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Cardio week 4 48-51

Total questions: 100

Worksheet time: 50mins

Name
Class
Date
1.

Which of the following is the most common cause of edema due to an increase in the 'pushing' force of fluid out of the capillaries?

a)

Increased Capillary Hydrostatic Pressure (Pc)

b)

Decreased Capillary Oncotic Pressure (πc)

c)

Increased Capillary Permeability

d)

Reduced Lymphatic Drainage

2.

A reduction in the 'pulling' force of proteins that keeps fluid in the capillaries, often due to low protein levels in the blood, is known as _________

a)

Decreased Capillary Oncotic Pressure (πc)

b)

Increased Capillary Hydrostatic Pressure (Pc)

c)

Decreased Interstitial Oncotic Pressure (πi)

d)

Increased Lymphatic Drainage

3.

Which mechanism of edema is often caused by inflammation, burns, sepsis, anaphylaxis, or tumors and allows more fluid and proteins to leak out of the capillaries?

a)

Increased Capillary Hydrostatic Pressure (Pc)

b)

Decreased Capillary Oncotic Pressure (πc)

c)

Increased Capillary Permeability

d)

Reduced Lymphatic Drainage

4.

When the lymphatic system is unable to remove excess fluid and proteins that escape the capillaries, it leads to a specific type of edema called _________

a)

lymphedema

b)

ascites

c)

anemia

d)

hematuria

5.

Lymphedema is distinguished from other types of edema by which of the following characteristics?

a)

Soft, pitting consistency

b)

Hard, non-pitting consistency

c)

Low protein content

d)

High water content

6.

What is Primary Lymphedema?

a)

A) A condition caused by infections

b)

B) A rare, congenital condition caused by genetic disorders that affect lymphatic development

c)

C) A condition caused by tumors

d)

D) A condition caused by deep venous thrombosis

7.

Which of the following is NOT a common cause of Secondary Lymphedema?

a)

Tumors or Malignancy

b)

Medical Treatments

c)

Infections like filariasis

d)

Diabetes

8.

Fill in the blank: Parasitic infections like ________ can cause severe lymphedema known as elephantiasis.

a)

filariasis

b)

malaria

c)

ascariasis

d)

leishmaniasis

9.

Which stage of lymphedema is characterized by significant enlargement (elephantiasis), extensive thickening, and skin breakdown?

a)

Stage 1

b)

Stage 2

c)

Stage 3

d)

Stage 4

10.

Stage 2 lymphedema is described as:

a)

Asymptomatic; the body compensates, and there is little to no swelling.

b)

The limb is visibly enlarged. Swelling may still be relieved by elevating the limb.

c)

Swelling is not easily relieved by elevation. The skin starts to show permanent changes like thickening and scarring.

d)

Characterized by significant enlargement (elephantiasis), extensive thickening, and skin breakdown.

11.

Deep Venous Thrombosis (DVT) can destroy lymphatic vessels in the affected area.

a)

True

b)

False

12.

What is pulmonary edema?

a)

Pulmonary edema is fluid accumulation in the alveoli of the lungs.

b)

Pulmonary edema is a bacterial infection of the bronchi.

c)

Pulmonary edema is the hardening of the lung tissue.

d)

Pulmonary edema is the collapse of the trachea.

13.

Cardiogenic pulmonary edema is caused by heart problems that lead to increased ________ pressure in the pulmonary capillaries.

a)

hydrostatic

b)

osmotic

c)

oncotic

d)

colloid

14.

What is the primary cause of cardiogenic pulmonary edema?

a)

Increased capillary permeability

b)

Increased capillary hydrostatic pressure

c)

Decreased lymphatic drainage

d)

Decreased capillary hydrostatic pressure

15.

On an X-ray, cardiogenic pulmonary edema often appears as a _______ or cloudy infiltrate around the center of the lungs.

a)

fluffy

b)

linear

c)

granular

d)

reticular

16.

Non-cardiogenic pulmonary edema is primarily caused by:

a)

Increased capillary hydrostatic pressure

b)

Increased capillary permeability

c)

Decreased cardiac output

d)

Decreased blood volume

17.

Which of the following is NOT a key diaphragm involved in fluid movement according to osteopathic considerations for edema?

a)

Pelvic diaphragm

b)

Thoracolumbar diaphragm

c)

Thoracic inlet

d)

Abdominal wall

18.

Practitioners assess for ________, asymmetries, and pulse differences to identify areas of congestion in patients with edema.

a)

tissue texture changes

b)

skin color changes

c)

muscle strength deficits

d)

joint deformities

19.

Which treatment technique involves manipulating the feet and legs to 'pump' stagnant fluid back toward the trunk?

a)

Rib Raising

b)

Pedal Pumping

c)

Thoracic Pump

d)

Diaphragm Doming

20.

Diaphragm Doming is a technique used to stretch and improve the function of the respiratory diaphragm, promoting fluid flow.

a)

True

b)

False

21.

According to the lecture, how many people per year died from heart failure in 2022?

a)

8.7 million

b)

2.3 million

c)

15 million

d)

500,000

22.

By 2037, the number of people projected to die from heart failure per year is expected to rise to:

a)

8.7 million

b)

10 million

c)

5 million

d)

12 million

23.

Which region in the US has the highest prevalence of heart failure according to the lecture?

a)

Midwest and Southeast US, with Texas being particularly affected

b)

Northeast and Pacific Northwest

c)

Southwest and Rocky Mountains

d)

New England and Mid-Atlantic

24.

Areas with the highest prevalence of heart failure also have the highest rates of which cardiovascular disease risk factors?

a)

Hypertension

b)

Obesity

c)

Hyperlipidemias

d)

Asthma

25.

The average cost per hospitalization for heart failure is estimated to be between ______ and ______.

a)

$25,000 and $50,000

b)

$5,000 and $10,000

c)

$100,000 and $200,000

d)

$1,000 and $2,000

26.

Which of the following is NOT listed as a common comorbidity of heart failure?

a)

Hypertension

b)

Diabetes

c)

Asthma

d)

Sleep disturbances

27.

The cost per day for heart failure hospitalization was estimated at around ______ in 2021.

a)

$2,000

b)

$500

c)

$5,000

d)

$10,000

28.

What is the clinical significance of comorbidities in heart failure?

a)

They have no effect on treatment

b)

They can affect which heart failure drugs are safe or effective

c)

They always improve prognosis

d)

They only affect young patients

29.

What is the condition called when a patient has both heart failure and renal disease, leading to a significantly worse prognosis?

a)

Cardio-renal syndrome

b)

Pulmonary embolism

c)

Mitral valve prolapse

d)

Hepatorenal syndrome

30.

Which of the following is a major cause of heart failure?

a)

Coronary Artery Disease (CAD)

b)

Diabetes

c)

Asthma

d)

Osteoporosis

31.

Chronic high blood pressure leads to compensatory hypertrophy, which can eventually fail and result in dilated cardiomyopathy. This describes which major cause of heart failure?

a)

Hypertension

b)

Coronary artery disease

c)

Valvular heart disease

d)

Congenital heart defect

32.

Issues with any heart valve (mitral, aortic, tricuspid, pulmonary) can cause heart failure. What is this condition called?

a)

Valvular Heart Disease

b)

Coronary Artery Disease

c)

Pericarditis

d)

Arrhythmia

33.

Which of the following is considered an 'other cause' of heart failure?

a)

Endocarditis

b)

Hypertension

c)

Cardiomyopathies

d)

Valvular Heart Disease

34.

What is a vague symptom of heart failure that is initially present with exertion and later at rest?

a)

Shortness of breath

b)

Chest rash

c)

Frequent urination

d)

Blurred vision

35.

What is orthopnea?

a)

Shortness of breath when lying down, relieved by sitting up

b)

Sudden shortness of breath that wakes a person from sleep

c)

Swelling in the ankles

d)

A third heart sound

36.

Paroxysmal nocturnal dyspnea (PND) is defined as sudden shortness of breath that wakes a person from sleep.

a)

True

b)

False

37.

Peripheral edema starts in the _______ and can progress to the knees and eventually ascites (abdominal fluid).

a)

ankles

b)

hands

c)

elbows

d)

shoulders

38.

Which of the following is a specific sign of heart failure?

a)

Elevated jugular venous pressure (JVP)

b)

Headache

c)

Fever

d)

Rash

39.

Diagnosis of heart failure requires two major criteria, or one major and two minor criteria.

a)

True

b)

False

40.

Which of the following is NOT a major diagnostic criterion for heart failure?

a)

Orthopnea

b)

Ankle edema

c)

S3 gallop

d)

Hepatojugular reflex

41.

The primary tool to determine ejection fraction (EF) in heart failure diagnosis is _______.

a)

echocardiography (ECHO)

b)

electrocardiography (ECG)

c)

chest X-ray

d)

cardiac catheterization

42.

Which lab work is used to measure natriuretic peptides (BNP) in the diagnostic algorithm for heart failure?

a)

Blood glucose

b)

BNP

c)

Troponin

d)

Creatinine

43.

What does BNP (B-type Natriuretic Peptide) indicate when released by the ventricles?

a)

The amount of BNP is proportional to the severity of ventricular remodeling. A normal BNP level almost always rules out significant ventricular disease.

b)

BNP is released in response to increased oxygen demand in skeletal muscles.

c)

BNP levels are used to diagnose liver dysfunction.

d)

BNP is a marker for acute kidney injury.

44.

Ejection Fraction (EF) is a measure of the percentage of blood pumped out of the ventricle with each beat. What is the normal range for EF?

a)

30-40%

b)

40-55%

c)

55-70%

d)

Above 70%

45.

Ejection Fraction (EF) is a measure of the percentage of blood pumped out of the ventricle with each beat. What EF percentage is considered heart failure?

a)

Below 40%

b)

40-55%

c)

55-70%

d)

Above 70%

46.

The type of heart failure is defined by the ejection fraction. Heart Failure with Reduced Ejection Fraction (HFrEF) is diagnosed when the ejection fraction is ________.

a)

Below 40%

b)

Above 50%

c)

Between 40% and 50%

d)

Exactly 50%

47.

The type of heart failure is defined by the ejection fraction. Heart Failure with Preserved Ejection Fraction (HFpEF) is diagnosed when the ejection fraction is ________.

a)

Normal or mildly reduced (above 50%)

b)

Severely reduced (below 30%)

c)

Moderately reduced (30-40%)

d)

Reduced (below 40%)

48.

Which of the following is true about Heart Failure with Preserved Ejection Fraction (HFpEF)?

a)

EF is below 40% and typical signs and symptoms are present

b)

EF is normal or mildly reduced (above 50%) and typical signs and symptoms are present, but without reduced EF

c)

EF is always above 70%

d)

EF is below 30%

49.

What is the purpose of M-mode Echocardiography?

a)

To measure ventricular wall thickness and chamber size during systole and diastole, and to calculate volumes, stroke volume, and ejection fraction.

b)

To assess coronary artery patency directly.

c)

To visualize the electrical activity of the heart.

d)

To detect pulmonary embolism with high specificity.

50.

Which stage in the American College of Cardiology (ACC) / American Heart Association (AHA) heart failure classification system is described as 'High risk, no structural damage or symptoms'?

a)

Stage A

b)

Stage B

c)

Stage C

d)

Stage D

51.

In the ACC/AHA heart failure classification, which stage is defined by 'Structural damage (e.g., hypertrophy), but no symptoms'?

a)

Stage A

b)

Stage B

c)

Stage C

d)

Stage D

52.

According to the ACC/AHA classification, which stage involves 'Structural damage and current or past symptoms'?

a)

Stage A

b)

Stage B

c)

Stage C

d)

Stage D

53.

What is the defining feature of Stage D in the ACC/AHA heart failure classification system?

a)

End-stage disease with refractory symptoms.

b)

Asymptomatic structural heart disease.

c)

Presence of risk factors without structural heart disease.

d)

Mild symptoms with slight limitation of physical activity.

54.

In the New York Heart Association (NYHA) classification, which class is described as 'No limitation of physical activity'?

a)

Class I

b)

Class II

c)

Class III

d)

Class IV

55.

Which NYHA class is defined by 'Marked limitation of physical activity, comfortable at rest'?

a)

Class I

b)

Class II

c)

Class III

d)

Class IV

56.

What is the main cause of pressure overload (concentric hypertrophy) in heart failure pathophysiology?

a)

Increased afterload, typically from conditions like hypertension or aortic stenosis.

b)

Decreased preload due to dehydration.

c)

Increased contractility from sympathetic stimulation.

d)

Volume overload from mitral regurgitation.

57.

What is the result of pressure overload (concentric hypertrophy) in the heart?

a)

Thickened ventricular walls and a smaller chamber.

b)

Thinned ventricular walls and a larger chamber.

c)

No change in ventricular wall thickness or chamber size.

d)

Thickened ventricular walls and a larger chamber.

58.

What is the cause of pressure overload (concentric hypertrophy) in the heart?

a)

Chronic volume stress

b)

Chronic pressure stress, as seen in hypertension or aortic stenosis

c)

Acute myocardial infarction

d)

Mitral regurgitation

59.

What is the result of pressure overload (concentric hypertrophy) in the heart?

a)

Stretched, thinned walls and a larger chamber

b)

Thickened walls and a smaller chamber

c)

Increased ejection fraction

d)

Decreased end-diastolic volume

60.

Fill in the blank: Myocytes stack in parallel, increasing stiffness and fibrosis in ________ hypertrophy.

a)

concentric

b)

eccentric

c)

restrictive

d)

dilated

61.

Volume overload (eccentric hypertrophy) is caused by chronic volume stress, as seen in which of the following conditions?

a)

Hypertension

b)

Aortic stenosis

c)

Mitral or aortic regurgitation

d)

Pulmonary embolism

62.

What is the result of volume overload (eccentric hypertrophy) in the heart?

a)

Thickened walls and a smaller chamber

b)

Stretched, thinned walls and a larger chamber

c)

Increased contractility

d)

Decreased end-diastolic volume

63.

Right heart failure results in ________ congestion. Blood backs up into the body, causing peripheral edema (in ankles and legs) and ascites.

a)

systemic

b)

pulmonary

c)

cerebral

d)

hepatic

64.

Left heart failure results in ________ congestion. Blood backs up into the lungs, causing shortness of breath, orthopnea, and pulmonary edema.

a)

pulmonary

b)

hepatic

c)

renal

d)

systemic

65.

Biventricular heart failure occurs when:

a)

Only the right ventricle fails

b)

Only the left ventricle fails

c)

Both ventricles fail, causing both pulmonary and systemic congestion

d)

The atria fail

66.

What percentage of patients die within 5 years of a heart failure diagnosis?

a)

10%

b)

25%

c)

50%

d)

75%

67.

Heart failure leads to more hospitalizations than all forms of cancer combined.

a)

True

b)

False

68.

Fill in the blank: Heart failure is a ________ condition characterized by the heart's inability to pump enough blood to meet the body's needs.

a)

progressive

b)

temporary

c)

infectious

d)

benign

69.

Heart failure can result from a problem with either ________ or ________.

a)

ventricular filling; ejection

b)

atrial contraction; relaxation

c)

arterial pressure; venous return

d)

pulmonary flow; systemic flow

70.

Which of the following is NOT a classification of heart failure based on Left Ventricular Ejection Fraction (LVEF)?

a)

Heart Failure with Reduced Ejection Fraction (HFrEF)

b)

Heart Failure with Mildly Reduced EF

c)

Heart Failure with Preserved Ejection Fraction (HFpEF)

d)

Heart Failure with Increased Ejection Fraction (HFiEF)

71.

Match the following heart failure types with their LVEF values:

a)

LVEF ≤ 40%

1.

HFrEF

b)

LVEF 41-49%

2.

Mildly Reduced EF

c)

LVEF ≥ 50%

3.

HFpEF

d)

LVEF was ≤ 40% but has since improved

4.

Improved EF

72.

The ACC/AHA classification system for heart failure includes which stages?

a)

1, 2, 3, 4

b)

A, B, C, D

c)

I, II, III, IV

d)

Alpha, Beta, Gamma, Delta

73.

The NYHA classification for heart failure is based on symptoms alone.

a)

True

b)

False

74.

What is the only combination drug classified as an Angiotensin Receptor–Neprilysin Inhibitor (ARNI)?

a)

Bisoprolol

b)

Sacubitril/Valsartan (Entresto)

c)

Carvedilol

d)

Metoprolol Succinate

75.

Which component of Sacubitril/Valsartan blocks the harmful effects of the Renin-Angiotensin-Aldosterone System (RAAS)?

a)

Sacubitril

b)

Valsartan

c)

Carvedilol

d)

Bisoprolol

76.

Fill in the blank: Sacubitril blocks the enzyme ________, which normally breaks down beneficial natriuretic peptides (ANP and BNP).

a)

neprilysin

b)

renin

c)

aldosterone

d)

angiotensin-converting enzyme

77.

Which of the following is a major concern as a side effect of ARNIs due to neprilysin inhibition?

a)

Bradycardia

b)

Angioedema

c)

Hyperglycemia

d)

Arrhythmia

78.

You should NEVER combine an ARNI with an ACE inhibitor.

a)

True

b)

False

79.

How long is the washout period required when switching from an ACE inhibitor to an ARNI?

a)

36-hour washout period

b)

12-hour washout period

c)

24-hour washout period

d)

48-hour washout period

80.

Which side effect is more common with ARNIs than with ARBs alone because both components lower blood pressure?

a)

Hyperkalemia

b)

Hypotension

c)

Bradycardia

d)

Tachycardia

81.

Name one approved beta blocker for heart failure.

a)

Bisoprolol, Metoprolol Succinate, or Carvedilol

b)

Atenolol

c)

Propranolol

d)

Esmolol

82.

What is the main mechanism of action of beta blockers in heart failure treatment?

a)

Increase heart rate

b)

Block the harmful effects of the Sympathetic Nervous System (SNS)

c)

Increase aldosterone release

d)

Promote sodium retention

83.

Which of the following beta blockers are beta-1 selective?

a)

A) Bisoprolol & Metoprolol Succinate

b)

B) Carvedilol

c)

C) Spironolactone

d)

D) Eplerenone

84.

What is the main caution when starting or increasing the dose of a beta blocker in a patient with heart failure?

a)

Never start or increase the dose in a 'wet patient' (a patient with signs of fluid overload like pulmonary congestion or edema).

b)

Always start with the maximum possible dose to achieve rapid effect.

c)

Increase the dose only if the patient is hypertensive.

d)

Start or increase the dose only if the patient is experiencing bradycardia.

85.

Which two MRAs are mentioned as treatments for heart failure?

a)

Spironolactone and Eplerenone

b)

Lisinopril and Metoprolol

c)

Furosemide and Digoxin

d)

Amlodipine and Atorvastatin

86.

What is the mechanism of action of mineralocorticoid receptor antagonists (MRAs) in heart failure treatment?

a)

MRAs are aldosterone antagonists that cause sodium and water loss (decreasing preload) and potassium retention (risk of hyperkalemia).

b)

MRAs increase aldosterone production, leading to sodium and water retention and potassium loss.

c)

MRAs act as beta-blockers, reducing heart rate and contractility.

d)

MRAs inhibit angiotensin-converting enzyme, reducing afterload and blood pressure.

87.

Eplerenone is more selective and has fewer endocrine side effects than spironolactone, but is more expensive.

a)

True

b)

False

88.

Which side effect should be monitored when using MRAs in heart failure treatment?

a)

Hyperkalemia

b)

Hypoglycemia

c)

Bradycardia

d)

Neutropenia

89.

Which SGLT2 inhibitors are mentioned as examples in the treatment of heart failure?

a)

Dapagliflozin and empagliflozin

b)

Canagliflozin and ertugliflozin

c)

Metformin and sitagliptin

d)

Pioglitazone and rosiglitazone

90.

What is the proposed benefit of SGLT2 inhibitors in heart failure treatment?

a)

They reduce mortality and hospitalizations.

b)

They increase blood pressure significantly.

c)

They cause rapid weight gain.

d)

They worsen kidney function.

91.

Which of the following drugs is a loop diuretic used on a PRN basis to rapidly mobilize edema fluid in patients with fluid overload?

a)

Digoxin

b)

Furosemide

c)

Vericiguat

d)

Hydralazine

92.

The combination of hydralazine and nitrates was the first drug to receive ethnically restricted approval in 2006, specifically for which patient population?

a)

Asian patients

b)

Hispanic patients

c)

Black/African American patients

d)

Elderly patients

93.

Vericiguat (Verquvo) works by directly stimulating which enzyme?

a)

Sodium-potassium ATPase

b)

Guanylate cyclase

c)

Phosphodiesterase III

d)

Adenylate cyclase

94.

Is Vericiguat (Verquvo) one of the four pillars of heart failure therapy?

a)

True

b)

False

95.

Inotropes such as digoxin work by inhibiting the sodium-potassium ATPase pump, leading to an indirect buildup of intracellular ________, which strengthens contraction.

a)

calcium

b)

potassium

c)

sodium

d)

magnesium

96.

What is a characteristic symptom of digoxin toxicity?

a)

Blue vision

b)

Yellow vision and arrhythmias

c)

Red skin rash

d)

Muscle cramps

97.

The treatment for acute digoxin toxicity is ________.

a)

digoxin immune fab fragments (Digibind)

b)

atropine

c)

naloxone

d)

protamine sulfate

98.

Non-pharmacologic treatments for advanced heart failure may include the use of ________, which are now used earlier and can sometimes lead to improvement in heart function.

a)

left ventricular assist devices (LVADs)

b)

beta-blockers

c)

angiotensin-converting enzyme (ACE) inhibitors

d)

statins

99.

Which of the following drug classes includes Sacubitril/Valsartan?

a)

Beta Blockers

b)

Angiotensin Receptor–Neprilysin Inhibitors (ARNI)

c)

SGLT2 Inhibitors

d)

Loop Diuretics

100.

What is the mechanism of action of Beta Blockers in heart failure management?

a)

Block the harmful effects of the sympathetic nervous system (SNS), decreasing heart rate and oxygen consumption, and reducing cardiac remodeling. Also block beta-1 receptors in the kidneys to reduce renin production.

b)

Increase the contractility of the heart by stimulating beta-1 receptors.

c)

Directly dilate coronary arteries to increase blood flow to the myocardium.

d)

Promote sodium and water retention to increase blood volume.