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First week of cardiology

Total questions: 101

Worksheet time: 58mins

Name
Class
Date
1.

The truncus arteriosus will become the _______

a)

ascending aorta and pulmonary trunk

b)

smooth portion of ventricles

c)

trabeculated portion of the ventricles

d)

trabeculated part of the atria

2.

The primitive atrium of the heart tube will become

a)

ascending aorta and pulmonary trunk

b)

smooth portion of ventricles

c)

trabeculated portion of the ventricles

d)

trabeculated part of the atria

3.

The primitive ventricle of the heart tube will become the

a)

ascending aorta and pulmonary trunk

b)

smooth portion of ventricles

c)

trabeculated portion of the ventricles

d)

trabeculated part of the atria

4.

The bulbus cordis will become

a)

ascending aorta and pulmonary trunk

b)

smooth portion of ventricles

c)

trabeculated portion of the ventricles

d)

trabeculated part of the atria

5.

A newborn is diagnosed with transposition of the great vessels shortly after birth. Which of the following maternal conditions is most commonly associated with an increased risk of this congenital heart defect?

a)

gestational hypertension

b)

gestational diabetes

c)

maternal hypothyroidism

d)

maternal anemia

6.

A term newborn presents with central cyanosis and minimal response to oxygen therapy. Echocardiography confirms transposition of the great vessels (TGV). Which of the following is the most appropriate immediate pharmacologic intervention to stabilize the infant?

a)

Administer indomethacin to close the ductus arteriosus

b)

Begin a dopamine infusion to improve cardiac output

c)

Administer prostaglandin E1 to maintain ductal patency

d)

Initiate furosemide to reduce pulmonary congestion

7.

Match the following

a)

ascending aorta and pulmonary trunk

1.

Truncus arteriosus

b)

ventricular septum and av valves

2.

endocardial cushions

c)

Superior vena cava

3.

common cardinal veins

d)

portal and mesenteric veins

4.

vitelline veins

e)

coronary sinus and posterior RA

5.

Sinus venosus

8.

Which of the following best explains the functional closure of the foramen ovale in a healthy newborn shortly after birth?

a)

Decreased systemic vascular resistance increases right atrial pressure, sealing the foramen ovale

b)

increased pulmonary vascular resistance reidrects blood through the foramen ovale, closing it

c)

Increased pulmonary venous return raises left atrial pressure, functionally closing the foramen ovale

d)

closure of the ductus arteriosus increases right atrial pressure, forcing the foramen ovale shut

9.

Which of the following is a potential complication of a patent foramen ovale (PFO) in an adult?

a)

volume overload of the right atrium leading ot heart failure

b)

right to left shunting of oxygenated blood causing systemic hypoxia

c)

passage of venous thrombi to the left atrium, increasing the risk of systemic embolism

d)

increasing pulmonary circulation pressure leading to pulmonary edema

10.

How will an atrial septal defect present on auscultation

a)
Loud S1 and diastolic murmur at the left lower sternal border.
b)
Single S2 with a continuous murmur at the right sternal border.
c)

Fixed wide split of S2 and possible systolic ejection murmur at the left upper sternal border.

d)
Normal heart sounds with no additional murmurs.
11.
Question Image

Match the following

a)

Blue

1.

Tricuspid

b)

Green

2.

mitral valve

c)

Orange

3.

Septal wall

d)

Red

4.

Right ventricle

e)

Purple

5.

Left atrium

12.
Question Image

Match the following

a)

Blue

1.

mitral valve

b)

green

2.

Left atrium

c)

Blue

3.

mitral valve

d)

Red

4.

Aorta

e)

Purple

5.

aortic valve

13.
Question Image

Match the following

a)

blue

1.

right atrium

b)

Green

2.

right ventricle

c)

Orange

3.

Left atrium

d)

red

4.

aorta

e)

purple

5.

Left ventricle

14.

S1 heart sound is produced by the closure of

a)
semilunar valves
b)
aortic valves
c)

pulmonary and aortic valves

d)

tricuspid and mitral valves (AV)

15.

S1 heart sound is produced by the closure of

a)
semilunar valves
b)
aortic valves
c)

pulmonary and aortic valves

d)

tricuspid and mitral valves (AV)

16.

S2 heart sound is produced by the closure of

a)
semilunar valves
b)
aortic valves
c)

pulmonary and aortic valves

d)

tricuspid and mitral valves (AV)

17.

S1 heart sound is best appreciated at the _____ and is accentuated by placing patient in the ______ position

a)
apex; left lateral decubitus
b)
base; right lateral decubitus
c)
apex; sitting position
d)
base; supine position
18.

What can pause pathological S2 splitting that is wide and fixed

a)
Coughing forcefully
b)

severe aortic stenosis; left bundle branch block

c)

atrial septal defect

d)

pulmonary stenosis; right bundle branch block

19.

What can pause pathological S2 splitting that is wide (but not fixed)

a)
Coughing forcefully
b)

severe aortic stenosis; left bundle branch block

c)

atrial septal defect

d)

pulmonary stenosis; right bundle branch block

20.

What can pause pathological S2 splitting that is paradoxical

a)
Coughing forcefully
b)

severe aortic stenosis; left bundle branch block

c)

atrial septal defect

d)

pulmonary stenosis; right bundle branch block

21.

Where is the P2 component of S2 best appreciated

a)

erbs point

b)

Cardiac apex

c)

2nd R parasternal ICS

d)

2nd L parasternal ICS

22.

Where is the A2 component of S2 best appreciated

a)

erbs point

b)

Cardiac apex

c)

2nd R parasternal ICS

d)

2nd L parasternal ICS

23.

Physiologic S2 splitting will cause a ______ of A2 and P2 during ________

a)

wide fixed splitting; expiration

b)
widening; expiration
c)
widening; inspiration
d)
narrowing; inspiration
24.

What is a paradoxical S2 split (seen in severe aortic stenosis and left bundle branch block)

a)
A paradoxical S2 split is caused by rapid aortic valve closure.
b)
A paradoxical S2 split is a split of the first heart sound during inspiration.
c)

A paradoxical S2 split occurs when P2 closes before A2

d)
A paradoxical S2 split occurs only in healthy individuals.
25.

Narrowing of S2 split in inspiration is indicative of ______ splitting

a)
physiologic splitting
b)
paradoxical splitting
c)

wide fixed splitting

d)
fixed splitting
26.

In a patient with excessive blood volume you will hear what heart sound early in diastole, after S2 (aka gallop)

a)
S1 heart sound
b)
S4 heart sound
c)
Murmur during diastole
d)
S3 heart sound
27.

S3 heart sound is physiologic in what conditions

a)
Elderly individuals
b)
Patients with heart disease
c)
Sedentary lifestyle
d)
Young individuals, athletes, pregnancy.
28.

S4 heart sound is physiologic in what conditions

a)
Elderly individuals
b)
Patients with heart disease
c)
Sedentary lifestyle
d)
Young individuals, athletes, pregnancy.
29.

S3 heart sounds are pathologic in what conditions

a)

Young and fit, pregnancy

b)

systolic heart failure, mitral regurgitation, aortic regurgitation

c)

Elderly individuals

d)

diastolic heart failure, chronic hypertension, aortic stenosis

30.

S4 heart sounds are pathologic in what conditions

a)

Young and fit, pregnancy

b)

systolic heart failure, mitral regurgitation, aortic regurgitation

c)

Elderly individuals

d)

diastolic heart failure, chronic hypertension, aortic stenosis

31.

____ is produced by atrial kick due to high left ventricular pressures

a)

S1

b)

S2

c)

S3

d)

S4

32.

S1 results from the closure of the AV valves. A softer/absent S1 can result from an immobile mitral valve. This can be seen in ________

a)

Severe/late mitral stenosis

b)

Early mitral stenosis

c)
tricuspid stenosis
d)
aortic regurgitation
33.

Systole starts when the _____ close

a)
aortic valve
b)
atrioventricular (AV) valves
c)
pulmonary valve
d)
semilunar valves
34.

______ begins after the closing of the mitral valve and is characterized by the highest oxygen consumption

a)
Ventricular filling
b)
Isovolumetric relaxation
c)
Isovolumetric contraction
d)
Atrial contraction
35.

During the cardiac cycle, the highest amount of oxygen consumption is during ________

a)
diastole
b)
atrial contraction
c)
ventricular filling
d)

isovolumetric contraction

36.

The T wave in the cardiac cycle represents what event

a)
Repolarization of the ventricles
b)
Depolarization of the atria
c)
Relaxation of the atria
d)
Contraction of the ventricles
37.

The ______ of the aortic pressure demarcates the end of systole and the onset of diastole, just after the aortic valve closes.

a)

systolic peak

b)

diastolic minimum

c)

pulse pressure

d)
dicrotic notch
38.

Which part of the cardiac cycle is associated with the QRS complex on ECG

a)

Isovolumetric contraction contraction

b)
Ventricular relaxation (diastole)
c)
Atrial contraction (systole)
d)
Atrial relaxation (diastole)
39.

The _____ phase of the cardiac cycle occurs after the opening to the aortic valve

a)
isovolumetric contraction phase
b)
ejection phase
c)
diastolic phase
d)
atrial contraction phase
40.

Once left ventricular pressure is lower than the aortic pressure, _____

a)

mitral valve opens

b)

Aortic valve closes

c)

tricuspid valve closes

d)

aortic valve closes

e)

Pulmonary valve closes

41.

Coronary blood flow is going to peak during

a)

early systole

b)

early diastole

c)

late systole

d)

late diastole

42.

Which heart sound occurs due to rapid filling into a volume overloaded left ventricle

a)

S1

b)

S2

c)

S3

d)

S4

43.

What heart sound is heard during atrial systole at the conclusion of diastole

a)

S1

b)

S2

c)

S3

d)

S4

44.

Red

a)

Mitral valve closes

b)

Aortic valve opens

c)

Aortic valve closes

d)

mitral valve opens

45.

Orange

a)

Mitral valve closes

b)

Aortic valve opens

c)

Aortic valve closes

d)

mitral valve opens

46.

Yellow

a)

Mitral valve closes

b)

Aortic valve opens

c)

Aortic valve closes

d)

mitral valve opens

47.

Green

a)

Mitral valve closes

b)

Aortic valve opens

c)

Aortic valve closes

d)

mitral valve opens

48.

Generally speaking, the jugular venous waveform focuses on

a)

right side of the heart

b)

left side of the heart

c)

systole only

d)

diastole only

49.

The P wave on an ecg represents ______

a)
ventricular depolarization
b)
atrial repolarization
c)
ventricular repolarization
d)
atrial depolarization
50.

If a p wave was absent from an ecg, what would be affected in the jugular venous wave form

a)

A wave

b)

C wave

c)

X descent

d)

V wave

e)

Y descent

51.

Which component of the jugular venous waveform corresponds to ventricular contraction

a)

A wave

b)

C wave

c)

X descent

d)

V wave

e)

Y descent

52.

Which component of the jugular venous waveform corresponds to atrial relaxation

a)

A wave

b)

C wave

c)

X descent

d)

V wave

e)

Y descent

53.

Which component of the jugular venous waveform corresponds to atrial filling

a)

A wave

b)

C wave

c)

X descent

d)

V wave

e)

Y descent

54.

Which component of the jugular venous waveform corresponds to ventricular filling

a)

A wave

b)

C wave

c)

X descent

d)

V wave

e)

Y descent

55.

How would tricuspid regurgitation present on a jugular venous wave form

a)

Absent A-waves

b)

Enhanced V wave

c)

Increased Y descent

d)

Blunting of Y descent

e)

Cannon A-waves

56.

How would atrial fibrillation present on a jugular venous wave form

a)

Absent A-waves

b)

Enhanced V wave

c)

Increased Y descent

d)

Blunting of Y descent

e)

Cannon A-waves

57.

How would tamponade present on a jugular venous wave form

a)

Absent A-waves

b)

Enhanced V wave

c)

Increased Y descent

d)

Blunting of Y descent

e)

Cannon A-waves

58.

How would constrictive pericarditis present on a jugular venous wave form

a)

Absent A-waves

b)

Enhanced V wave

c)

Increased Y descent

d)

Blunting of Y descent

e)

Cannon A-waves

59.

In aortic stenosis, the left ventricular pressure will be

a)

unaffected

b)

much greater than the aortic pressure

c)

much lower than the aortic pressure

d)

the same as the aortic pressure

60.

Which of the following best describes the effect of chronic aortic regurgitation on pulse pressure

a)

narrowed pulse pressure due to decreased stroke volume

b)

widened pulse pressure due to increased stroke volume and decreased diastolic pressure

c)

No change in pulse pressure because cardiac output remains constant

d)

widened pulse pressure due to increased diastolic pressure

61.

Which of the following will present with the loss of the dicrotic notch

a)

Aortic stenosis

b)

Aortic regurgitation

c)

Mitral stenosis

d)

Mitral regurgitation

62.

Which of the following will present with a tall V-wave

a)

Aortic stenosis

b)

Aortic regurgitation

c)

Mitral stenosis

d)

Mitral regurgitation

63.

Which of the following will present with much greater left atrial pressures (relative to left ventricular pressures) during diastole

a)

Aortic stenosis

b)

Aortic regurgitation

c)

Mitral stenosis

d)

Mitral regurgitation

64.

Which of the following would not classically result from aortic regurgitation

a)

Increased pulse pressure

b)

Increased aortic pressure during diastole

c)

Loss of dicrotic notch

d)

increased aortic pressure during systole

65.

Right sided heart failure often results from

a)

Primary pulmonary problem (i.e. pulmonary hypertension)

b)

Secondary systemic problem (i.e. peripheral edema)

c)

Secondary pulmonary problem (i.e. pulmonary edema)

d)

Primary systemic problem (i.e. hypertension, increased SVR)

66.

Match the phases

a)

Phase 0

1.

Sodium rapidly enters cells; Ca slowly

b)

Phase 1

2.

Sodium channels close

c)

Phase 2

3.

K+ rapidly exits cell; Ca++ slowly enter

d)

Phase 3

4.

Ca++ channels close; K+ exits

e)

Phase 4

5.

Na+/K+ pump restores resting potential

67.

Class 1 Arrhythmics

a)

sodium channel blocker

b)

beta blocker

c)

potassium channel blocker

d)

calcium channel blocker

68.

Class 2 Antiarrhythmics

a)

sodium channel blocker

b)

beta blocker

c)

potassium channel blocker

d)

calcium channel blocker

69.

Class 3 Antiarrhythmics

a)

sodium channel blocker

b)

beta blocker

c)

potassium channel blocker

d)

calcium channel blocker

70.

Class 4 Antiarrhythmics

a)

sodium channel blocker

b)

beta blocker

c)

potassium channel blocker

d)

calcium channel blocker

71.

The ______ represents the duration of the ventricular action potential

a)

P wave

b)

T wave

c)

QT Interval

d)

QRS Interval

e)

PR Interval

72.

The ____ represents the conduction time from atrium to ventricle

a)

P wave

b)

T wave

c)

QT Interval

d)

QRS Interval

e)

PR Interval

73.

The ______ represents the intraventricular conduction time (ventricular depolarization)

a)

P wave

b)

T wave

c)

QT Interval

d)

QRS Interval

e)

PR Interval

74.

The ______ represents the conduction time from atrium to ventricle

a)

P wave

b)

T wave

c)

QT Interval

d)

QRS Interval

e)

PR Interval

75.

Match the following antiarrhythmic drugs

a)

Quinidine, Procainamide

1.

1a

b)

Lidocaine, phenytoin

2.

1b

c)

Verapamil, diltiazem

3.

4

d)

Amiodarone, sotalol

4.

3

e)

Propranalol, metaprolol

5.

2

76.

______ are used for refractory Vtac and WPW, as well as Afib without any structural cardiac or valvular changes.

a)

Flecainide and propafenone

b)

Quinidine and procainamide

c)

lidocaine

d)

propanolol and metaprolol

77.

Which class of antiarrhythmics block voltage gated sodium channels, inhibiting depolarization (phase 0), as well as lower selectivity to block calcium and potassium channels

a)

Class I antiarrythmics

b)

Class II antiarrythmics

c)

Class III antiarrythmics

d)

Class IV antiarrythmics

78.

Which group of antiarrhythmics elongate atrial refractory period, slow SA rate, and slow conduction through the AV node

a)

Class I antiarrythmics

b)

Class II antiarrythmics

c)

Class III antiarrythmics

d)

Class IV antiarrythmics

79.

Non-selective Beta1 and Beta2 blocker.

a)

Propranolol

b)

Esmolol

c)

Labetalol

d)

Metaprolol

80.

Which of the following is a side effect that is more strongly associated with/unique to propranolol amongst the other beta blockers

a)

AV block

b)

bradycardia

c)

hypotension

d)

exercise intolerance

e)

nightmares

81.

Lidocaine, a Class 1B antiarrhythmic, decreases the AP duration and is effective in treating ventricular arrhythmias post MI. Generally, class 1 antiarrhythmics decrease the conduction of depolarized cardiac cells. Which component of the ventricular action potential is influenced by Class 1 antiarrhythmics?

a)

Phase 0

b)

Phase 1

c)

Phase 2

d)

Phase 3

e)

Phase 4

82.

A 66 year old female presents to the emergency department with substernal chest pain. ECG reveals an ST elevation myocardial infarction (STEMI) and the patient undergoes percutaneous coronary intervention with successful stunting. The following day, she complains of palpitations and shortness of breath. Her blood pressure is 100/72 mmHg. The attending physician opts for medical management of this patient’s arrhythmia. Which of the following antiarrhythmics is contraindicated in this patient

a)

Amiodarone

b)

Mexiletine

c)

Flecainide

d)

Procainamide

e)

Sotalol

83.

A researcher is studying a new compound for use in the acute treatment of ischemic ventricular arrhythmia. When tested on myocardial cells, it causes a decrease in the slope of phase 0 depolarization and a decrease in the duration of the action potential. The compound exhibits increased activity when exposed to ischemic ventricular tissue. The experimental drug resembles which of the following

a)

Disopyramide

b)

Propafenone

c)

Dofetilide

d)

Carvedilol

e)

Lidocaine

84.

What is the most efficient class III antiarrhythmic drug

a)
Dronedarone
b)
Sotalol
c)
Amiodarone
d)
Flecainide
85.

Two major drug interactions with amiodarone are with _____ and _____

a)

aspirin, heparin

b)

metformin, warfarin

c)

lisinopril, heparin

d)

warfarin, procainamide

86.

Which class of antiarrhythmics can cause profound decreases in heart rate and contractility

a)

Class I

b)

Class II

c)

Class III

d)

Class IV

87.

Side effects of _____ antiarrhythmics include gingival hyperplasia, peripheral edema, hypotension, dyspepsia, and hyperglycemia

a)

Class I

b)

Class II

c)

Class III

d)

Class IV

88.

A 62 year old female presents to the emergency department with a 2 hour history of chest pain with ST-segment elevations in leads II, III, and aVF. She has a history of diabetes millitus. She receives emergent angioplasty and stunting but has recurrent runs of ventricular tachycardia after the procedure. She is then prescribed an antiarrhythmic drug that acts by slowing phase 3 depolarization of the action potential. Which of the following medications was she most likely prescribed.

a)

Diltiazem

b)

Procainamide

c)

Esmolol

d)

Quinidine

e)

Sotalol

89.

______ Inhibits the membrane of Na/K pump; enhancing myocardial contractility. Stimulates parasympathetic system via the vagus nerve; inhibits SAN rate and decrease conduction through AVN.

a)

Digoxin/digitalis

b)

adenosine

c)

Mg++

d)

Procainamide

e)

K+

90.

_____ is a cofactor of the membrane Na/K ATPase pump and a calcium ion antagonist; decreasing HR

a)

Digoxin/digitalis

b)

adenosine

c)

Mg++

d)

Procainamide

e)

K+

91.

________ stabilizes the membrane potential; increases the refractory period of the SA node and slows conduction through the AV node.

a)

Digoxin/digitalis

b)

adenosine

c)

Mg++

d)

Procainamide

e)

K+

92.

A 50 year old woman presents with a facial rash, arthralgia and muscle pain (myalgia) for the last 3 months. She has been treated with drug X for the past 6 months. Lab findings reveal elevated antinuclear antibodies (ANA) with homogenous patterns. Drug X is most likely which of the following?

a)

Procainamide

b)

Imipramine

c)

Thioridazine

d)

Tetracycline

e)

Rifampin

93.

Match the following following the physiological effects of adrenergic receptors

a)

Alpha-1

1.

NE>E

b)

Alpha-2

2.

E>NE

c)

Beta-1

3.

E=NE

d)

Beta-2

4.

E>>NE

94.

Vasoconstriction of blood vessels of:

-Skin

-GIT

-Kidney

-Brain

a)

Alpha-1; postsynaptic

b)

Alpha-2;

Presynaptic

c)

Beta-1;

Postsynaptic

d)

Beta-2;

Postsynaptic

95.

Inhibits release of norepinephrine; at skeletal muscle synapses inhibits alpha1-mediated constriction in skeletal muscle arteries

a)

Alpha-1; postsynaptic

b)

Alpha-2;

Presynaptic

c)

Beta-1;

Postsynaptic

d)

Beta-2;

Postsynaptic

96.

Gq protein coupled activates phospholipase C; PIP2–>IP3 + DAG

a)

Alpha-1; postsynaptic

b)

Alpha-2;

Presynaptic

c)

Beta-1;

Postsynaptic

d)

Beta-2;

Postsynaptic

97.

Gi protein coupled inhibits adenyl cyclase

ATP—> X —> cAMP

a)

Alpha-1; postsynaptic

b)

Alpha-2;

Presynaptic

c)

Beta-1;

Postsynaptic

d)

Beta-2;

Postsynaptic

98.

FDA Indication:

-Bradyarrhythmias (heart blocks)

-Opthamology for retinal dilator

-Organophosphate poisoning

a)

Atropine

b)

Ipratropium/tiotropium

c)

scopolamine

d)

oxybutynin

e)

Dicyclomine

99.

FDA Indication:

-Bradyarrhythmias (heart blocks)

-Opthamology for retinal dilator

-Organophosphate poisoning

a)

Atropine

b)

Ipratropium/tiotropium

c)

scopolamine

d)

oxybutynin

e)

Dicyclomine

100.

FDA Indication:

Bronchiodilator COPD and asthma

a)

Atropine

b)

Ipratropium/tiotropium

c)

scopolamine

d)

oxybutynin

e)

Dicyclomine

101.

FDA Indication:

Motion sickness

Post-op nausea/vomiting

a)

Atropine

b)

Ipratropium/tiotropium

c)

scopolamine

d)

oxybutynin

e)

Dicyclomine