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WorksheetsHypertension and Cholesterol Management
Total questions: 60
Worksheet time: 30mins
Which equation correctly relates blood pressure to cardiovascular determinants?
BP equals TPR minus stroke volume
BP equals CO plus venous return
BP equals HR divided by SV
BP equals CO multiplied by TPR
Within the RAAS, which primary effect elevates blood pressure?
Enhances diuresis via ADH blockade
Increases intravascular volume via aldosterone
Decreases heart rate via vagal tone
Dilates arterioles via nitric oxide
Which system provides rapid short‑term control of arterial pressure?
Aldosterone‑mediated sodium retention
Renin secretion from macula densa
ADH synthesis in the kidneys
Sympathetic nervous system activation
Antidiuretic hormone primarily influences blood pressure by which action?
Stimulates beta‑1 receptors to raise rate
Promotes water reabsorption to raise volume
Blocks calcium entry to relax vessels
Inhibits renin release to lower pressure
Which class is standard first‑line therapy for high LDL cholesterol?
Fibrates as PPAR‑alpha agonists
Niacin as lipolysis inhibitor
Statins as HMG‑CoA reductase inhibitors
Ezetimibe as cholesterol transporter blocker
What is the direct enzymatic target inhibited by statins?
ATP‑citrate lyase in cytosol
HMG‑CoA reductase in hepatocytes
Lipoprotein lipase in adipocytes
PCSK9 in the endoplasmic reticulum
Statins lower plasma LDL primarily via which mechanism?
Upregulate hepatic LDL receptor uptake
Increase intestinal cholesterol excretion
Enhance macrophage foam cell clearance
Reduce VLDL secretion from pancreas
Which sequence best describes early atherosclerotic plaque formation?
LDL entry, monocyte migration, foam cells
Smooth muscle apoptosis, collagen loss, thrombus
Platelet plug, fibrinolysis, endothelial repair
Vasodilation, nitric oxide rise, shear stress
Which component forms the fibrous cap of a mature plaque?
Reticulin strands and pericyte webs
Collagen fibers and smooth muscle cells
Elastin sheets and endothelial cilia
Platelet microvesicles and fibrin mesh
Which factor increases risk of endothelial damage in arteries?
Aerobic exercise improving shear stress
Adequate sleep stabilizing catecholamines
Omega‑3 intake lowering inflammation
Chronic hyperglycemia raising blood viscosity
Which option identifies an antihypertensive class that lowers heart rate and renin?
Beta‑blockers targeting beta‑1 receptors
Calcium channel blockers targeting L‑type
Alpha‑blockers targeting alpha‑1 receptors
ACE inhibitors targeting kininase II
In acute coronary syndrome, what transition occurs in ischemic myocardium?
Apoptosis shifts to hyperplasia
Protein synthesis shifts to proteolysis
Glycogenolysis shifts to gluconeogenesis
Aerobic metabolism shifts to anaerobic
Which ECG change most closely indicates progressing myocardial cell death during ischaemia?
ST segment elevation developing over minutes
Prolonged PR interval with stable rhythm
Sinus bradycardia without ST deviation
Isolated T-wave inversion resolving quickly
Which statement best distinguishes ischaemia from necrosis in myocardial tissue?
Necrosis preserves membrane integrity
Ischaemia is permanent myocyte loss
Necrosis is reversible edema only
Ischaemia is reversible energy deficit
Which complication is most characteristic of a transmural STEMI compared with a subendocardial infarction?
Transient chest pain without enzymes
Limited conduction changes isolated
Mild diastolic dysfunction only
Free wall rupture with pseudoaneurysm
Which mechanical complication of MI most likely causes acute severe mitral regurgitation?
Pericardial effusion increasing pressure
Papillary muscle rupture after infarct
Atrial septal defect from injury
Coronary spasm of right vessel
In early management of suspected STEMI, why is aspirin given first?
To correct bradyarrhythmias
To slow clot growth rapidly
To raise systemic blood pressure
To relieve chest pain directly
Chewing and dispersing aspirin in the mouth is recommended because it primarily does what?
Increases platelet production
Prevents gastric irritation fully
Speeds buccal absorption onset
Converts to active metabolite
Which description best explains normal platelet behavior before vascular injury?
Circulate inactive and discoid
Adhere constantly to endothelium
Release thromboxane continuously
Aggregate with fibrinogen routinely
Aspirin’s antiplatelet effect occurs mainly through which mechanism?
Irreversible COX‑1 inhibition in platelets
Reversible COX‑2 blockade in endothelium
Direct thrombin receptor antagonism
Enhancement of fibrinogen crosslinking
What is the typical duration of aspirin’s antiplatelet effect following a single dose?
Eight to ten days lifespan
Twenty-four hours maximum
Three to five days average
Until serum levels decline
Beyond antiplatelet action, COX‑2 inhibition by aspirin contributes most directly to which outcome?
Heightened central pain sensitivity
Increased chemotaxis signaling
Enhanced clot formation speed
Reduced inflammation and fever
Which statement best describes glyceryl trinitrate (GTN) action in vascular smooth muscle?
Blocks voltage-gated calcium channels to lower tone
Activates cGMP via nitric oxide to relax muscle
Inhibits ACE to reduce angiotensin II mediated tone
Blocks beta-1 receptors to reduce heart contractility
What is the primary clinical effect of GTN on cardiac workload in left ventricular failure?
Reduces preload and alleviates breathlessness
Increases afterload and raises blood pressure
Enhances contractility and stroke volume
Decreases heart rate via beta-1 blockade
Preload is best defined as which of the following?
Volume ejected per beat from the ventricle
Pressure in the aorta after systole
Stretch of ventricles before contraction
Resistance offered by arterioles to flow
Which pharmacokinetic feature is correct for sublingual GTN?
Absorbed through oral mucosa into bloodstream
Activated by gastric acid in the stomach
Requires intestinal absorption with food
Primarily eliminated unchanged in feces
Which anti-hypertensive class inhibits conversion of angiotensin I to angiotensin II?
Diuretics such as bendroflumethiazide
ACE inhibitors such as enalapril
Alpha blockers such as prazosin
Beta blockers such as atenolol
Alpha blockers lower blood pressure primarily by which mechanism?
Increase renal sodium excretion reducing volume
Block calcium channels lowering vascular tone
Antagonize beta-1 receptors decreasing heart rate
Antagonize alpha adrenoceptors reducing vasoconstriction
Which statement correctly matches class and exemplar drug?
ACE inhibitors—propranolol, bisoprolol
Beta blockers—doxazosin, prazosin
Calcium channel blockers—amlodipine, nifedipine
Diuretics—atenolol, bisoprolol
Beta blockers reduce blood pressure mainly by what action?
Block sodium reabsorption increasing water excretion
Block beta-1 receptors reducing heart rate and contractility
Block alpha receptors relaxing vascular smooth muscle
Activate cGMP pathway causing vasodilation
Which anti-hypertensive class directly increases renal excretion of salt and water?
Beta blockers such as atenolol
ACE inhibitors such as perindopril
Alpha blockers such as prazosin
Diuretics such as bendroflumethiazide
Clopidogrel’s primary antiplatelet mechanism involves which receptor pathway?
ADP (P2Y12) receptor antagonism
Thrombin receptor activation
Calcium channel inhibition
Beta-1 adrenoceptor blockade
Which outcome is a direct effect of clopidogrel therapy?
Enhances ventricular contractility and output
Raises blood pressure via vasoconstriction
Increases thrombin formation from fibrinogen
Prevents platelet aggregation and shape change
Which pharmacokinetic property is accurate for oral clopidogrel?
Absorbed mainly through oral mucosa
Undergoes first-pass metabolism in the liver
Unbound in plasma circulation
Excreted unchanged via kidneys
Which receptor-mediated effect of adrenaline most directly increases heart rate during cardiac arrest management?
Alpha2 central sympathetic inhibition
Beta1 enhanced conduction and contractility
Beta2 bronchodilation with mediator release
Alpha1 vasoconstriction with mucosal edema
Adrenaline 1:10,000 is indicated in which cardiac arrest rhythms?
Neither shockable nor non-shockable
Only shockable rhythms like VF
Only non-shockable rhythms like PEA
Both shockable and non-shockable rhythms
What is the most appropriate route for rapid systemic delivery of adrenaline in resuscitation?
Intranasal spray via mucosal absorption
Subcutaneous injection for slow release
Intravenous or intraosseous administration
Oral ingestion with first-pass effect
Which cardiovascular tissue response is associated with beta2 receptor activation by adrenaline?
Increased SA node automaticity raising heart rate
Papillary dilation in the eye increasing light entry
Smooth muscle relaxation causing bronchodilation
Vasoconstriction of skeletal muscle vessels
Amiodarone’s primary anti-arrhythmic mechanism is best described as which action on cardiac myocytes?
Stimulating beta1 receptors to increase conduction
Blocking sodium influx during upstroke
Blocking potassium currents to prolong repolarisation
Enhancing calcium entry to increase contractility
Which clinical scenario supports long-term prescribing of amiodarone?
Persistent fast atrial fibrillation or ventricular tachycardia
Compensated heart failure without ectopy
Stable angina without arrhythmia
Sinus bradycardia with hypotension
Which pharmacokinetic feature characterizes amiodarone compared with adrenaline?
Very long half-life around fifteen weeks
Rapid hepatic inactivation by a common enzyme
Exclusive renal excretion in urine
Short half-life under one hour
What is the principal elimination route noted for amiodarone after IV administration?
Pulmonary exhalation of volatile metabolites
Biliary excretion leading to faecal elimination
Sweat gland secretion with dermal loss
Renal tubular secretion into urine
Atropine’s therapeutic effect in bradycardia primarily results from which action?
Sodium channel blockade slowing depolarisation
Beta2 agonism improving airway patency
Muscarinic antagonism reducing vagal influence
Alpha1 agonism increasing systemic vascular resistance
Which statement about atropine’s impact on cardiac function is most accurate?
Decreases heart rate while improving contractility
Increases both heart rate and ventricular contractility
Increases heart rate without improving ventricular contractility
Has no effect on SAN or AVN automaticity
Blocking which nerve pathway explains atropine’s ability to raise heart rate by up to 40 bpm in severe bradycardia?
Hypoglossal nerve sympathetic fibers
Vagus nerve parasympathetic fibers
Sciatic nerve somatic fibers
Phrenic nerve parasympathetic fibers
Which adrenergic receptor effect would most increase blood pressure during adrenaline administration?
Beta1 receptor activation in ventricular muscle
Alpha1 receptor-mediated vasoconstriction in vessels
Beta2 receptor-mediated bronchodilation in lungs
Alpha2 receptor-mediated presynaptic inhibition
Which STEMI complication listed requires vigilance during post-infarct care?
Physiologic sinus tachycardia after exertion
Cardiomyopathy following myocardial damage
Transient conjunctival edema after aspirin
Benign pericardial rub without effusion
Which pairing correctly matches drug and primary target?
Atropine—beta1 receptor antagonism
Amiodarone—potassium channel blockade
Adrenaline—muscarinic receptor agonism
Amiodarone—alpha1 receptor stimulation
Which statement best describes cardiac tamponade pathophysiology?
Valve regurgitation increases preload without pericardial pressure
Fluid accumulates in pericardial sac reducing diastolic filling
Thrombus lodges in coronary artery causing systolic failure
Air enters pleural space increasing lung compliance markedly
Which classic triad is most consistent with cardiac tamponade?
Hypertension, loud S1, peripheral edema predominance
Hyperthermia, pleuritic chest pain, productive cough
Bradycardia, clear lung fields, bounding peripheral pulses
Hypotension, muffled heart sounds, jugular venous distension
In left-sided heart failure, which finding is most typical?
Basal crackles on auscultation due to pulmonary congestion
Ankle edema predominance with preserved breath sounds
Isolated tachycardia with normal pulmonary examination
Marked hepatomegaly without pleural involvement
Right-sided heart failure commonly presents with which feature?
Pink frothy sputum from alveolar flooding
Pleural effusions with orthopnea predominance
Fine inspiratory crackles isolated to lung bases
Peripheral edema including ankles and sacral area
Heart failure is often due to decreased stroke volume from impairment of which chamber?
Left ventricle function leading to reduced output
Right atrium contractility causing venous pooling
Pulmonary artery elasticity reducing forward flow
Aortic valve stiffness improving cardiac performance
Which statement best defines cardiomyopathy?
Diseases of myocardium with mechanical or electrical dysfunction
Acute coronary thrombosis causing immediate ischemic necrosis
Inflammation of pericardium leading to chest pain exclusively
Congenital valve malformation without myocardial involvement
Furosemide’s primary site of action is which nephron segment?
Proximal straight tubule within cortex
Ascending limb of the loop of Henle
Collecting duct principal cell region
Descending limb with aquaporin abundance
What ion transport does furosemide inhibit?
Sodium and chloride reabsorption from the loop lumen
Potassium secretion into distal nephron lumen
Magnesium uptake through collecting duct channels
Calcium reabsorption across proximal tubule cells
A patient with pulmonary edema receives furosemide. What immediate therapeutic goal is expected?
Increase urine output to reduce preload rapidly
Decrease heart rate to improve diastolic filling
Enhance myocardial contractility via beta stimulation
Raise systemic vascular resistance to maintain pressure
General signs of heart failure include which combination?
Hyperthermia, strong pulses, elevated oxygen saturation
Jaundice predominance, hypotension, brisk capillary refill
Flushed extremities, bradycardia, bounding pulses
Pale peripheries, tachycardia, low-volume pulses
Cardiac tamponade most directly reduces cardiac output by causing which change?
Enhanced venous return via negative intrathoracic pressure
Increased systolic ejection due to afterload reduction
Decreased ventricular diastolic filling due to compression
Improved contractility via sympathetic stimulation alone
Which pharmacokinetic property of an IV drug labeled as having bioavailability of 100 is correct?
Most is destroyed before entering circulation
Half reaches systemic circulation after first-pass
All administered drug reaches systemic circulation
Only protein-bound fraction is bioavailable
