Download Answers to Questions by Ellen Drake, CMT, AHDI

Answers to Questions
by Ellen Drake, CMT, AHDI-F
Based on
The Cardiovascular System: Anatomy, Physiology, Pathology
by John H. Dirckx, M.D.
1. B
Feedback: Valves prevent blood from flowing back into the atria and ventricles after it has
been pumped out.
2. C
Feedback: Although the atria act as pumps to some degree (in that they move the blood into
the ventricles), the workhorses of the heart are the ventricles, which is why Dr. Dirckx refers to
the ventricle as the "pump proper."
3. C
Feedback: The contraction of a chamber is called systole; although this is reflected in the
systolic number of a blood pressure reading, that reading is not systole.
4. A
Feedback: Relaxation of a ventricle is referred to as diastole; although reflected the lower
number of a blood pressure reading, the reading is not diastole.
5. D
Feedback: The sinoatrial node is the pacemaker, the origin of the electrical impulse that
stimulates first the atrium and then the ventricle to contract.
6. A
Feedback: Venous blood is blood that is returning to the heart after circulating through the
body; it has delivered oxygen to tissues throughout and picked up carbon dioxide as a waste
product.
7. C
Feedback: Right ventricular systole sends venous blood through the pulmonary artery to the
lungs, in whose capillaries the blood picks up fresh oxygen from inspired air and discharges
excess carbon dioxide into air that is about to be expired.
8. D
Feedback: During systole the tricuspid valve prevents blood from leaking back into the right
atrium.
Cardiology, The SUM Program Advanced Medical Transcription Unit, 2nd ed., 2011
Health Professions Institute
www.hpisum.com
9. D
Feedback: During the diastole the pulmonic valve keeps blood from leaking back into the
right ventricle.
10. B
Feedback: During left ventricular systole, the mitral valve prevents blood from being driven
back into the left atrium.
11. A
Feedback: During left ventricular diastole, the aortic valve prevents blood from leaking back
into the ventricle.
12. B
Feedback: The pulmonary veins are the only veins in the body that deliver oxygenated blood
because they deliver the blood from the lungs where it is oxygenated and purified back to the
heart.
13. A
Feedback: Passing from the left atrium to the left ventricle, the blood is pumped through the
aorta into the arteries of the systemic circulation.
14. D
Feedback: The venae cavae collect venous blood and deliver it to the right atrium; the
pulmonary artery delivers deoxygenated blood from the right ventricle to the lungs, and the left
ventricle pumps oxygenated blood into the ascending aorta.
15. B
Feedback: Although death MAY result if the circulation to a vital organ is compromised,
death is not inevitable due to increasingly effective methods of diagnosis and treatment.
16. B
Feedback: Pulmonary hypertension, affecting the pulmonary arteries, which carry blood to
the lungs from the right ventricle, is a separate disorder [from hypertension of the circulatory
system] usually related to disease of the lungs, pulmonary vasculature, or mitral valve.
17. C
Feedback: The systolic pressure is the highest pressure reached by the blood in the large
arteries with each beat of the heart; it is part of the blood pressure reading, but not the blood
pressure itself.
18. D
Feedback: The diastolic pressure is the lowest level to which the pressure drops between
beats of the heart; it is part of the blood pressure reading, but not the blood pressure itself.
Cardiology, The SUM Program Advanced Medical Transcription Unit, 2nd ed., 2011
Health Professions Institute
www.hpisum.com
19. D
Feedback: The difference between systolic and diastolic pressures is called the pulse
pressure.
20. A
Feedback: The elasticity of the arteries minimizes the difference (called the pulse pressure)
between systolic and diastolic pressures.
21. A
Feedback: Diet and exercise are not discussed as physiologic factors that interact to affect
blood pressure.
22. D
Feedback: The release of renin is not triggered by a complex interaction of hormones and
enzymes produced at widely differing sites, although this interaction figures into the reninangiotensin-aldosterone system that provides longer-term regulation of blood pressure.
23. D
Feedback: The conversion of antiotensin I to angiotensin II is triggered by angiotensinconverting enzyme (ACE), a glycoprotein produced in various tissues, principally the lung.
24. A
Feedback: Angiotensin II is not produced in the lung, but angiotensin-converting enzyme
(ACE) is.
25. C
Feedback: Secondary hypertension, which makes up fewer than 10% of total cases of
hypertension, is due to identifiable causes such as renal ischemic or hormone-producing tumor.
26. A
Feedback: Although the causes of essential hypertension are complex and not completely
understood, essential hypertension is not caused by congestive heart failure but may instead
cause congestive heart failure.
27. C
Feedback: Although essential hypertension can be treated with drugs that reduce peripheral
vascular resistance or enhance renal excretion of sodium, ACE and angiotensin II inhibitors work
even better.
28. B
Feedback: Although extremely high diastolic pressure can be associated with headache,
dizziness, or even seizures and coma, uncomplicated hypertension seldom causes any symptoms.
29. A
Feedback: Atherosclerosis is a causative factor in all of the diseases listed except diabetes
mellitus.
Cardiology, The SUM Program Advanced Medical Transcription Unit, 2nd ed., 2011
Health Professions Institute
www.hpisum.com
30. C
Feedback: Although dietary intake of cholesterol was once thought to be a significant factor
in the development of atherosclerosis, it is now believed that atherosclerosis is more of an
inflammatory process.
31. A
Feedback: Stenosis is reduction in the caliber or diameter of an artery due to the expansion of
atheromatous plaque; ischemia is impairment of blood supply; occlusion is complete obstruction,
and dissection is the separation or splitting of layers of the arterial wall.
32. B
Feedback: Occlusion is complete obstruction of blood flow to an area; ischemia is
impairment of blood supply; occlusion is complete obstruction, and dissection is the separation
or splitting of layers of the arterial wall.
33. C
Feedback: Ischemia is impairment of blood supply; occlusion is complete obstruction of
blood flow to an area; infarction is irreversible damage to tissues; occlusion is complete
obstruction, and dissection is the separation or splitting of layers of the arterial wall.
34. B
Feedback: Emboli are circulating fragments of atheromatous plaque. A thrombus is a blood
clot. Foam cells are macrophages in the lining (tunica intima) of an artery that look foamy
because they are stuffed with cholesterol. They are the earliest stage in the atheromatous process
that can be recognized on histopathologic study.
35. D
Feedback: Insulin resistance—not necessarily severe enough to constitute frank diabetes
mellitus—is believed to be the central abnormality in the metabolic syndrome. That is, the
obesity and disturbances of lipid (cholesterol and triglyceride) levels that are part of this
syndrome are thought to be secondary to a disorder of carbohydrate (glucose) metabolism
resulting from insulin resistance.
36. B
Feedback: Although many patients display atypical or variant forms of angina, the features
of classical angina pectoris virtually ensure a diagnosis of myocardial ischemia.
37. B
Feedback: Decubitus means lying down, recumbent; angina decubitus refers to angina
pectoris that is precipitated by assuming a recumbent posture.
38. C
Feedback: There are several triggering events for angina pectoris, or classical angina
pectoris, and angina decubitus is precipitated by lying down. Prinzmetal angina occurs without
an obvious precipitating event.
Cardiology, The SUM Program Advanced Medical Transcription Unit, 2nd ed., 2011
Health Professions Institute
www.hpisum.com
39. A
Feedback: Syndrome X refers to typical angina pectoris in a patient with normal blood flow
in coronary arteries, as shown by imaging studies. The etiology is unclear, but since drugs that
improve coronary flow relieve the symptoms, it is presumed to be due to vascular spasm.
40. D
Feedback: An extreme form of [unstable angina] is status anginosus, in which the patient
experiences many attacks each day with one attack following another so closely that pain is more
or less continuous. The occurrence … is ominous; hence it may also be called pre-infarct angina.
41. A
Feedback: The Bruce protocol is used for a treadmill stress test as described.
42. A
Feedback: Although calcium channel blockers and beta-adrenergic block agents may be used
to treat angina pectoris, the standard treatment is sublingual nitroglycerin or longer-acting
nitrates taken orally or applied to the skin in the form of ointments or patches.
43. B
Feedback: A coronary artery bypass graft (CABG) involves bypassing diseased coronary
arteries with patent vessels of natural or artificial origin.
44. B
Feedback: The question describes a percutaneous transluminal coronary angioplasty (PTCA),
a less invasive technique in which the caliber of a diseased coronary artery is mechanically
enlarged.
45. D
Feedback: Arterial spasm and thrombus may cause an MI but are not the definition;
separation or splitting of layers of the arterial wall is a dissection. An MI is death of a segment of
heart muscle caused by obstruction to blood flow in one or more branches of the coronary
system.
46. D
Feedback: Myoglobin, lactic dehydrogenase, CK MB, and troponins are lab studies done the
blood serum; they are not fond on an EKG.
47. B
Feedback: Tissue plasminogen activator (TPA) and streptokinase are thrombolytic agents
intended to restore circulation by dissolving a thrombus in an artery.
Cardiology, The SUM Program Advanced Medical Transcription Unit, 2nd ed., 2011
Health Professions Institute
www.hpisum.com
48. C
Feedback: Heart failure is a spectrum of clinical states having in common a reduction in the
pumping efficiency of the heart but varying widely in symptoms, signs, and impact on normal
function, but the full expression congestive heart failure refers to the elevation of central venous
pressure that typically accompanies this reduction in pumping efficiency.
49. C
Feedback: The difference between systolic and diastolic blood pressures is the pulse
pressure; the volume of blood expelled from the ventricle during systole is the stroke volume;
and that proportion of the blood in the ventricle at the end of diastole that is actually expelled
during systole is the ejection fraction. Cardiac output is the amount of blood pumped into the
aorta with each contraction of the left ventricle.
50. C
Feedback: Orthopnea is shortness of breath (dyspnea) in the recumbent position (lying
down), relieved by sitting up; paroxysmal nocturnal dyspnea is an attack of shortness of breath
that awakens the patient from sleep during the night.
51. B
Feedback: Anasarca is edema that involves the trunk and upper limbs as well as the lower
limbs; brawny ("tough") edema is chronic swelling with induration; and dependent edema is
swelling of the lower limbs. Pitting edema is caused by the impressions of the fingers on the skin
which refill slowly.
52. D:
Feedback: Examination of the heart generally reveals tachycardia, cardiac dilatation, a weak
first heart sound, and a prominent fourth heart sound (protodiastolic gallop). The latter two
findings reflect a faltering in the contractile force and pumping efficiency of the ventricles.
53. D
Feedback: Crepitant rales are caused by bubbling of air through free edema fluid in small air
passages and sound like a piece of cellophane is being crumpled.
54. B
Feedback: Pleural effusion is free edema fluid in the pleural space that may cause blunting of
the costophrenic sulci; Kerley B lines are short radiopaque streaks indicating edema in the walls
between the alveoli (interalveolar septa). Hepatojugular reflux is a visible wave of increased
engorgement in the jugular veins after manual compression of the swollen liver and has nothing
to do with a chest x-ray.
Cardiology, The SUM Program Advanced Medical Transcription Unit, 2nd ed., 2011
Health Professions Institute
www.hpisum.com
55. List 5 consequences of sustained elevation of systolic pressure
a. cardiac failure
b. ventricular dilatation
c. ventricular hypertrophy
d. hypertensive retinopathy
e. loss of tone and elasticity in arteries
f. aggravation of arterial changes due to aging or atherosclerosis
g. damage to renal vasculature caused by hypertension can augment the overproduction of
renin, leading to more severe hypertension and accelerated progression of disease.
56. List the 4 Keith-Wagener-Barker stages of hypertensive retinopathy
Grade 1 – Focal or diffuse narrowing of arteriolar caliber due to spasm
Grade 2 – Arteriolar diameter less than 50% of that of corresponding venules; “silver wire,”
“copper wire,” or “pipestem” appearance of arterioles, indicating structural changes in
vessel walls.
Grade 3 – In addition to the above changes, retinal hemorrhages or exudates. (A whitish spot
of variable size, shape, and composition—usually a deposit of lipid material at a site of
old hemorrhage or infarction.)
Grade 4 – In addition to the above, papilledema (swelling of the optic nerve head).
57. List 6 risk factors for essential hypertension
a. a family history of hypertension
b. African American ethnicity
c. age over 60
d. the postmenopausal state
e. overweight
f. a sedentary lifestyle
g. excessive intake of dietary sodium
h. excessive use of alcohol
i. chronic emotional stress.
58. List 3 categories or classes of drugs used to treat hypertension
a. diuretics that promote renal excretion of sodium
b. beta-adrenergic and calcium channel blockers, which blunt the effects of sympathetic
nerve stimuli and of circulating adrenergic agents on heart action and vascular tone
c. angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists
d. alpha-1 adrenergic antagonists
e. centrally acting alpha-agonists
Cardiology, The SUM Program Advanced Medical Transcription Unit, 2nd ed., 2011
Health Professions Institute
www.hpisum.com
59a. List 10 risk factors for atherosclerosis
a. male sex
b. advancing age
c. the postmenopausal state
d. a family history of atherosclerosis
e. cigarette smoking
f. elevation of plasma total cholesterol and low-density lipoprotein (LDL) cholesterol
g. hypertension
h. diabetes mellitus
i. overweight
j. a sedentary lifestyle.
59b. Other risk factors detectable by biochemical testing include
k. elevation of plasma triglycerides
l. fasting insulin
m. fibrinogen
n. C-reactive protein
o. amyloid A
p. interleukin-6
q. apolipoproteins A and B
r. lipoprotein (a)
s. homocysteine.
60. How is metabolic syndrome diagnosed?
The components of metabolic syndrome include the following, any three of which
establishes the diagnosis of metabolic syndrome. A component is considered to be present,
regardless of current laboratory findings, if the patient is under treatment for the condition in
question.
1. Hyperglycemia: fasting plasma glucose 100 mg/dL (5.55 mmol/L) or higher;
2. Truncal obesity: waist circumference over 40 inches (102 cm) in men and over 35 inches
(89 cm) in women;
3. Systemic hypertension: systolic blood pressure over 130 or diastolic pressure over 85;
4. Low high-density lipoprotein (HDL) cholesterol: less than 40 mg/dL (1.03 mmol/L) in
men and less than 50 mg/dL (1.29 mmol/L) in women;
5. High triglycerides: 150 mg/dL (1.69 mmol/L) or more.
61. Describe the features of classical angina pectoris.
Sudden, moderately severe to excruciating pain in the anterior chest (precordial or substernal
area), often described as a pressure, heaviness, or constriction, that resolves spontaneously in
5-15 minutes. The pain may radiate into the neck, jaw, interscapular area, shoulder, or arm,
particularly the left arm. It is typically triggered by one or more of the four E’s: eating
(particularly a heavy meal), emotion (anxiety or anger precipitated by some sudden event),
exertion (walking uphill, shoveling snow), or exposure to cold. The duration of pain can
usually be shortened by resting or taking nitroglycerin.
Cardiology, The SUM Program Advanced Medical Transcription Unit, 2nd ed., 2011
Health Professions Institute
www.hpisum.com
62. List 6 standard diagnostic measures, besides the basic history and physical examination, that
may be used to assess a patient with angina pectoris
a. resting electrocardiogram (ECG)
b. continuous (ambulatory) ECG recording by Holter monitor
c. exercise stress testing
d. coronary arteriography (imaging studies with radiopaque material injected into the
coronary circulation)
e. radioactive scanning (study of myocardial perfusion with injected thallium-201)
f. echocardiography (ultrasound examination of the heart)
g. cardiac catheterization
h. cineangiography after injection of technetium-99m (with or without multiple-gated
acquisition (MUGA) bloodpool imaging)
i. single-photon emission computed tomography (SPECT).
63. List the four levels of functional impairment in heart failure of the New York Heart
Association Classification.
I Asymptomatic.
II Symptomatic with moderate exertion.
III Symptomatic with minimal exertion.
IV Symptomatic at rest.
64. Measures used to treat chronic congestive heart failure include (list 3)
a. whatever measures are available to control underlying factors such as hypertension and
coronary artery disease.
b. limitation of dietary sodium to 2-3 g/day
c. diuretics
d. ACE inhibitors
e. beta-blocking agents
f. Digoxin
65. List the measures used to treat acute pulmonary edema.
a. morphine
b. an intravenous diuretic
c. sublingual and intravenous nitroglycerin
d. nitroprusside.
66. What types of drugs are used to treat refractory acute cardiac failure?
Inotropic drugs such as dobutamine and dopamine
Cardiology, The SUM Program Advanced Medical Transcription Unit, 2nd ed., 2011
Health Professions Institute
www.hpisum.com