BHSC 3302 Quiz Questions Midterm 2

In a patient under 50 years of age, hypertension is defined as a blood pressure in excess of:

140/90

Hypertension increases the risk of all of the following except:

a. atherosclerosis

b. cerebral hemorrhage

c. myocardial infarction

d. acute renal failure

e. retinal detachment and blindness

acute renal failure

All of the following are consequences of systemic hypertension except:

a. concentric hypertrophy of the left ventricle

b. enlargement of the heart

c. a decline in the LV end-diastolic volume due to diminished compliance

d. angina

e. a decline in myocardial oxygen consumption

a decline in myocardial oxygen consumption

The most common form of hypertension is:

essential hypertension

All of the following occur with increasing age except:

a. a gradual increase in the systolic blood pressure

b. a gradual increase in the diastolic blood pressure

c. there is gradual increase in the peripheral resistance to flow

d. an increase in both the systolic and diastolic blood pressure but a decline in the pulse pressure

e. the compliance of the arteries diminishes

an increase in both the systolic and diastolic blood pressures but a decline in the pulse pressure

An adult would be defined as hypertensive if:

the systolic pressure consistently exceeds 120 mm Hg and the diastolic blood pressure consistently exceeds 90 mm Hg

Secondary hypertension:

is a consequence of several different metabolic and endocrine abnormalities

Systemic arterial hypertension accelerates atherosclerosis, most probably by:

stretching and damaging the endothelial lining of arteries, allowing more lipids and cholesterol to penetrate through the lining and accumulate beneath the intimal layer

Hypertension greatly increases the risk of stroke as a consequence of all of the following except:

a. accelerated atherosclerosis of cerebral vessels and subsequent thrombosis

b. obstruction of a cerebral vessel by embolization of plaque material derived from an atheroma torn open by hypertension

c. formation of berry aneurysms in the circle of willis

d. rupture of a pre-existing congenital aneurysm

e. rupture of a cerebral artery weakened by atherosclerosis

formation of berry aneurysms in the circle of Willis

Which of the following statements concerning the treatment of hypertension is correct?

Calcium channel blockers reduce blood pressure by directly influencing calcium uptake by smooth muscle cells. This results in arteriolar vasodilation that reduces the peripheral resistance to blood flow

Rheumatic heart disease:

is probably the result of antibodies to bacterial proteins cross-reacting with host heart proteins

Acute infective endocarditis is most commonly caused by:

staphylococcus aureus

The patient with an established heart murmur is at risk of infective endocarditis after all of the following except:

Radiation therapy of the chest

Infective endocarditis is a common problem among intravenous drug abusers. In these cases vegetations form most frequently on the:

tricuspid valve

Which of the following statements concerning sub-acute infectious endocarditis is incorrect?

Since the advent of antibiotics the incidence of bacterial endocarditis has fallen so that viruses are now the most frequent organisms causing subacute endocarditis

A 54-year-old male presents for an evaluation of a systolic heart murmur. He had initially contacted his physician after he started having dizzy spells. He is overweight and reports difficulty in breathing even though he has never smoked. His blood pressure is 100/75. Auscultation of the chest demonstrates a loud pansystolic murmur and a paradoxical splitting of the second heart sound. A chest X-ray shows apparent enlargement and thickening of the wall of the LV. An echocardiogram would likely show evidence of:

aortic stenosis

Semilunar valvular insufficiency is often without significant impairment of cardiac output until it is well advanced. This is because:

the ejection fraction increases and the stroke volume rises by the same volume as that which flows back into the upstream chamber

Mitral insufficiency (regurgitation):

is a common consequence of bacterial endocarditis

Rupture of a papillary muscles in the left ventricle will result in all of the following except:

a. mitral insufficiency

b. systolic murmur

c. a decreased left ventricular output

d. premature opening of the aortic semilunar valve

e. pulmonary congestion

premature opening of the aortic semilunar valve

A large carotid pulse pressure that rises and falls rapidly would typically be found in a patient with:

aortic semilunar valve insufficiency

All of the following disorders can result in aortic insufficiency due to dilation or distortion of the valve annulus except:

a. infective endocarditis

b. marfan’s syndrome

c. aneurysm or dissection of the ascending aorta

d. malformation of the membranous portion of the interventricular septum

e. syphilitic aortitis

Infective endocarditis

The patient with acute aortic insufficiency can present with all of the following except:

a. severe, acute shock

b. left heart failure

c. a low mean arterial pressure but large pulse pressure

d. dilated left atrium and ventricle

e. systemic venous hypertension

Dilated left atrium and ventricle

Chronic aortic insufficiency is better tolerated than acute aortic insufficiency because:

The left ventricle enlarges to accommodate the regurgitating blood and the ejection fraction increases to maintain an adequate cardiac output

Which of the following is not a potential cause of tricuspid insufficiency?

Right to left shunts

The most common cause of pulmonary valve insufficiency is:

Dilation of the valve annulus following prolonged pulmonary artery hypertension

Aortic stenosis can potentially cause all of the following signs and symptoms except:

a. angina pectoris

b. left ventricular hypertrophy

c. pulmonary congestion

d. paroxysmal nocturnal dyspnea

e. peripheral edema (before the appearance of pulmonary edema)

peripheral edema (before the appearance of pulmonary edema)

Which of the following is unlikely to be found in aortic stenosis?

an increased pulse pressure

Mitral stenosis is often caused by a thickening of the cusps of the mitral valve that increases the resistance to blood flow. This will result in:

pulmonary congestion and edema

The most common cause of pulmonary stenosis is congenital malformation of the valve and vessel. The consequences of the disorder include all of the following except:

a. increased afterload for the right ventricle

b. right ventricular dilation and hypertrophy

c. right heart failure

d. systemic venous congestion

e. pulmonary congestion

pulmonary congestion

The primary response to aortic stenosis is:

left ventricular hypertrophy

The echocardiographic finding of right ventricular hypertrophy without pulmonary hypertension suggests a diagnosis of:

pulmonary stenosis

Mitral stenosis:

causes a diastolic murmur

Using the modified Bernoulli equation the pressure gradient across the obstructed aortic valve can be calculated from the maximum velocity of blood flow through the constricted aortic valve. If the peak velocity is 3 meters/second the pressure gradient across the valve is:

36 mm Hg

All of the following are true of tricuspid stenosis except:

a. the disorder rarely occurs in isolation

b. tricuspid insufficiency and stenosis may co-exist

c. the outcome of severe stenosis is right heart failure

d. the right atrial and systemic venous blood pressures are reduced

e. most cases are rheumatic in origin

The right atrial and systemic venous blood pressures are reduced.

Antigen-antibody complexes formed following acute rheumatic fever are deposited through the body, including the heart, but especially:

On the rims of the aortic and mitral valves

Pulmonary embolism is primarily the result of venous embolization. All of the following factors contribute to an increased risk of venous thrombosis except:

a. prolonged bedrest

b. congestive heart failure

c. hypercoagulability of blood

d. administration of heparin or warfarin

e. varicose veins and venous vessel wall injury

administration of heparin or warfarin

A thromboembolus arising in the femoral vein will most probably lodge in:

a pulmonary artery

All of the following can lead to pulmonary artery hypertension except:

a. left sided congestive heart failure

b. an increase in pulmonary venous resistance

c. an increase in resistance to flow somewhere in the pulmonary vascular system that causes the pulmonary artery pressure to rise

d. right sided congestive heart failure

e. shunting of blood from the left ventricle to the right ventricle through a septal defect

right-sided congestive heart failure

All of the following are characteristic findings of pulmonary embolism except:

a. chest pain

b. dyspnea

c. cyanosis

d. symptoms of shock

e. hypoventilation and respiratory acidosis

hypoventilation and respiratory acidosis

Which of the following would be considered a normal pulmonary arterial blood pressure?

22/8

The mean arterial-venous pressure gradient in the pulmonary circulation is:

approximately one tenth of the gradient in the systemic circulation

The pulmonary vascular resistance (PVR) is dependent on all of the following except the:

a. total cross sectional area of the pulmonary arterioles

b. pulmonary flow rate

c. blood viscosity

d. ventilation rate

e. total number of vessels, in parallel, that carry blood through the lungs

ventilation rate

If the mean pulmonary arterial pressure is 30 mm Hg, the mean pulmonary venous pressure is 12 mm Hg and pulmonary flow rate is 6.0 Liters/minute, then the pulmonary vascular resistance is:

3 mm Hg/Liter/minute

All of the following are true of the pulmonary artery of a normal subject except:

a. the pulmonary arterial mean pressure is approximately 14 mm Hg

b. the vessel is not normally susceptible to atherosclerosis

c. it arises from the right ventricle divides into the left and right pulmonary arteries, the left branch of which passes under the aortic arch on its way to the left lungs

d. it does not have a pulse

e. it carries poorly oxygenated blood

it does not have a pulse

Pulmonary edema is defined as the:

fluid derived from the blood in the interstitium of the lungs and within the alveoli

Eisenmengers syndrome

Congenital defect that narrows the lumen and thicken walls. This can cause blood to shunt from the RV to LV without oxygen

Impaired drainage of pulmonary veins is caused by

pulmonary artery hypertension due to LHF

Impaired flow through the pulmonary capillaries is due to

primary disease of the lung

Impaired flow through the pulmonary arteries due to

scarring of the lung following injury, increasing resistance to pulmonary flow causing pulmonary artery hypertension

ARDs is:

increased permeability due to the inflammatory response which allows exudate to accumulate on the surfaces of the alveoli, which impairs gas exchange and ventilation

Hypoventilation is

caused by breathing air with low oxygen, resulting in reflex constriction of pulmonary arteries

Pulmonary Embolism is:

common complication or cause of death in hospitalized patient obstruction of the main pulmonary artery or one its branches

Describe Cor Pulmonale:

hypertrophy and dilation of the right ventricle from diseases that alter structure and function of the lungs

Which stenosis is the most common?

Mitral

s2 followed by short opening snap, when noncompliant cusps and chord tendineae stop abruptly is seen in

mitral stenosis

Loud, harsh midsytolic or pasystolic murmur as blood jets through constriction is seen in

aortic stenosis

vigorous atrial contraction results in a prominent a wave is seen in

tricuspid stenosis

S2 is widely split in

pulmonary stenosis

What is the first observation in mitral valve prolapse is

mid systolic click

which condition has a giant V wave

Chronic MR

A bounding pulse is seen in

aortic regurgitation

Prominent a wave is seen in

tricuspid regurgitation

Turbulent blood flow causes endothelial injury which

provokes platelets to the site of injury