vessel wall
    • B) Normal platelet function
    • C) Normal coagulation system
    • D) All of the above
  153. Correct Answer(s): D
  154. Of the following tumors, which is the most common primary tumor of the heart in adults:
    • A) Metastatic carcinoma
    • B) Angiosarcoma
    • C) Rhabdomyosarcoma
    • D) Cardiac myxoma
  155. Correct Answer(s): D
  156. If you use a blood pressure cuff that is too small for your patient’s arm, the reading that you get will be falsely low.
    • A) True
    • B) False
  157. Correct Answer(s): False
  158. Which of the following regulates blood pressure:
    • A) Heart rate
    • B) Stroke volume
    • C) Total peripheral resistance
    • D) All of the above
  159. Correct Answer(s): D
  160. Unlike chronic stress, moderate levels of stress can modify cardiovascular function in generally useful ways. Select the two most common endocrine related pathways that can modify cardiovascular factors to compensate for increased demands. (Select 2 answers; 1 point each correct answer).
    • A) The renin-angiotensin pathway modulates sympathetic discharge to the vascular smooth muscle.
    • B) The atrial naturetic peptide pathway regulates fluid retention in the kidneys.
    • C) The direct sympathetic stimulation of the adrenal medulla to secrete catecholamines.
    • D) The hypothalmo-pituitary-adrenal axis stimulates the adrenal cortex to release cortisol.
    • E) The calcium-calmodulin-myosin kinase pathway regulates smooth muscle relaxation.
    • Points Earned: 2.0/2.0
  161. Correct Answer(s): C , D
  162. The following terms describe different amounts of accumulation of blood within tissue:
    • A) Petechiae
    • B) Purpura
    • C) Ecchymoses
    • D) All of the above
  163. Correct Answer(s): D
  164. Which of the following is true of hypertension:
    • A) It is always due to renal disease
    • B) It is never due to renal disease
    • C) A cause can always be found
    • D) A variety of drugs can cause hypertension
  165. Correct Answer(s): D
  166. Which of the following is not true of cardiac tumors:
    • A) Most are primary lesions
    • B) Most are benign
    • C) Metastatic tumors are more common than primary tumors
    • D) Of the metastatic tumors, carcinomas of lung and breast are among the most common
  167. Correct Answer(s): A
  168. On EKG, myocardial ischemia may be manifested as:
    • A) Q wave abnormality
    • B) St segment elevation
    • C) T wave inversion
    • D) All of the above
  169. Correct Answer(s): D
  170. Select the single correct statement about the coronary circulation.
    • A) The coronary artery blood flow in the left ventricle is the greatest during systole.
    • B) The coronary artery blood flow is highly dependent upon diastolic blood pressure.
    • C) The coronary artery blood flow in the left ventricle is tightly coupled to right ventricular pressure.
    • D) The coronary artery blood flow is almost entirely determined by flow autoregulation.
    • E) There is about a 1:4 ratio of coronary capillaries to myocytes.
  171. Correct Answer(s): B
  172. Which of the following is not true of pulmonary embolism:
    • A) Results in hundreds of thousands of deaths per year in the United States
    • B) Most originate from the veins above the waist
    • C) Inactivity and surgery predispose to their occurence
    • D) Pulmonary infarction almost always complicates pulmonary embolism
  173. Correct Answer(s): B
  174. Your dental patient is found to have a blood pressure of 180/100. You let the patient rest for five minutes and recheck it. Now it is 155/92. According to the guidelines discussed in class, you should:
    • A) Refer the patient to his/her physician prior to performing elective dental care
    • B) Proceed with treatment today
    • C) Send the patient to the nearest emergency room
    • D) Refer the patient for dental treatment in a hospital setting.
  175. Correct Answer(s): B
  176. Which of the following would not be considered a congenital cardiac malformation:
    • A) Ventricular septal defect
    • B) Coarctation of the aorta
    • C) Tetralogy of Fallot
    • D) Infective endocarditis
  177. Correct Answer(s): D
  178. The following have anti-coagulation effects:
    • A) Vitamin K
    • B) Protein S
    • C) The fibrinolytic system
    • D) Prostacyclin
  179. Correct Answer(s): B
  180. After which of the following is it safe to let your patient drive home?
    • A) Vasovagal syncope
    • B) Orthostatic hypotension
    • C) Both of the above
    • D) Neither of the above
  181. Correct Answer(s): B
  182. The normal coagulation system consists of:
    • A) A sequence of enzymatic conversions turning pro-enzymes into activated enzymes
    • B) Involves conversion of soluble fibrinogen into insoluble fibrin
    • C) Involves calcium at multiple steps
    • D) All of the above
  183. Correct Answer(s): D
  184. In addition to thrombi, other types of emboli include:
    • A) Gas
    • B) Amniotic fluid
    • C) Fat
    • D) All of the above
  185. Correct Answer(s): D
  186. In which phase of the Valsalva maneuver might someone with autonomic dysfunction pass out?
    • A) Phase 1.
    • B) Phase 2.
    • C) Phase 3.
    • D) Phase 4.
    • E) No one can ever pass out doing the Valsalva.
  187. Correct Answer(s): B
  188. What percentage of medical emergencies that occur in the dental office are potentially preventable?
    • A) 30%
    • B) 60%
    • C) 90%
    • D) 100%
  189. Correct Answer(s): C
  190. Treatment of cardiac ischemia may involve:
    • A) Catheter ablation therapy
    • B) Use of vasodilators
    • C) Coronary angiography
    • D) Nuclear medicine testing
  191. Correct Answer(s): B
  192. Children are more likely to lose consciousness due to vasodepressor syncope than are adults.
    • A) True
    • B) False
  193. Correct Answer(s): B

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