cardiac pathophysiology pt.1 and 2 questions

C. Family history of CAD before age 55 in men

1. Which of the following is a nonmodifiable risk factor for coronary artery disease (CAD)?

A. Smoking
B. Obesity
C. Family history of CAD before age 55 in men
D. Physical inactivity

B. Deposition of lipid in the arterial wall

2. What is the primary pathological change in atherosclerosis?

A. Reduction in venous return
B. Deposition of lipid in the arterial wall
C. Hyperplasia of myocardial cells
D. Loss of bone marrow function

B. Myocardial infarction

3. What is the most common cause of depressed myocardial contractility in heart failure?

A. Hyperthyroidism
B. Myocardial infarction
C. Severe anemia
D. Beriberi

5. Which of the following symptoms is associated with left ventricular failure?

A. Ascites
B. Dependent edema
C. Paroxysmal nocturnal dyspnea
D. Jugular venous distension

. Which determinant directly affects the preload in cardiac function?

A. End-diastolic volume
B. Contractility
C. Afterload
D. Chronotropy
Answer: A

C. Hepatomegaly

6. What is a hallmark sign of right ventricular failure?

A. Pulmonary rales
B. Orthopnea
C. Hepatomegaly
D. S3 heart gallop

C. Tobacco smoking

7. Which of the following lifestyle choices is a modifiable risk factor for atherosclerosis?

A. Male gender
B. Age over 65
C. Tobacco smoking
D. Family history of stroke

D. Atherosclerosis

8. High-output heart failure can be caused by all of the following EXCEPT:

A. Sepsis
B. Hyperthyroidism
C. Beriberi
D. Atherosclerosis

B. Diuretics

9. Which of the following therapies is used to reduce preload in heart failure?

A. Vasoconstrictors
B. Diuretics
C. Calcium supplements
D. Beta agonists

C. Elevated LDL penetrates the arterial wall and accumulates

10. What is the 'lipid hypothesis' in the context of atherosclerosis?

A. High HDL leads to atherosclerosis
B. LDL is converted to HDL in the liver
C. Elevated LDL penetrates the arterial wall and accumulates
D. Lipid ingestion reverses plaque formation

B. Primary (essential) hypertension

11. Which classification of hypertension has no identifiable cause?

A. Secondary hypertension
B. Primary (essential) hypertension
C. Malignant hypertension
D. Renovascular hypertension

C. Cerebrovascular accident (stroke)

12. Which of the following is a complication of chronic hypertension?

A. Carpal tunnel syndrome
B. Appendicitis
C. Cerebrovascular accident (stroke)
D. Hypocalcemia

C. Increased stiffness and reduced compliance of the LV

13. What does an increased left ventricular end-diastolic pressure (LVEDP) indicate?

A. Enhanced ejection fraction
B. Reduced diastolic pressure
C. Increased stiffness and reduced compliance of the LV
D. Lower cardiac output

C. Elasticity of large arteries

14. What is the Windkessel effect related to?

A. Venous return
B. Valve closure
C. Elasticity of large arteries
D. Coronary blood flow

B. Kidneys

15. Which organ becomes more volume-dependent as hypertension progresses?

A. Liver
B. Kidneys
C. Brain
D. Lungs

B. ACE inhibitors

16. What is a common pharmacologic treatment used to reduce afterload in heart failure?

A. Beta-blockers
B. ACE inhibitors
C. Digoxin
D. Calcium

B. Collateral vessel formation

17. What occurs during high-grade coronary lesions that helps prevent infarction?

A. Increased blood pressure
B. Collateral vessel formation
C. Bradycardia
D. Vasoconstriction

C. Elevated LDL cholesterol

18. Which of the following is considered a biochemical modifiable risk factor for CAD?

A. Male gender
B. Tobacco use
C. Elevated LDL cholesterol
D. Sedentary lifestyle

C. Chronic endothelial injury hypothesis

19. Which hypothesis describes endothelial injury as the initiating event in atherosclerosis?

A. Fat embolism theory
B. Vascular elasticity theory
C. Chronic endothelial injury hypothesis
D. Monocyte migration theory

C. Frank-Starling mechanism

20. What compensatory mechanism maintains stroke volume in early heart failure?

A. Vasodilation
B. Reduced preload
C. Frank-Starling mechanism
D. Hyperventilation

B. Mitral valve

21. Which valve is often functionally affected during heart failure?

A. Pulmonary valve
B. Mitral valve
C. Aortic valve
D. Semilunar valve

B. Increased metabolic demand

22. What does left ventricular hypertrophy lead to initially?

A. Reduced contractility
B. Increased metabolic demand
C. Right heart failure
D. Enhanced atrial contraction

B. Heart failure functional limitation

23. What is the New York Heart Association (NYHA) classification used for?

A. Stroke severity
B. Heart failure functional limitation
C. Cardiac enzyme levels
D. Blood pressure staging

B. Liver

24. Which organ is most likely to be affected by congestion in right heart failure?

A. Brain
B. Liver
C. Kidneys
D. Lungs

C. Hypertension

25. Which of the following is NOT typically a symptom of pulmonary edema?

A. Diaphoresis
B. Marked dyspnea
C. Hypertension
D. Cyanosis

C. Systemic vascular resistance

26. What is the primary determinant of afterload?

A. Heart rate
B. Preload
C. Systemic vascular resistance
D. Atrial contractility

B. Ventricular dilation

27. What results from chronic volume overload in the failing heart?

A. Reduced ejection fraction
B. Ventricular dilation
C. Aortic stenosis
D. Hypotension

B. Right ventricular failure

28. What is a characteristic finding in right-sided S3 or S4 heart sounds?

A. Valvular stenosis
B. Right ventricular failure
C. Left atrial dilation
D. Aortic regurgitation

C. Weight gain

29. Which is NOT a symptom associated with cerebral hypoxia from heart failure?

A. Confusion
B. Memory impairment
C. Weight gain
D. Sleep disturbances

B. Positive inotropes

30. Which therapy increases myocardial contractility in heart failure?

A. Beta-blockers
B. Positive inotropes
C. Diuretics
D. Vasodilators

B. Hypertension with no identifiable cause

31. What does the term “essential hypertension” refer to?

A. Hypertension caused by kidney disease
B. Hypertension with no identifiable cause
C. Hypertension caused by tumors
D. Malignant hypertension

C. Coronary

32. Which artery is typically the focus in coronary artery disease?

A. Femoral
B. Brachial
C. Coronary
D. Carotid

B. Active atrial contraction

33. The stiffer the left ventricle, the more it depends on which of the following?

A. Diastolic filling
B. Active atrial contraction
C. Isovolumetric contraction
D. SA node pacing

B. Coronary perfusion is reduced

34. What happens when LVEDP increases excessively?

A. Decreased oxygen delivery
B. Coronary perfusion is reduced
C. Stroke volume increases
D. Systolic pressure drops

B. Graded aerobic exercise

35. Which physical therapy intervention is appropriate for managing heart failure?

A. Massage therapy
B. Graded aerobic exercise
C. Static stretching only
D. Plyometric drills

D. Dependent

36. What kind of edema is associated with right-sided heart failure?

A. Pulmonary
B. Cerebral
C. Periorbital
D. Dependent

B. Media hypertrophy and increased wall-to-lumen ratio

37. In hypertension, what causes vascular remodeling?

A. Hypovolemia
B. Media hypertrophy and increased wall-to-lumen ratio
C. Vascular rupture
D. Arterial plaque rupture

B. Prolonged relaxation and reduced compliance

38. Which diastolic abnormality is a result of LV hypertrophy?

A. Reduced ejection fraction
B. Prolonged relaxation and reduced compliance
C. Increased blood viscosity
D. Premature ventricular contraction

C. Intima

39. Atherosclerotic plaque is primarily located in which arterial layer?

A. Adventitia
B. Media
C. Intima
D. Tunica externa

B. Total arterial occlusion

40. What is the main danger of advanced atherosclerotic lesions?

A. Bradycardia
B. Total arterial occlusion
C. Increased clotting time
D. Enhanced contractility

B. Diabetes mellitus

41. Which metabolic condition contributes heavily to atherosclerosis progression?

A. Hypoglycemia
B. Diabetes mellitus
C. Hyperkalemia
D. Hyponatremia

B. Right ventricular hypertrophy

42. A common result of elevated pulmonary artery pressure is:

A. Systemic hypertension
B. Right ventricular hypertrophy
C. Pulmonary fibrosis
D. Bradycardia

B. Helps remove LDL cholesterol from the bloodstream

43. What is the role of HDL cholesterol in cardiovascular health?

A. Causes arterial plaque buildup
B. Helps remove LDL cholesterol from the bloodstream
C. Increases blood viscosity
D. Induces vasoconstriction

A. Renin-angiotensin-aldosterone system (RAAS)

44. Which hormone system is activated in long-standing hypertension and leads to volume expansion?

A. Renin-angiotensin-aldosterone system (RAAS)
B. Cortisol pathway
C. Insulin signaling pathway
D. Adrenal medulla system

45. What is one nonpharmacologic approach to managing high blood pressure?

A. Smoking
B. High-sodium diet
C. Weight reduction
D. Sleep deprivation

D. Left ventricle

46. Which chamber of the heart is most impacted by systemic hypertension?

A. Right atrium
B. Right ventricle
C. Left atrium
D. Left ventricle

C. Increases blood pressure

47. What effect does excessive alcohol intake have on cardiovascular health?

A. Reduces LDL
B. Improves contractility
C. Increases blood pressure
D. Lowers stroke volume

C. High-output

48. What kind of heart failure may still have a normal or supranormal cardiac output at rest?

A. Diastolic
B. Low-output
C. High-output
D. Right-sided

C. Pulmonary rales

49. Which finding is most consistent with pulmonary congestion due to left heart failure?

A. Ascites
B. Hepatomegaly
C. Pulmonary rales
D. Peripheral cyanosis

B. Compensatory stimulation increases heart rate and vasoconstriction

50. What is the role of the sympathetic nervous system in heart failure?

A. Suppresses myocardial contraction
B. Compensatory stimulation increases heart rate and vasoconstriction
C. Promotes vasodilation
D. Reduces fluid retention

B. Imbalance between oxygen supply and demand

1. What is the primary cause of myocardial ischemia?

A. Excess sympathetic stimulation
B. Imbalance between oxygen supply and demand
C. Decreased heart rate
D. Valve prolapse

C. Pressure or tightness in the chest

2. Stable angina is most often described as:

A. Sharp, stabbing chest pain
B. A throbbing sensation in the chest
C. Pressure or tightness in the chest
D. Pain only during sleep

D. Occurs at rest and lasts longer

3. Which of the following is characteristic of unstable angina?

A. Predictable with exertion
B. Relieved by rest
C. Short duration episodes
D. Occurs at rest and lasts longer

C. Troponin

4. Which cardiac enzyme rises within 4-6 hours and remains elevated for several days?

A. CK-MB
B. Myoglobin
C. Troponin
D. LDH

D. Left anterior descending artery

5. Which coronary artery occlusion leads to infarction of the anterior left ventricle?

A. Left circumflex artery
B. Posterior descending artery
C. Right coronary artery
D. Left anterior descending artery

C. Transmural M

6. What type of myocardial infarction involves full-thickness necrosis?

A. Subendocardial MI
B. Silent MI
C. Transmural MI
D. Partial MI

B. Back pressure and indigestion

7. What is a common sign of a heart attack in women and minorities?

A. Elbow pain
B. Back pressure and indigestion
C. Right knee pain
D. Nosebleeds

C. Myocardial rupture

8. Which of the following is a life-threatening complication post-MI?

A. Mitral valve prolapse
B. Right ventricular hypertrophy
C. Myocardial rupture
D. Sinus arrhythmia

C. Incomplete valve opening

9. Valvular stenosis leads to:

A. Complete closure of the valve
B. Backward bulging of valve leaflets
C. Incomplete valve opening
D. No impact on blood flow

C. Reduced cardiac output

10. Sinus tachycardia above 100 bpm may lead to which complication?

A. Increased stroke volume
B. Increased diastolic filling time
C. Reduced cardiac output
D. Prolonged repolarization

B. Asymptomatic myocardial ischemia

11. What condition may present with ECG findings but no symptoms?

A. Silent stroke
B. Asymptomatic myocardial ischemia
C. Arrhythmogenic RV dysplasia
D. Sinus tachycardia

C. Indigestion and palpitations

2. Atypical MI symptoms in women include:

A. Epigastric pain only
B. Sweating and increased urination
C. Indigestion and palpitations
D. Hypertension and fever

B. Troponin I

13. Which enzyme is most specific for myocardial infarction diagnosis?

A. CK-MM
B. Troponin I
C. LDH
D. SGOT

C. Coronary angiography

14. What diagnostic tool is the gold standard to confirm infarct site?

A. Chest X-ray
B. ECG
C. Coronary angiography
D. Serum enzyme panel

C. Dyspnea

15. What is an anginal equivalent in older adults?

A. Arm numbness
B. Throat tightness
C. Dyspnea
D. Left shoulder pain

C. Occlusive coronary thrombus

16. What is the most common cause of MI?

A. Coronary vasospasm
B. Prolonged hypertension
C. Occlusive coronary thrombus
D. Aortic dissection

B. Reduced cardiac output

17. Sinus bradycardia under 60 bpm may lead to:

A. Enhanced oxygen delivery
B. Reduced cardiac output
C. Increased afterload
D. Hypertension

B. Insufficiency

18. What heart valve issue results in backward flow of blood?

A. Stenosis
B. Insufficiency
C. Prolapse
D. Spasm

C. Multiple P waves per QRS

19. What is a hallmark ECG feature of atrial flutter?

A. Flat P waves
B. Tall QRS complex
C. Multiple P waves per QRS
D. Absence of QRS complexes

B. Quivering of the atria without effective contraction

20. Atrial fibrillation is best described as:

A. Organized multiple atrial foci
B. Quivering of the atria without effective contraction
C. Rapid but organized atrial activity
D. Premature atrial depolarizations

C. Junctional rhythm

21. Which rhythm disturbance is most associated with “escape beats”?

A. Atrial flutter
B. AV block
C. Junctional rhythm
D. Sinus tachycardia

B. 40-60 bpm

22. What is the typical depolarization rate of the AV node?

A. 20-40 bpm
B. 40-60 bpm
C. 60-100 bpm
D. >100 bpm

C. They can lead to lethal arrhythmias

23. Premature ventricular contractions (PVCs) are dangerous because:

A. They always reduce oxygenation
B. They are painful
C. They can lead to lethal arrhythmias
D. They increase ejection fraction

C. Arises from multiple ventricular locations

24. A multifocal PVC differs from unifocal in that it:

A. Comes from one origin
B. Is less dangerous
C. Arises from multiple ventricular locations
D. Is a type of supraventricular tachycardia

C. Catecholamine release

25. What causes the skin to become clammy during MI?

A. Loss of plasma volume
B. Vasovagal response
C. Catecholamine release
D. Bradycardia

D. Myoglobin

26. Which enzyme peaks earliest after myocardial infarction?

A. LDH
B. CK-MB
C. Troponin
D. Myoglobin

C. 24 hours

27. What is the typical peak time for CK-MB levels after MI?

A. 1 hour
B. 6 hours
C. 24 hours
D. 72 hours

D. Zone of hypoxic injury

28. What is the name for myocardial tissue that may recover if perfusion is restored?

A. Necrotic zone
B. Zone of infarction
C. Zone of injury
D. Zone of hypoxic injury

B. Atrial fibrillation

29. What arrhythmia is most likely caused by multiple ectopic foci?

A. Atrial flutter
B. Atrial fibrillation
C. Junctional tachycardia
D. Ventricular escape rhythm

B. Atrioventricular block

30. What is a complication of inferior MI due to right coronary artery occlusion?

A. SA node failure
B. Atrioventricular block
C. Bundle branch block
D. Pericarditis

C. Valve leaflets bulge backward

31. What best describes valvular prolapse?

A. Valve leaflets don’t open
B. Valve is calcified
C. Valve leaflets bulge backward
D. Valve becomes rigid

B. Acute valvular dysfunction

32. Which condition may develop after papillary muscle rupture?

A. Aortic stenosis
B. Acute valvular dysfunction
C. AV nodal reentry
D. Sinus pause

B. Respiratory sinus arrhythmia

33. What rhythm disturbance results from changes in intrathoracic pressure?

A. Sinus tachycardia
B. Respiratory sinus arrhythmia
C. Ventricular flutter
D. Supraventricular tachycardia

C. Coronary angiography

34. What is the most definitive way to identify a coronary artery lesion?

A. Echocardiogram
B. Serial ECG
C. Coronary angiography
D. Chest radiograph

B. Mitral valve

35. Which valve is most likely to be involved in post-MI mechanical defects?

A. Pulmonic valve
B. Mitral valve
C. Tricuspid valve
D. Aortic valve

B. Prolonged ECG pause with escape rhythm

36. What occurs in sinoatrial (SA) block?

A. SA node stops firing permanently
B. Prolonged ECG pause with escape rhythm
C. Bradycardia below 40 bpm
D. Atrial depolarization without contraction

A. PAC

37. What term describes an ECG event from a single irritable atrial focus?

A. PAC
B. PVC
C. SVT
D. Junctional escape

C. Increased heart rate

38. What increases myocardial oxygen demand?

A. Bradycardia
B. Decreased preload
C. Increased heart rate
D. Vasodilation

B. Chest pain lasting over 30 minutes

39. What is a major symptom of a transmural MI?

A. Mild fatigue
B. Chest pain lasting over 30 minutes
C. Sinus arrhythmia
D. Pain relieved by nitroglycerin

D. CK-MB

40. What cardiac enzyme is found in skeletal and myocardial muscle?

A. CK-MM
B. Troponin T
C. Myoglobin
D. CK-MB

C. P wave

41. What ECG feature is absent in junctional rhythms?

A. QRS complex
B. ST segment
C. P wave
D. T wave

C. LDH

42. Which enzyme is least cardiac-specific for diagnosing MI?

A. CK-MB
B. Troponin I
C. LDH
D. Troponin T

C. Progression to ventricular fibrillation

43. What is the risk of multifocal PVCs?

A. Increased stroke volume
B. Decreased preload
C. Progression to ventricular fibrillation
D. Enhanced atrial contraction

B. Sinus bradycardia

44. Which condition is normal in trained athletes?

A. Sinus tachycardia
B. Sinus bradycardia
C. First-degree heart block
D. Ventricular tachycardia

C. Stenosis

45. What condition arises from the failure of a valve to fully open?

A. Prolapse
B. Regurgitation
C. Stenosis
D. Myocardial rupture

B. Fatigue or dizziness

46. What is a symptom of reduced diastolic filling time during tachycardia?

A. High pulse pressure
B. Fatigue or dizziness
C. Bradycardia
D. Cyanosis

B. Atrial or AV node depolarization

47. What initiates the escape rhythm in a sinus pause?

A. Atrial repolarization
B. Atrial or AV node depolarization
C. T wave inversion
D. Diastolic depolarization

C. Catecholamines

48. Which hormone surge during MI causes vasoconstriction and sweating?

A. Insulin
B. Aldosterone
C. Catecholamines
D. Cortisol

C. Above 100 bpm

49. In atrial fibrillation with rapid ventricular response (RVR), HR is:

A. Below 60 bpm
B. 60–100 bpm
C. Above 100 bpm
D. Irregular but under 100 bpm

C. Monitor vitals and prevent complications

50. What is the primary goal during early inpatient PT post-MI?

A. Strength training
B. Maximal exertion testing
C. Monitor vitals and prevent complications
D. Aerobic endurance training