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  • Question 1 - Cardiac myocytes are connected to each other by which of the following: ...

    Incorrect

    • Cardiac myocytes are connected to each other by which of the following:

      Your Answer: T-tubules

      Correct Answer: Intercalated discs

      Explanation:

      Adjacent cardiac myocytes are connected to each other by intercalated discs. The intercalated discs provide both a structural attachment by ‘glueing’ cells together at desmosomes and an electrical contact made up of proteins called connexons, called a gap junction, which essentially creates a low-resistance pathway between cells.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      21.1
      Seconds

  • Question 2 - What is the main mechanism of action of dobutamine as an inotropic sympathomimetic:...

    Incorrect

    • What is the main mechanism of action of dobutamine as an inotropic sympathomimetic:

      Your Answer: Alpha1-receptor agonist

      Correct Answer: Beta1-receptor agonist

      Explanation:

      Dobutamine directly stimulates the beta1-adrenergic receptors in the heart and increases contractility and cardiac output with little effect on the rate. In addition action on beta2-receptors causes vasodilation.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      44.6
      Seconds

  • Question 3 - Digoxin is predominantly used for which of the following: ...

    Correct

    • Digoxin is predominantly used for which of the following:

      Your Answer: Rate control in persistent and permanent atrial fibrillation

      Explanation:

      Digoxin is most useful for controlling the ventricular response in persistent and permanent atrial fibrillation and atrial flutter. Digoxin is usually only effective for controlling the ventricular rate at rest, and should therefore only be used as monotherapy in predominantly sedentary patients with non-paroxysmal atrial fibrillation. It is now rarely used for rapid control of heart rate, as even with intravenous administration, response may take many hours. Digoxin is reserved for patients with worsening or severe heart failure due to left ventricular systolic dysfunction refractory to combination therapy with first-line agents. Digoxin is contraindicated in supraventricular arrhythmias associated with accessory conduction pathways e.g. Wolff-Parkinson-White syndrome.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      48
      Seconds

  • Question 4 - Blood flows from the left atrium into the left ventricle via: ...

    Correct

    • Blood flows from the left atrium into the left ventricle via:

      Your Answer: The mitral valve

      Explanation:

      Blood flows from the right atrium into the right ventricle via the tricuspid atrioventricular valve and from the left atrium into the left ventricle via the mitral atrioventricular valve. Blood is ejected from the right ventricle through the pulmonary semilunar valve into the pulmonary artery and from the left ventricle via the aortic semilunar valve into the aorta.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      11.8
      Seconds

  • Question 5 - Which of the following describes the pulse pressure: ...

    Correct

    • Which of the following describes the pulse pressure:

      Your Answer: Systolic - diastolic pressure

      Explanation:

      During systole, the pressure in the left ventricle increases and blood is ejected into the aorta. The rise in pressure stretches the elastic walls of the aorta and large arteries and drives blood flow. Systolic pressure is the maximum arterial pressure during systole. During diastole, arterial blood flow is partly maintained by elastic recoil of the walls of large arteries. The minimum pressure reached before the next systole is the diastolic pressure. The difference between the systolic and diastolic pressure is the pulse pressure.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      17.7
      Seconds

  • Question 6 - Which of the following is most true of the sinoatrial node: ...

    Incorrect

    • Which of the following is most true of the sinoatrial node:

      Your Answer: It is a region of specialised nerve cells that can initiate an impulse.

      Correct Answer: Frequency of depolarisation is increased by sympathetic stimulation.

      Explanation:

      Cardiac myocyte contraction is not dependent on an external nerve supply but instead the heart generates its own rhythm, demonstrating inherent rhythmicity. The heartbeat is initiated by spontaneous depolarisation of the sinoatrial node (SAN), a region of specialised myocytes in the right atrium close to the coronary sinus, at a rate of 100-110 beats/min. This intrinsic rhythm is primarily influenced by autonomic nerves, with vagal influences being dominant over sympathetic influences at rest. This vagal tone reduces the resting heart rate down to 60-80 beats/min. To increase heart rate, the autonomic nervous system increases sympathetic outflow to the SAN, with concurrent inhibition of vagal tone. These changes mean the pacemaker potential more rapidly reaches the threshold for action potential generation.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      32.1
      Seconds

  • Question 7 - Lidocaine's antiarrhythmic mode of action is as follows: ...

    Correct

    • Lidocaine's antiarrhythmic mode of action is as follows:

      Your Answer: Blocks inactivated Na+ channels

      Explanation:

      Lidocaine is a class 1B antidysrhythmic; combines with fast Na channels and thereby inhibits recovery after repolarization, resulting in decreasing myocardial excitability and conduction velocity. However, in ischaemic areas, where anoxia causes depolarisation and arrhythmogenic activity, many Na+ channels are inactivated and therefore susceptible to lidocaine.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      46.6
      Seconds

  • Question 8 - The QRS duration of a broad-complex tachyarrhythmia is: ...

    Incorrect

    • The QRS duration of a broad-complex tachyarrhythmia is:

      Your Answer: Greater than 0.12 s

      Correct Answer: Greater than or equal to 0.12 s

      Explanation:

      It’s a broad-complex tachycardia if the QRS duration is 0.12 seconds or more. It’s a narrow-complex tachycardia if the QRS complex is shorter than 0.12 seconds. The QRS duration should be examined if the patient with tachyarrhythmia is stable.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      14.8
      Seconds

  • Question 9 - An 82 year old man taking warfarin as a maintenance medication comes in...

    Incorrect

    • An 82 year old man taking warfarin as a maintenance medication comes in to your clinic because of an infection. Which antibiotic is the safest choice for this patient?

      Your Answer: Doxycycline

      Correct Answer: Cefalexin

      Explanation:

      Alterations in the international normalized ratio (INR) brought about by the concurrent use of antibiotics and warfarin may result in either excessive clotting or excessive bleeding if they are deemed to have a high risk for interaction. As such, there should be careful consideration of the class of antibiotic to be used.

      Antibiotics from the following drug classes should generally be avoided as they have a high risk for interaction with warfarin, possible enhancing the anticoagulant effects of warfarin resulting in bleeding: Fluoroquinolones (e.g. ciprofloxacin, levofloxacin), Macrolides (e.g. clarithromycin, erythromycin, azithromycin), Nitroimidazoles (e.g. metronidazole), Sulphonamides (e.g. co-trimoxazole, a combination of trimethoprim and sulfamethoxazole), Trimethoprim, Tetracyclines (e.g. doxycycline).

      Low risk antibiotics that have low risk for interaction with warfarin includes cephalexin, from the cephalosporin class, and clindamycin which is a lincomycin.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      25.6
      Seconds

  • Question 10 - Regarding cardiac excitation-contraction coupling, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding cardiac excitation-contraction coupling, which of the following statements is CORRECT:

      Your Answer: In relaxation, most Ca 2+ is actively pumped out of the myocyte.

      Correct Answer: The Treppe effect refers to an increase in contractility secondary to an increase in heart rate.

      Explanation:

      Although Ca2+entry during the action potential (AP) is essential for contraction, it only accounts for about 25% of the rise in intracellular Ca2+. The rest is released from Ca2+stores in the sarcoplasmic reticulum (SR). In relaxation, about 80% of Ca2+is rapidly pumped back into the SR (sequestered) by Ca2+ATPase pumps. The Ca2+that entered the cell during the AP is transported out of the cell primarily by the Na+/Ca2+exchanger in the membrane. When more action potentials occur per unit time, more Ca2+enters the cell during the AP plateau, more Ca2+is stored in the SR, more Ca2+is released from the SR and thus more Ca2+is left inside the cell and greater tension is produced during contraction. Increased heart rate increases the force of contraction in a stepwise fashion as intracellular [Ca2+] increases cumulatively over several beats; this is the Treppe effect. Cardiac glycosides such as digoxin have a positive inotropic effect.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      1127.8
      Seconds

  • Question 11 - An elderly patient presents to ED following a fall after feeling light headed...

    Correct

    • An elderly patient presents to ED following a fall after feeling light headed when standing up. You are reviewing his medication and note that he is taking a high dose of furosemide. Loop diuretics act primarily at which of the following sites in the nephron:

      Your Answer: Thick ascending limb

      Explanation:

      Loop diuretics inhibit the Na+/K+/2Cl- symporter on the luminal membrane in the thick ascending limb of the loop of Henle, thus preventing reabsorption of NaCl and water. These agents reduce reabsorption of Cl- and Na+ and increase Ca2+ excretion and loss of K+ and Mg2+.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      582.4
      Seconds

  • Question 12 - Regarding alteplase, which of the following statements is INCORRECT: ...

    Correct

    • Regarding alteplase, which of the following statements is INCORRECT:

      Your Answer: Alteplase is commonly associated with hypotensive effects.

      Explanation:

      Alteplase is a recombinant tissue-type plasminogen activator (tPA), a naturally occurring fibrin-specific enzyme that has selectivity for activation of fibrin-bound plasminogen. It has a short half-life of 3 – 4  minutes and must be given by continuous intravenous infusion but is not associated with antigenic or hypotensive effects, and can be used in patients when recent streptococcal infections or recent use of streptokinase contraindicates the use of streptokinase.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      54.7
      Seconds

  • Question 13 - As a response to low blood pressure, the baroreceptor reflex will facilitate vasoconstriction...

    Correct

    • As a response to low blood pressure, the baroreceptor reflex will facilitate vasoconstriction by activating which receptor?

      Your Answer: Alpha1

      Explanation:

      The rate of baroreceptor firing slows down when blood pressure falls too low. This causes an increase in sympathetic stimulation of the heart, resulting in an increase in cardiac output. It also causes vasoconstriction by activating alpha 1 receptors in smooth muscle, which causes sympathetic stimulation of peripheral vessels.

      Alpha2 receptors can be found in both the brain and the peripheral nervous system. They control sympathetic outflow in the brain stem.

      Beta1 receptors, which are found on the cell membrane of cardiac muscle cells, stimulate heart rate and myocardial contractility. The smooth muscle cell membrane contains beta2 receptors, which promote smooth muscle relaxation in the lungs causing bronchodilation, GI tract, and peripheral blood vessels.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      11
      Seconds

  • Question 14 - Regarding ACE inhibitors, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding ACE inhibitors, which of the following statements is CORRECT:

      Your Answer: ACE-inhibitors cause a increase in histamine release which can result in a persistent dry cough.

      Correct Answer: Angiotensin-II receptor blockers are a useful alternative in patients who cannot tolerate ACE-inhibitors due a persistent cough.

      Explanation:

      ACE inhibitors should be used with caution in patients of Afro-Caribbean descent who may respond less well; calcium channel blockers are first line for hypertension in these patients. ACE inhibitors have a role in the management of diabetic nephropathy. ACE inhibitors are contraindicated in pregnant women. ACE inhibitors inhibit the breakdown of bradykinin; this is the cause of the persistent dry cough. Blocking ACE also diminishes the breakdown of the potent vasodilator bradykinin which is the cause of the persistent dry cough. Angiotensin-II receptor blockers do not have this effect, therefore they are useful alternative for patients who have to discontinue an ACE inhibitor because of persistent cough.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      522
      Seconds

  • Question 15 - Regarding calcium channel blockers, which of the following statements is CORRECT: ...

    Correct

    • Regarding calcium channel blockers, which of the following statements is CORRECT:

      Your Answer: Calcium channel blockers inhibit L-type voltage-sensitive calcium channels in arterial smooth muscle causing vasodilation.

      Explanation:

      Calcium channel blockers inhibit L-type voltage-sensitive calcium channels in arterial smooth muscle, causing relaxation and vasodilation (reduction in peripheral vascular resistance). They also block calcium channels within the myocardium and conducting tissues of the heart which produces a negative inotropic effect by reducing calcium influx during the plateau phase of the action potential.
      They have a variety of uses, including:
      Hypertension
      Angina
      Atrial fibrillation
      Migraine
      Calcium channel blockers have been found to be moderately useful in the prevention of migraines. The best evidence is for this is with verapamil. This may be due to the prevention of the arteriolar constriction that is associated with migraine. They are commonly used for this elsewhere in the world but are not currently licensed for this use in the UK.
      The following are common side effects of all calcium-channel blockers:
      Abdominal pain
      Dizziness
      Drowsiness
      Flushing
      Headache
      Nausea and vomiting
      Palpitations
      Peripheral oedema
      Skin reactions
      Tachycardia
      Verapamil is highly negatively inotropic and reduces cardiac output, slows the heart rate and may impair atrioventricular conduction. It may precipitate heart failure, exacerbate conduction disorders, and cause hypotension at high doses and should not be used with beta-blockers. Nifedipine has less myocardial effects than verapamil and has no antiarrhythmic properties but has more influence on the vessels. Nimodipine is used solely for the prevention and treatment of vascular spasm following aneurysmal subarachnoid haemorrhage.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      71181.6
      Seconds

  • Question 16 - A 60-year-old patient had a sudden onset of palpitations and shortness of breath....

    Incorrect

    • A 60-year-old patient had a sudden onset of palpitations and shortness of breath. He had a history of poorly controlled hypertension and ischemic heart disease. His ECG also shows atrial fibrillation. Based on the patient’s condition, which pharmacologic cardioversion would be best to use?

      Your Answer: Adenosine

      Correct Answer: Amiodarone

      Explanation:

      Chemical cardioversion, or pharmacologic cardioversion, is the treatment of abnormal heart rhythms using drugs.

      Flecainide and propafenone are examples of drugs used as chemical cardioverters.

      However, given the situation of the patient, these drugs are contraindicated for his ischaemic heart disease. Amiodarone is also an antiarrhythmic drug and is the best choice for this situation.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      68.2
      Seconds

  • Question 17 - A patient who was put on low molecular weight heparin for suspected DVT...

    Incorrect

    • A patient who was put on low molecular weight heparin for suspected DVT and was scheduled for an ultrasound after the weekend, arrives at the emergency department with significant hematemesis. Which of the following medications can be used as a heparin reversal agent:

      Your Answer: Phytomenadione

      Correct Answer: Protamine sulfate

      Explanation:

      The management of bleeding in a patient receiving heparin depends upon the location and severity of bleeding, the underlying thromboembolic risk, and the current aPTT (for heparin) or anti-factor Xa activity (for LMW heparin). As an example, a patient with minor skin bleeding in the setting of a mechanical heart valve (high thromboembolic risk) and a therapeutic aPTT may continue heparin therapy, whereas a patient with major intracerebral bleeding in the setting of venous thromboembolism several months prior who is receiving heparin bridging perioperatively may require immediate heparin discontinuation and reversal with protamine sulphate. If haemorrhage occurs it is usually sufficient to withdraw unfractionated or low molecular weight heparin, but if rapid reversal of the effects of the heparin is required, protamine sulphate is a specific antidote (but only partially reverses the effects of low molecular weight heparins). Clinician judgment and early involvement of the appropriate consulting specialists is advised.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      19.5
      Seconds

  • Question 18 - At the start of the cardiac cycle, towards the end of diastole, all...

    Incorrect

    • At the start of the cardiac cycle, towards the end of diastole, all of the following statements are true EXCEPT for:

      Your Answer: The atrial pressure is greater than the ventricular pressure.

      Correct Answer: The semilunar valves are open.

      Explanation:

      At the start of the cardiac cycle, towards the end of diastole, the whole of the heart is relaxed. The atrioventricular (AV) valves are open because the atrial pressure is still slightly greater than the ventricular pressure. The semilunar valves are closed, as the pressure in the pulmonary artery and aorta is greater than the ventricular pressures. The cycle starts when the sinoatrial node (SAN) initiates atrial systole.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      57.8
      Seconds

  • Question 19 - Adenosine has a half-life of approximately: ...

    Incorrect

    • Adenosine has a half-life of approximately:

      Your Answer: 1 hour

      Correct Answer: 8 - 10 seconds

      Explanation:

      Adenosine stimulates A1-adenosine receptors and opens acetylcholine sensitive K+ channels, increasing K+ efflux. This hyperpolarises the cell membrane in the atrioventricular node and, by inhibiting the calcium channels, slows conduction in the AVN. As it has a very short duration of action (half-life only about 8 – 10 seconds), most side effects are short lived.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      16.1
      Seconds

  • Question 20 - The Frank-Starling curve is shifted downhill in heart failure due to which of...

    Incorrect

    • The Frank-Starling curve is shifted downhill in heart failure due to which of the following?

      Your Answer: Increase in preload

      Correct Answer: Decrease in contractility

      Explanation:

      The Frank–Starling mechanism states that the left ventricle can increase its force of contraction and hence stroke volume in response to increases in venous return and thus preload.

      Changes in afterload or inotropy cause the Frank–Starling curve to rise or fall. In heart failure, the Frank–Starling curve is shifted downward (flattened), requiring higher venous return and filling pressure to enhance contractility and stroke volume.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      15.7
      Seconds

  • Question 21 - Regarding hypertensive crises, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding hypertensive crises, which of the following statements is CORRECT:

      Your Answer: Hypertensive urgency requires intravenous antihypertensive therapy.

      Correct Answer: In a hypertensive emergency, blood pressure should be reduced by 20 - 25% within 2 hours.

      Explanation:

      A hypertensive emergency is defined as severe hypertension (blood pressure ≥ 180/110 mmHg) with acute damage to the target organs. Prompt treatment with intravenous antihypertensive therapy is generally required; over the first few minutes or within 2 hours, blood pressure should be reduced by 20 – 25%. Severe hypertension without acute target organ damage is defined as hypertensive urgency.; blood pressure should be reduced gradually over 24 – 48 hours with oral antihypertensive therapy. If blood pressure is reduced too quickly in the management of hypertensive crises, there is a risk of reduced organ perfusion leading to cerebral infarction, blindness, deterioration in renal function, and myocardial ischaemia.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      37.2
      Seconds

  • Question 22 - Which of the following increases the tendency for oedema to occur? ...

    Incorrect

    • Which of the following increases the tendency for oedema to occur?

      Your Answer: Venodilation

      Correct Answer: Increased venous pressure

      Explanation:

      When more fluid is filtered out of the capillaries than can be returned to the circulation by the lymphatics, oedema occurs. Changes that increase capillary hydrostatic pressure or decrease plasma oncotic pressure will increase filtration.
      Arteriolar constriction reduces hydrostatic capillary pressure and transiently increase absorption of fluid.
      Dehydration increases plasma protein concentration and therefore increases plasma oncotic pressure and absorption. Capillary hydrostatic pressure and filtration are increased when there is increased venous pressure.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      20.3
      Seconds

  • Question 23 - The mechanism of action of abciximab is by: ...

    Correct

    • The mechanism of action of abciximab is by:

      Your Answer: Blocking the binding of fibrinogen to GPIIb/IIIa receptor sites

      Explanation:

      Abciximab is a glycoprotein IIb/IIIa inhibitors and prevents platelet aggregation by blocking the binding of fibrinogen to receptors on platelets.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      80.5
      Seconds

  • Question 24 - In ventricular myocytes, the plateau phase of the action potential comes about through which...

    Incorrect

    • In ventricular myocytes, the plateau phase of the action potential comes about through which of the following:

      Your Answer: Closing of voltage-gated K + channels.

      Correct Answer: Opening of voltage-gated Ca 2+ channels

      Explanation:

      After the intial upstroke of the action potential, Na+channels and currents rapidly inactivate, but in cardiac myocytes, the initial depolarisation activates voltage-gated Ca2+channels (slow L-type channels, threshold approximately – 45 mV) through which Ca2+floods into the cell. The resulting influx of Ca2+prevents the cell from repolarising and causes a plateau phase, that is maintained for about 250 ms until the L-type channels inactivate. The cardiac AP is thus much longer than that in nerve or skeletal muscle.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      22.9
      Seconds

  • Question 25 - What is the recommended dosing regime for amiodarone in the treatment of a...

    Incorrect

    • What is the recommended dosing regime for amiodarone in the treatment of a stable regular broad-complex tachycardia:

      Your Answer:

      Correct Answer: 300 mg IV over 10 - 60 minutes, followed by an IV infusion of 900 mg over the next 24 hours

      Explanation:

      A ventricular tachycardia (or broad-complex tachycardia of uncertain origin) should be treated with amiodarone 300 mg IV over 10 – 60 min, followed by an infusion of 900 mg over the next 24 hours.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 26 - Intracellular [Ca2+] rise in cardiac excitation-contraction coupling is mainly as a result of:...

    Incorrect

    • Intracellular [Ca2+] rise in cardiac excitation-contraction coupling is mainly as a result of:

      Your Answer:

      Correct Answer: Ca 2+ release from sarcoplasmic reticulum

      Explanation:

      Although Ca2+entry during the action potential (AP) is essential for contraction, it only accounts for about 25% of the rise in intracellular Ca2+. The rest is released from Ca2+stores in the sarcoplasmic reticulum (SR). APs travel down invaginations of the sarcolemma called T-tubules, which are close to, but do not touch, the terminal cisternae of the SR. During the AP plateau, Ca2+enters the cell and activates Ca2+sensitive Ca2+release channels in the sarcoplasmic reticulum allowing stored Ca2+to flood into the cytosol; this is called Ca2+-induced Ca2+release. The amount of Ca2+released is dependent on how much is stored, and on the size of the initial Ca2+influx during the AP.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 27 - Which of the following is NOT a pharmacological effect of beta-blockers: ...

    Incorrect

    • Which of the following is NOT a pharmacological effect of beta-blockers:

      Your Answer:

      Correct Answer: Reduced AV conduction time

      Explanation:

      Effects of beta-blockers:
      Cardiovascular system:
      Reduce blood pressure
      Reduce heart rate, contractility and cardiac output
      Increase AV conduction time, refractoriness and suppress automaticity

      Eye:
      Reduce intraocular pressure

      Respiratory system:
      Cause bronchoconstriction

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 28 - Myocardial contractility is best correlated with the intracellular concentration of: ...

    Incorrect

    • Myocardial contractility is best correlated with the intracellular concentration of:

      Your Answer:

      Correct Answer: Ca2+

      Explanation:

      Contractility of myocardial cells depends on the intracellular [Ca2+], which is regulated by Ca2+entry across the cell membrane during the plateau of the action potential and by Ca2+uptake into and release from the sarcoplasmic reticulum (SR).

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 29 - Which of the following represents ventricular repolarisation on the ECG: ...

    Incorrect

    • Which of the following represents ventricular repolarisation on the ECG:

      Your Answer:

      Correct Answer: T wave

      Explanation:

      P wave = Atrial depolarisation
      QRS complex = Ventricular depolarisation
      T wave = Ventricular repolarisation

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 30 - Which of the following is NOT a common side effect of adenosine: ...

    Incorrect

    • Which of the following is NOT a common side effect of adenosine:

      Your Answer:

      Correct Answer: Yellow vision

      Explanation:

      Common side effects of adenosine include:
      Apprehension
      Dizziness, flushing, headache, nausea, dyspnoea
      Angina (discontinue)
      AV block, sinus pause and arrhythmia (discontinue if asystole or severe bradycardia occur)

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 31 - A 72 year old man is brought to ED by ambulance with sudden...

    Incorrect

    • A 72 year old man is brought to ED by ambulance with sudden onset chest pain, palpitations and shortness of breath. His HR is 160 bpm and BP 90/65. ECG demonstrates new-onset fast atrial fibrillation. Which of the following is the first-line treatment option in this case:

      Your Answer:

      Correct Answer: Synchronised DC cardioversion

      Explanation:

      All patients with adverse features suggesting life-threatening haemodynamic instability (shock, syncope, heart failure, myocardial ischaemia) caused by new onset atrial fibrillation should undergo emergency electrical cardioversion with synchronised DC shock without delaying to achieve anticoagulation.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 32 - Which of the following does NOT predispose to digoxin toxicity in a patient...

    Incorrect

    • Which of the following does NOT predispose to digoxin toxicity in a patient taking digoxin:

      Your Answer:

      Correct Answer: Hyponatraemia

      Explanation:

      Hypoxia, hypercalcaemia, hypokalaemia and hypomagnesaemia predispose to digoxin toxicity. Care should also be taken in the elderly who are particularly susceptible to digoxin toxicity. Hypokalaemia may be precipitated by use of diuretics. Although hyponatremia can result in the development of other pathological disturbances, it does not potentiate digoxin toxicity.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 33 - All of the statements regarding vascular tone are correct except: ...

    Incorrect

    • All of the statements regarding vascular tone are correct except:

      Your Answer:

      Correct Answer: Most endogenous vasodilators act by decreasing levels of cAMP or cGMP.

      Explanation:

      Most vasoconstrictors bind to G-protein coupled receptors. These mediate elevation in intracellular [Ca2+] which leads to vascular smooth muscle contraction. Important vasoconstrictors include noradrenaline, endothelin-1 and angiotensin II.

      Increased intracellular Ca2+ is as a result of the release of Ca2+from the sarcoplasmic reticulum and depolarisation and entry of Ca2+via L-type voltage-gated Ca2+channels. Most types of vascular smooth muscle do not generate action potentials – instead, the depolarisation is graded, which allows graded entry of Ca2+.
      sequestration by the sarcoplasmic reticulum Ca2+ATPase, removal from the cell by a plasma membrane Ca2+ATPase and Na+/Ca2+exchange decreases intracellular Ca2+, resulting in vasodilation. Relaxation is a result of most endogenous vasodilators when there is an increase in cyclic guanosine monophosphate (cGMP) like nitric oxide) or cyclic adenosine monophosphate (cAMP) like prostacyclin and beta-adrenergic receptor agonists. These activate protein kinases causing substrate level phosphorylation.
      Clinically effective vasodilators are L-type Ca2+channel blocker drugs.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 34 - Which of the following best characterizes the correct administration of amiodarone for a...

    Incorrect

    • Which of the following best characterizes the correct administration of amiodarone for a shockable rhythm in adults on advanced life support:

      Your Answer:

      Correct Answer: Give 300 mg IV amiodarone after 3 shocks

      Explanation:

      After three shocks, 300 mg IV amiodarone should be administered. After five defibrillation attempts, a further dose of 150 mg IV amiodarone may be considered. If amiodarone is not available, lidocaine may be used as a substitute, but it should not be given if amiodarone has previously been administered.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 35 - Continuous capillaries are typically found where in the body: ...

    Incorrect

    • Continuous capillaries are typically found where in the body:

      Your Answer:

      Correct Answer: Blood-brain barrier

      Explanation:

      Continuous capillaries, found in the skin, lungs, muscles and CNS, are the most selective with low permeability, as junctions between the endothelial cells are very tight, restricting the flow of molecules with MW > 10,000.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 36 - Which JVP waveform correlates to atrial systole? ...

    Incorrect

    • Which JVP waveform correlates to atrial systole?

      Your Answer:

      Correct Answer: The a wave

      Explanation:

      JVP Waveform in Cardiac Cycle Physiology: a wave Right atrial contraction causes atrial systole (end diastole). the c wave During right isovolumetric ventricular contraction, the tricuspid valve bulges into the right atrium, resulting in isovolumetric contraction (early systole). descent by x Rapid ventricular ejection (mid systole) is caused by a combination of right atrial relaxation, tricuspid valve downward movement during right ventricular contraction, and blood ejection from both ventricles. the v-wave Ventricular ejection and isovolumetric relaxation (late systole) occur as a result of venous return filling the right atrium. y lineage Ventricular filling occurs when the tricuspid valve opens, allowing blood to flow rapidly from the right atrium to the right ventricle.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 37 - Regarding the heart sounds in the cardiac cycle, which of the following statements...

    Incorrect

    • Regarding the heart sounds in the cardiac cycle, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: The third heart sound is caused by filling of an abnormally stiff ventricle in atrial systole.

      Explanation:

      Heart Sound – Phase of Cardiac Cycle – Mechanical Event:
      First heart sound – Start of systole – Caused by closure of the atrioventricular (mitral & tricuspid) valves
      Second heart sound – End of systole – Caused by closure of the semilunar (aortic and pulmonary) valves
      Third heart sound – Early diastole – Caused by rapid flow of blood from the atria into the ventricles during the ventricular filling phase
      Fourth heart sound – Late diastole – Caused by filling of an abnormally stiff ventricle in atrial systole

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 38 - Which of the following is the primary indication for loop diuretics? ...

    Incorrect

    • Which of the following is the primary indication for loop diuretics?

      Your Answer:

      Correct Answer: Acute pulmonary oedema

      Explanation:

      Loop diuretics have long been the cornerstone of pulmonary oedema treatment, with furosemide being the most commonly used of these drugs. Premedication with drugs that decrease preload (e.g., nitro-glycerine [NTG]) and afterload (e.g., angiotensin-converting enzyme [ACE] inhibitors) before the administration of loop diuretics can prevent adverse hemodynamic changes.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 39 - In adult advanced life support, which of the following best describes the correct...

    Incorrect

    • In adult advanced life support, which of the following best describes the correct administration of adrenaline for a non-shockable rhythm:

      Your Answer:

      Correct Answer: Give 1 mg of adrenaline as soon as intravenous access is achieved and every 3 - 5 minutes thereafter

      Explanation:

      IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be given after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 40 - Bendoflumethiazide may cause all of the following electrolyte imbalances EXCEPT for: ...

    Incorrect

    • Bendoflumethiazide may cause all of the following electrolyte imbalances EXCEPT for:

      Your Answer:

      Correct Answer: Hypocalcaemia

      Explanation:

      Common side effects of thiazide diuretics include:
      Excessive diuresis, postural hypotension, dehydration, renal impairment
      Acid-base and electrolyte imbalance
      Hypokalaemia, hyponatraemia, hypomagnesaemia, hypercalcaemia, hypochloraemic alkalosis
      Metabolic imbalance
      Hyperuricaemia and gout
      Impaired glucose tolerance and hyperglycaemia
      Altered plasma-lipid concentrations
      Mild gastrointestinal disturbances

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 41 - What is the main mechanism of action of flecainide: ...

    Incorrect

    • What is the main mechanism of action of flecainide:

      Your Answer:

      Correct Answer: Blocks Na+ channels

      Explanation:

      Flecainide inhibits the transmembrane influx of extracellular Na+ ions via fast channels on cardiac tissues resulting in a decrease in rate of depolarisation of the action potential, prolonging the PR and QRS intervals. At high concentrations, it exerts inhibitory effects on slow Ca2+ channels, accompanied by moderate negative inotropic effect.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 42 - Nitric oxide release from endothelium is stimulated by all of the following EXCEPT...

    Incorrect

    • Nitric oxide release from endothelium is stimulated by all of the following EXCEPT for:

      Your Answer:

      Correct Answer: Noradrenaline

      Explanation:

      Nitric oxide (NO) production by the endothelium is increased by factors that elevate intracellular Ca2+, including local mediators such as bradykinin, histamine and serotonin, and some neurotransmitters (e.g. substance P). Increased flow (shear stress) also stimulates NO production and additionally activates prostacyclin synthesis. The basal production of NO continuously modulates vascular resistance; increased production of nitric oxide acts to cause vasodilation. Nitric oxide also inhibits platelet activation and thrombosis.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 43 - What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?...

    Incorrect

    • What is the correct adrenaline dose for a patient with pulseless ventricular tachycardia?

      Your Answer:

      Correct Answer: 10 ml of 1 in 10,000 adrenaline solution

      Explanation:

      Ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) are referred to as shockable rhythm.

      IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be administered after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter for a shockable rhythm.

      For a non-shockable rhythm, 1 mg IV adrenaline should be administered as soon as IV access is obtained, and then every 3 – 5 minutes/after alternate shocks thereafter.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 44 - What is the earliest physiological effect that causes postural hypotension: ...

    Incorrect

    • What is the earliest physiological effect that causes postural hypotension:

      Your Answer:

      Correct Answer: A fall in central venous pressure

      Explanation:

      When autonomic reflexes are impaired or intravascular volume is markedly depleted, a significant reduction in blood pressure occurs upon standing, a phenomenon termed Postural Hypotension (orthostatic hypotension). Orthostatic hypotension can cause dizziness, syncope, and even angina or stroke. When autonomic reflexes are impaired, blood pressure falls progressively after standing because the gravitational pooling of blood in the legs cannot be compensated by sympathetic vasoconstriction.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 45 - What is nimodipine used predominantly in the treatment of? ...

    Incorrect

    • What is nimodipine used predominantly in the treatment of?

      Your Answer:

      Correct Answer: Prevention and treatment of vascular spasm following subarachnoid haemorrhage

      Explanation:

      Nimodipine is a smooth muscle relaxant that is related to nifedipine, but the effects preferentially act on cerebral arteries. It is exclusively used for the prevention and treatment of vascular spasm after an aneurysmal subarachnoid haemorrhage.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 46 - Which of the following statements is correct with regards to heparin-induced thrombocytopaenia (HIT)?...

    Incorrect

    • Which of the following statements is correct with regards to heparin-induced thrombocytopaenia (HIT)?

      Your Answer:

      Correct Answer: HIT typically develops 5-10 days after starting heparin.

      Explanation:

      Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder caused by antibodies that recognize complexes of platelet factor 4 (PF4) and heparin. HIT is frequently considered in the differential diagnosis of thrombocytopenia occurring in patients on heparin therapy. HIT is a challenging diagnosis because of routine heparin use in hospitalized patients, the common occurrence of thrombocytopenia. The process of heparin dependent IgG antibodies binding to heparin/platelet factor 4 complexes activates platelets and produces a hypercoagulable state. This syndrome typically develops 5-10 days (range 4-15 days) after heparin is commenced. It can occur with unfractionated heparin, low molecular weight heparin, or, rarely, fondaparinux. The diagnosis of HIT requires the combination of a compatible clinical picture and laboratory confirmation of the presence of heparin dependent platelet activating HIT antibodies. Discontinuation of heparin alone or initiation of a vitamin K antagonist alone like warfarin, is not sufficient to stop the development of thrombosis in patients with acute HIT. If there is moderate clinical suspicion for HIT, all sources of heparin must be discontinued and there must be consideration of anticoagulant treatment with a non-heparin drug.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 47 - Digoxin exhibits its positive inotropic effect by which of the following mechanisms: ...

    Incorrect

    • Digoxin exhibits its positive inotropic effect by which of the following mechanisms:

      Your Answer:

      Correct Answer: Inhibits the Na+/K+ pump on the myocyte membrane

      Explanation:

      Cardiac glycosides (e.g. digoxin) slow the removal of Ca2+from the cell by inhibiting the membrane Na+pump (Na+/K+ATPase) which generates the Na+gradient required for driving the export of Ca2+by Na+/Ca2+exchange; consequently the removal of Ca2+from the myocyte is slowed and more Ca2+is available for the next contraction.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 48 - Noradrenaline exhibits its positive inotropic effect by which of the following mechanisms: ...

    Incorrect

    • Noradrenaline exhibits its positive inotropic effect by which of the following mechanisms:

      Your Answer:

      Correct Answer: Binds to beta1-receptors and causes increased Ca2+ entry via L-type channels during the action potential

      Explanation:

      Noradrenaline (the sympathetic neurotransmitter) is a positive inotrope; it binds to β1-adrenoceptors on the membrane and causes increased Ca2+entry via L-type channels during the AP and thus increases Ca2+release from the SR. Noradrenaline also increases Ca2+sequestration into the SR and thus more Ca2+is available for the next contraction. Cardiac glycosides (e.g. digoxin) slow the removal of Ca2+from the cell by inhibiting the membrane Na+pump which generates the Na+gradient required for driving the export of Ca2+; consequently the removal of Ca2+from the myocyte is slowed and more Ca2+is available for the next contraction. Acidosis is negatively inotropic, largely because H+competes for Ca2+binding sites.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 49 - Regarding postural hypotension, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding postural hypotension, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: Postural hypotension usually causes a reflex bradycardia.

      Explanation:

      On standing from a prone position, gravity causes blood to pool in veins in the legs. Central venous pressure (CVP) falls, causing a fall in stroke volume and cardiac output (due to Starling’s law) and thus a fall in blood pressure. Normally this fall in BP is rapidly corrected by the baroreceptor reflex which causes venoconstriction (partially restoring CVP), and an increase in heart rate and contractility, so restoring cardiac output and blood pressure. Impaired autonomic nervous activity in the elderly accounts for the greater likelihood of postural hypotension. Any symptoms of dizziness, blurred vision or syncope is due to a transient fall in cerebral perfusion that occurs before cardiac output and mean arterial pressure (MAP) can be corrected.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 50 - Regarding fibrinolytics, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding fibrinolytics, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: Fibrinolytic drugs act as thrombolytics by directly degrading the fibrin mesh and so breaking up thrombi.

      Explanation:

      Fibrinolytic drugs act as thrombolytics by activating plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 51 - ACE inhibitors are indicated for all of the following EXCEPT for: ...

    Incorrect

    • ACE inhibitors are indicated for all of the following EXCEPT for:

      Your Answer:

      Correct Answer: Angina

      Explanation:

      ACE inhibitors have many uses and are generally well tolerated. They are indicated for:

      • Heart failure
      • Hypertension
      • Diabetic nephropathy
      • Secondary prevention of cardiovascular events

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 52 - Regarding cardiac excitation-contraction coupling, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding cardiac excitation-contraction coupling, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: In relaxation, Ca 2+ is transported out of the cell using energy from a Na + gradient.

      Explanation:

      During the AP plateau, Ca2+enters the cell and activates Ca2+sensitive Ca2+release channels in the sarcoplasmic reticulum allowing stored Ca2+to flood into the cytosol; this is called Ca2+-induced Ca2+release. In relaxation, about 80% of Ca2+is rapidly pumped back into the SR (sequestered) by Ca2+ATPase pumps. The Ca2+that entered the cell during the AP is transported out of the cell primarily by the Na+/Ca2+exchanger in the membrane which pumps one Ca2+ion out in exchange for three Na+ions in, using the Na+electrochemical gradient as an energy source. Increased heart rate increases the force of contraction in a stepwise fashion as intracellular [Ca2+] increases cumulatively over several beats; this is the Treppe effect. Factors that affect intracellular [Ca2+] and hence cardiac contractility are called inotropes.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 53 - In the treatment of bradyarrhythmias with adverse characteristics or risk of asystole, what...

    Incorrect

    • In the treatment of bradyarrhythmias with adverse characteristics or risk of asystole, what is the initial suggested dose of atropine?

      Your Answer:

      Correct Answer: 500 micrograms

      Explanation:

      Atropine 500 mcg IV bolus should be administered if there are any adverse features or risk of asystole. If the reaction is not adequate, repeat the steps every 3 to 5 minutes up to a maximum dose of 3 mg. In the case of acute myocardial ischemia or myocardial infarction, atropine should be taken with caution since the increased heart rate may aggravate the ischemia or increase the size of the infarct.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 54 - Fenestrated capillaries are typically found where in the body: ...

    Incorrect

    • Fenestrated capillaries are typically found where in the body:

      Your Answer:

      Correct Answer: Renal glomeruli

      Explanation:

      Fenestrated capillaries, found in renal glomeruli, endocrine glands and intestinal villi, are more permeable than continuous capillaries with less tight junctions, and the endothelial cells are also punctured by pores which allow large amounts of fluids or metabolites to pass.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 55 - What is the direct mechanism of action of digoxin as a positive inotrope:...

    Incorrect

    • What is the direct mechanism of action of digoxin as a positive inotrope:

      Your Answer:

      Correct Answer: Inhibition of Na+/K+ ATPase pump

      Explanation:

      Digoxin directly inhibits membrane Na+/K+ ATPase, which is responsible for Na+/K+ exchange across the myocyte cell membrane. This increases intracellular Na+ and produces a secondary increase in intracellular Ca2+ that increases the force of myocardial contraction. The increase in intracellular Ca2+ occurs because the decreased Na+ gradient across the membrane reduces the extrusion of Ca2+ by the Na+/Ca2+ exchanger that normally occurs during diastole. Digoxin and K+ ions compete for the receptor on the outside of the muscle cell membrane, and so the effects of digoxin may be dangerously increased in hypokalaemia.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 56 - For a tachyarrhythmia caused by hypovolaemic shock, which of the following is the...

    Incorrect

    • For a tachyarrhythmia caused by hypovolaemic shock, which of the following is the first-line treatment:

      Your Answer:

      Correct Answer: Synchronised DC shock

      Explanation:

      If there are any adverse symptoms, immediate cardioversion with synchronized DC shock is recommended. If cardioversion fails to stop the arrhythmia and the symptoms persist, amiodarone 300 mg IV over 10–20 minutes should be administered before attempting another cardioversion. The loading dosage of amiodarone is followed by a 24-hour infusion of 900 mg administered into a large vein.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 57 - What is the mechanism of action of captopril: ...

    Incorrect

    • What is the mechanism of action of captopril:

      Your Answer:

      Correct Answer: Angiotensin-converting enzyme inhibitor

      Explanation:

      Captopril is an angiotensin-converting enzyme (ACE) inhibitor, which inhibits the conversion of angiotensin I to angiotensin II.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 58 - Regarding endothelin-1, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding endothelin-1, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: Endothelin-1 release is inhibited by noradrenaline.

      Explanation:

      Endothelin-1 (ET-1) is an extremely potent vasoconstrictor peptide which is released from the endothelium in the presence of many other vasoconstrictors, including angiotensin II, antidiuretic hormone (ADH) and noradrenaline, and may be increased in disease and hypoxia.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 59 - You are teaching a group of medical students about cardiovascular examination. You are...

    Incorrect

    • You are teaching a group of medical students about cardiovascular examination. You are discussing heart sounds and the cardiac cycle. Which of the following stages of the cardiac cycle occurs immediately after the aortic valve closes:

      Your Answer:

      Correct Answer: Isovolumetric relaxation

      Explanation:

      Immediately after the closure of the semilunar valves, the ventricles rapidly relax and ventricular pressure decreases rapidly but the AV valves remain closed as initially the ventricular pressure is still greater than atrial pressure. This is isovolumetric relaxation. Atrial pressure continues to rise because of venous return, with the v wave of the JVP waveform peaking during this phase. Rapid flow of blood from the atria into the ventricles during the ventricular filling phase causes thethird heart sound, which is normal in children but, in adults, is associated with disease such as ventricular dilation.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 60 - Captopril should not be used if you have any of the following conditions:...

    Incorrect

    • Captopril should not be used if you have any of the following conditions:

      Your Answer:

      Correct Answer: Renal artery stenosis

      Explanation:

      Contraindications indications of Captopril include:
      – Bilateral renal artery stenosis
      – Hypersensitivity to ACE inhibitors
      – Anuria
      – History of ACEI-induced angioedema
      – Hereditary or idiopathic angioedema
      – Co-administration of Neprilysin inhibitors (e.g., sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hours of switching to or from sacubitril/valsartan.
      If ACE inhibitors are used, they should be initiated only under specialist supervision and renal function should be monitored regularly. ACE inhibitors should also be used with particular caution in patients who may have undiagnosed and clinically silent renovascular disease. This includes patients with peripheral vascular disease or those with severe generalised atherosclerosis.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 61 - Which of the following conditions require IV Lidocaine administration? ...

    Incorrect

    • Which of the following conditions require IV Lidocaine administration?

      Your Answer:

      Correct Answer: Refractory ventricular fibrillation in cardiac arrest

      Explanation:

      IV Lidocaine is indicated in Ventricular Arrhythmias or Pulseless Ventricular Tachycardia (after defibrillation, attempted CPR, and vasopressor administration)

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 62 - If the ejection fraction increases, there will be a decrease in: ...

    Incorrect

    • If the ejection fraction increases, there will be a decrease in:

      Your Answer:

      Correct Answer: End-systolic volume

      Explanation:

      An increase in ejection fraction means that a higher fraction of the end-diastolic volume is ejected in the stroke volume (e.g. because of the administration of a positive inotropic agent). When this situation occurs, the volume remaining in the ventricle after systole, the end-systolic volume, will be reduced. Cardiac output, stroke volume, and mean arterial pressure will be increased.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 63 - What is the primary mode of action of Enoxaparin? ...

    Incorrect

    • What is the primary mode of action of Enoxaparin?

      Your Answer:

      Correct Answer: Inhibits factor Xa

      Explanation:

      Heparin acts as an anticoagulant by enhancing the inhibition rate of clotting proteases by antithrombin III impairing normal haemostasis and inhibition of factor Xa. Low molecular weight heparins have a small effect on the activated partial thromboplastin time and strongly inhibit factor Xa. Enoxaparin is derived from porcine heparin that undergoes benzylation followed by alkaline depolymerization.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 64 - On which of the following is preload primarily dependent? ...

    Incorrect

    • On which of the following is preload primarily dependent?

      Your Answer:

      Correct Answer: End-diastolic volume

      Explanation:

      Preload refers to the initial stretching of the cardiac myocytes before contraction. It is therefore related to muscle sarcomere length. The sarcomere length cannot be determined in the intact heart, and so, other indices of preload are used, like ventricular end-diastolic volume or pressure. The end-diastolic pressure and volume of the ventricles increase when venous return to the heart is increased, and this stretches the sarcomeres, which increase their preload.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 65 - The risk of renal impairment in a patient on ACE inhibitor therapy is...

    Incorrect

    • The risk of renal impairment in a patient on ACE inhibitor therapy is increased by concomitant treatment with which of the following drug classes:

      Your Answer:

      Correct Answer: NSAIDs

      Explanation:

      Concomitant treatment with NSAIDs increases the risk of renal damage, and with potassium-sparing diuretics (or potassium-containing salt substitutes) increases the risk of hyperkalaemia. Hyperkalaemia and other side effects of ACE inhibitors are more common in the elderly and in those with impaired renal function and the dose may need to be reduced.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 66 - What is the mechanism of action of captopril: ...

    Incorrect

    • What is the mechanism of action of captopril:

      Your Answer:

      Correct Answer: Inhibition of the conversion of angiotensin I to angiotensin II

      Explanation:

      Angiotensin-converting enzyme inhibitors (ACE inhibitors) e.g. captopril inhibit the conversion of angiotensin I to angiotensin II, and thus have a vasodilatory effect, lowering both arterial and venous resistance. The cardiac output increases and, because the renovascular resistance falls, there is an increase in renal blood flow. This latter effect, together with reduced aldosterone release, increases Na+ and H2O excretion, contracting the blood volume and reducing venous return to the heart.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 67 - All of the following statement about the microcirculation are correct except: ...

    Incorrect

    • All of the following statement about the microcirculation are correct except:

      Your Answer:

      Correct Answer: Over the capillary bed, there is a net absorption of fluid.

      Explanation:

      The hydrostatic pressure along the length of the capillary is usually greater than plasma oncotic pressure. As a result, there is a small net filtration of fluid from the capillary into the interstitial space. The regulation of blood flow into the microcirculation is via the vasoconstriction of small arterioles, which is activated by the sympathetic nervous system through numerous nerve endings in their walls. Unlike proteins, most ions and small molecules diffuse easily across capillary walls and thus the crystalloid osmotic pressure they exert is roughly the same on either side of the capillary wall. Because the plasma colloid osmotic pressure is higher than interstitial colloid osmotic, fluid is drawn intravascularly. A reduction of hydrostatic capillary pressure and transient increase in absorption of fluid is a result of arteriolar constriction.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 68 - In the treatment of hypertensive episodes in pheochromocytoma, which of the following medication...

    Incorrect

    • In the treatment of hypertensive episodes in pheochromocytoma, which of the following medication types is administered as first-line management:

      Your Answer:

      Correct Answer: Alpha-blockers

      Explanation:

      The first line of management in controlling blood pressure and preventing intraoperative hypertensive crises is to use a combination of alpha and beta-adrenergic inhibition. In phaeochromocytoma, alpha-blockers are used to treat hypertensive episodes in the short term. Tachycardia can be managed by the careful addition of a beta-blocker, preferably a cardioselective beta-blocker, once alpha blockade has been established. Long term management of pheochromocytoma involves surgery.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 69 - A patient who is taking ramipril for high blood pressure complains of a...

    Incorrect

    • A patient who is taking ramipril for high blood pressure complains of a dry persistent cough. What is the mechanism of cough in ACE inhibitor therapy:

      Your Answer:

      Correct Answer: Decreased bradykinin breakdown

      Explanation:

      Blocking ACE also diminishes the breakdown of the potent vasodilator bradykinin which is the cause of the persistent dry cough. Angiotensin-II receptor blockers do not have this effect, therefore they are useful alternative for patients who have to discontinue an ACE inhibitor because of persistent cough.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 70 - Which of the following drugs is first line treatment for a stable regular...

    Incorrect

    • Which of the following drugs is first line treatment for a stable regular broad-complex tachycardia:

      Your Answer:

      Correct Answer: Amiodarone

      Explanation:

      A regular broad-complex tachycardia is likely to be ventricular tachycardia or a regular supraventricular rhythm with bundle branch block. A ventricular tachycardia (or broad-complex tachycardia of uncertain origin) should be treated with amiodarone 300 mg IV over 10 – 60 min, followed by an infusion of 900 mg over the next 24 hours. If previously confirmed as SVT with bundle branch block, the patient should be treated as for narrow-complex tachycardia.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 71 - Which of the following is NOT an adverse effect associated with warfarin therapy:...

    Incorrect

    • Which of the following is NOT an adverse effect associated with warfarin therapy:

      Your Answer:

      Correct Answer: Neutropenia

      Explanation:

      Adverse effects of warfarin:
      The most common adverse effect of warfarin is bleeding

      Other common adverse effects of warfarin include nausea, vomiting, diarrhoea, jaundice, hepatic dysfunction, pancreatitis, pyrexia, alopecia, purpura, and rash

      Skin necrosis is a rare but serious adverse effect of warfarin; treatment with warfarin should be stopped if warfarin related skin necrosis is suspected

      Calciphylaxis is a rare, but a very serious condition that causes vascular calcification and cutaneous necrosis

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 72 - Regarding autoregulation of local blood flow, which of the following statements is CORRECT:...

    Incorrect

    • Regarding autoregulation of local blood flow, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: An increase in blood flow dilutes locally produced vasodilating factors causing vasoconstriction.

      Explanation:

      Autoregulation is the ability to maintain a constant blood flow despite variations in blood pressure (between 50 – 170 mmHg). It is particularly important in the brain, kidney and heart. There are two main methods contributing to autoregulation:
      The myogenic mechanism involves arterial constriction in response to stretching of the vessel wall, probably due to activation of smooth muscle stretch-activated Ca2+channels and Ca2+entry. A reduction in pressure and stretch closes these channels, causing vasodilation.
      The second mechanism of autoregulation is due to locally produced vasodilating factors; an increase in blood flow dilutes these factors causing vasoconstriction, whereas decreased blood flow has the opposite effect.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 73 - When a person changes from a supine to an upright position, which of...

    Incorrect

    • When a person changes from a supine to an upright position, which of the followingcompensatory mechanismsoccurs:

      Your Answer:

      Correct Answer: Increased contractility

      Explanation:

      On standing from a prone position, gravity causes blood to pool in veins in the legs. Central venous pressure (CVP) falls, causing a fall in stroke volume and cardiac output (due to Starling’s law) and thus a fall in blood pressure. Normally this fall in BP is rapidly corrected by the baroreceptor reflex which causes venoconstriction (partially restoring CVP), and an increase in heart rate and contractility, so restoring cardiac output and blood pressure. Impaired autonomic nervous activity in the elderly accounts for the greater likelihood of postural hypotension. Any symptoms of dizziness, blurred vision or syncope is due to a transient fall in cerebral perfusion that occurs before cardiac output and mean arterial pressure (MAP) can be corrected.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 74 - Regarding the cardiac cycle, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding the cardiac cycle, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: The second heart sound occurs in late diastole caused by closure of the atrioventricular valves.

      Explanation:

      Diastole is usually twice the length of systole at rest, but decreases with increased heart rate. During systole, contraction of the ventricles compresses the coronary arteries and suppresses blood flow. This is particularly evident in the left ventricle, where during systole the ventricular pressure is the same as or greater than that in the arteries and as a result more than 85% of left ventricular perfusion occurs during diastole. This becomes a problem if the heart rate is increased as the diastolic interval is shorter and can result in ischaemia. The second heart sound, caused by closure of the semilunar valves, marks the end of systole.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 75 - Which of the following is NOT an adverse effect associated with statin therapy:...

    Incorrect

    • Which of the following is NOT an adverse effect associated with statin therapy:

      Your Answer:

      Correct Answer: Aplastic anaemia

      Explanation:

      Adverse effects of statins include:, Headache, Epistaxis, Gastrointestinal disorders (such as constipation, flatulence, dyspepsia, nausea, and diarrhoea), Musculoskeletal and connective tissue disorders (such as myalgia, arthralgia, pain in the extremity, muscle spasms, joint swelling, and back pain), Hyperglycaemia and diabetes, Myopathy and rhabdomyolysis, Interstitial lung disease and Hepatotoxicity

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 76 - Arterial baroreceptors are located primarily in which of the following: ...

    Incorrect

    • Arterial baroreceptors are located primarily in which of the following:

      Your Answer:

      Correct Answer: Carotid sinus and aortic arch

      Explanation:

      Arterial baroreceptors are located in the carotid sinus and aortic arch, and detect the mean arterial pressure (MAP). A decrease in MAP (such as in postural hypotension, or haemorrhage) reduces arterial stretch and decreases baroreceptor activity, resulting in decreased firing in afferent nerves travelling via the glossopharyngeal nerve (carotid sinus) and vagus nerve (aortic arch) to the medulla where the activity of the autonomic nervous system is coordinated. Sympathetic nerve activity consequently increases, causing an increase in heart rate and cardiac contractility, peripheral vasoconstriction with an increase in TPR, and venoconstriction with an increase in CVP and thus an increase in cardiac output and blood pressure. Parasympathetic activity (vagal tone) decreases, contributing to the rise in heart rate.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 77 - What is the main mechanism of action of dopamine as an inotropic sympathomimetic: ...

    Incorrect

    • What is the main mechanism of action of dopamine as an inotropic sympathomimetic:

      Your Answer:

      Correct Answer: Beta1-receptor agonist

      Explanation:

      Dopamine is a neurotransmitter and a metabolic precursor of the catecholamines. It acts on beta1-receptors in cardiac muscle increasing cardiac contractility, and increases renal perfusion by stimulating dopamine receptors in the renal vasculature. This is of benefit in cardiogenic shock where deterioration of renal function is common.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 78 - Which of the following statements is correct regarding the lymphatic system? ...

    Incorrect

    • Which of the following statements is correct regarding the lymphatic system?

      Your Answer:

      Correct Answer: Lymphatic vessels contain both smooth muscle and unidirectional valves.

      Explanation:

      Fluid filtration out of the capillaries is usually slightly greater than fluid absorption into the capillaries. About 8 L of fluid per day is filtered by the microcirculation and returns to the circulation by the lymphatic system. Lymphatic capillaries drain into collecting lymphatics, then into larger lymphatic vessels. Both of these containing smooth muscle and unidirectional valves. From this point, lymph is propelled by smooth muscle constriction and vessel compression by body movements into afferent lymphatics. It then goes to the lymph nodes where phagocytes remove bacteria and foreign materials. It is here that most fluid is reabsorbed by capillaries, and the remainder returns to the subclavian veins via efferent lymphatics and the thoracic duct. The lymphatic system has a major role to play in the body’s immune defence and also has a very important role in the absorption and transportation of fats.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 79 - Which of the following is NOT a common side effect of amiodarone: ...

    Incorrect

    • Which of the following is NOT a common side effect of amiodarone:

      Your Answer:

      Correct Answer: Blue/green teeth discolouration

      Explanation:

      Common side effects of amiodarone include: Bradycardia, Nausea and vomiting, Thyroid disorders – hypothyroidism and hyperthyroidism, Persistent slate grey skin discoloration, Photosensitivity, Pulmonary toxicity (including pneumonitis and fibrosis), Hepatotoxicity, Corneal microdeposits (sometimes with night glare), Peripheral neuropathy and Sleep disorders.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 80 - Digoxin is contraindicated in all of the following EXCEPT for: ...

    Incorrect

    • Digoxin is contraindicated in all of the following EXCEPT for:

      Your Answer:

      Correct Answer: Asthma

      Explanation:

      Digoxin is contraindicated in:Supraventricular arrhythmias associated with accessory conduction pathways e.g. Wolff-Parkinson-White syndromeVentricular tachycardia or fibrillationHeart conduction problems e.g. second degree or intermittent complete heart blockHypertrophic cardiomyopathy (unless concomitant atrial fibrillation and heart failure but should be used with caution)

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 81 - All of the following are indications for beta-blockers EXCEPT for: ...

    Incorrect

    • All of the following are indications for beta-blockers EXCEPT for:

      Your Answer:

      Correct Answer: Prinzmetal's angina

      Explanation:

      Beta-blockers are contraindicated in Prinzmetal’s angina.Beta-blockers may be indicated in:HypertensionPheochromocytoma (only with an alpha-blocker)AnginaSecondary prevention after ACSArrhythmias including atrial fibrillationHeart failureThyrotoxicosisAnxietyProphylaxis of migraineEssential tremorGlaucoma

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 82 - Which of the following drug classes may cause bronchoconstriction: ...

    Incorrect

    • Which of the following drug classes may cause bronchoconstriction:

      Your Answer:

      Correct Answer: Beta-blockers

      Explanation:

      Beta-blockers, including those considered to be cardioselective, should usually be avoided in patients with a history of asthma, bronchospasm or a history of obstructive airways disease. However, when there is no alternative, a cardioselective beta-blocker can be given to these patients with caution and under specialist supervision. In such cases the risk of inducing bronchospasm should be appreciated and appropriate precautions taken.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 83 - Which of the following is NOT a typical electrolyte disturbance caused by furosemide:...

    Incorrect

    • Which of the following is NOT a typical electrolyte disturbance caused by furosemide:

      Your Answer:

      Correct Answer: Hypercalcaemia

      Explanation:

      Adverse effects of loop diuretics include:
      Mild gastrointestinal disturbances, pancreatitis and hepatic encephalopathy
      Hyperglycaemia
      Acute urinary retention
      Water and electrolyte imbalance
      Hyponatraemia, hypocalcaemia, hypokalaemia, hypomagnesaemia, hypochloraemiaHypotension, hypovolaemia, dehydration, and venous thromboembolism
      Metabolic alkalosis
      Hyperuricaemia
      Blood disorders (bone marrow suppression, thrombocytopenia, and leucopenia)
      Visual disturbance, tinnitus and deafness
      Hypersensitivity reactions

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 84 - What is the most common application of Nitrates? ...

    Incorrect

    • What is the most common application of Nitrates?

      Your Answer:

      Correct Answer: Angina

      Explanation:

      In patients with exertional stable angina, nitrates improve exercise tolerance, time to onset of angina, and ST-segment depression during exercise testing. In combination with beta-blockers or calcium channel blockers, nitrates produce greater anti-anginal and anti-ischemic effects.
      While they act as vasodilators, coronary vasodilators, and modest arteriolar dilators, the primary anti ischemic effect of nitrates is to decrease myocardial oxygen demand by producing systemic vasodilation more than coronary vasodilation. This systemic vasodilation reduces left ventricular systolic wall stress.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 85 - A patient has a cardiac output of 4.8 L/min and a heart rate...

    Incorrect

    • A patient has a cardiac output of 4.8 L/min and a heart rate of 80 bpm, therefore their stroke volume is:

      Your Answer:

      Correct Answer: 60 mL

      Explanation:

      Cardiac output (CO) = Stroke volume (SV) x Heart rate (HR).
      Therefore SV = CO/HR
      = 4.8/80
      = 0.06 L = 60 mL.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 86 - In adult basic life support, chest compressions should be performed at which of...

    Incorrect

    • In adult basic life support, chest compressions should be performed at which of the following rates:

      Your Answer:

      Correct Answer: 100 - 120 per minute

      Explanation:

      Chest compressions should be performed at a rate of 100 – 120 per minute.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 87 - Regarding loop diuretics, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding loop diuretics, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: The risk of hypokalaemia is greater with loop diuretics than with an equipotent dose of a thiazide diuretic.

      Explanation:

      Hypokalaemia can occur with both thiazide and loop diuretics. The risk of hypokalaemia depends on the duration of action as well as the potency and is thus greater with thiazides than with an equipotent dose of a loop diuretic. Hypokalaemia is dangerous in severe cardiovascular disease and in patients also being treated with cardiac glycosides. Often the use of potassium-sparing diuretics avoids the need to take potassium supplements. In hepatic failure, hypokalaemia caused by diuretics can precipitate encephalopathy, particularly in alcoholic cirrhosis.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 88 - Discontinuous capillaries are typically found where in the body: ...

    Incorrect

    • Discontinuous capillaries are typically found where in the body:

      Your Answer:

      Correct Answer: Reticuloendothelial system

      Explanation:

      Discontinuous capillaries, found in the reticuloendothelial system (bone marrow, liver and spleen), have large gaps between endothelial cells and are permeable to red blood cells.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 89 - All of the following statement are correct regarding endothelium derived nitric oxide except:...

    Incorrect

    • All of the following statement are correct regarding endothelium derived nitric oxide except:

      Your Answer:

      Correct Answer: Nitric oxide production is inhibited by local mediators such as bradykinin, histamine and serotonin.

      Explanation:

      Factors that elevate intracellular Ca2+ increase nitric oxide (NO) production by the endothelium included local mediators such as histamine and serotonin, bradykinin, and some neurotransmitters like substance P. NO production is also stimulated by increased flow (shear stress) and additionally activates prostacyclin synthesis. As a result of basal production of NO, there is continuous modulation of vascular resistance and as a result, there is increased production of nitric oxide acts which causes vasodilation. Platelet activation and thrombosis are inhibited by nitric oxide.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 90 - Which of the following medications may lessen warfarin's anticoagulant effect: ...

    Incorrect

    • Which of the following medications may lessen warfarin's anticoagulant effect:

      Your Answer:

      Correct Answer: Phenytoin

      Explanation:

      Phenytoin will decrease the level or effect of warfarin by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
      Metronidazole will increase the level or effect of warfarin by affecting hepatic enzyme CYP2C9/10 metabolism.
      NSAIDs, when given with Warfarin, increase anticoagulation.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 91 - Which of the following is NOT a benefit of low molecular weight heparin...

    Incorrect

    • Which of the following is NOT a benefit of low molecular weight heparin (LMWH) over unfractionated heparin therapy:

      Your Answer:

      Correct Answer: Its effects can be rapidly and completely reversed with protamine sulfate.

      Explanation:

      Advantages of LMWHGreater ability to inhibit factor Xa directly, interacting less with platelets and so may have a lesser tendency to cause bleedingGreater bioavailability and longer half-life in plasma making once daily subcutaneous administration possibleMore predictable dose response avoiding the need for routine anticoagulant monitoringLower associated risk of heparin-induced thrombocytopenia or of osteoporosis

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 92 - Which of the following causes the first heart sound? ...

    Incorrect

    • Which of the following causes the first heart sound?

      Your Answer:

      Correct Answer: Closing of the atrioventricular valves

      Explanation:

      The heart sounds are as a result of the various parts of the cardiac cycle.
      Heart Sound – Phase of Cardiac Cycle – Mechanical Event:
      1st heart sound – Systole starts – there is closure of the atrioventricular (mitral & tricuspid) valves
      2nd heart sound – Systole ends – there is closure of the semilunar (aortic and pulmonary) valves
      3rd heart sound – Early diastole – this is caused by rapid flow of blood from the atria into the ventricles during the ventricular filling phase
      4th heart sound – Late diastole – this is caused by filling of an abnormally stiff ventricle in atrial systole

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 93 - A 40-year-old man who has a history of asthma arrives at the emergency...

    Incorrect

    • A 40-year-old man who has a history of asthma arrives at the emergency department complaining of palpitations that have been going on for 5 days. Which of the following beta-blockers is the safest for an asthmatic patient?

      Your Answer:

      Correct Answer: Atenolol

      Explanation:

      Atenolol is a beta blocker, which is a type of medication that works by preventing certain natural substances in the body, such as epinephrine, from acting on the heart and blood vessels.

      This effect reduces heart rate, blood pressure, and cardiac strain. Atenolol, bisoprolol fumarate, metoprolol tartrate, nebivolol, and (to a lesser extent) acebutolol have a lower action on beta2 (bronchial) receptors and are thus cardio selective but not cardiac specific.

      They have a lower effect on airway resistance, although they are not without this adverse effect.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 94 - Which of the following best describes the correct administration of adrenaline for a...

    Incorrect

    • Which of the following best describes the correct administration of adrenaline for a shockable rhythm in adult advanced life support?

      Your Answer:

      Correct Answer: Give 1 mg of adrenaline after the second shock and every 3 - 5 minutes thereafter

      Explanation:

      Give adrenaline 1 mg IV (IO) (10 mL of 1:10,000 solution) after the 2nd shock for adult patients in cardiac arrest with a shockable rhythm. Repeat adrenaline 1 mg IV (IO) every 3-5 minutes whilst ALS continues.

      Figure 3. Adult Cardiac Arrest Algorithm

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 95 - All of the following are indications for beta-blockers EXCEPT for: ...

    Incorrect

    • All of the following are indications for beta-blockers EXCEPT for:

      Your Answer:

      Correct Answer: Raynaud's disease

      Explanation:

      Beta-blockers are contraindicated in Raynaud’s syndrome.
      Beta-blockers may be indicated in:
      Hypertension
      Pheochromocytoma (only with an alpha-blocker)
      Angina
      Secondary prevention after ACS
      Arrhythmias including atrial fibrillation
      Heart failure
      Thyrotoxicosis
      Anxiety
      Prophylaxis of migraine
      Essential tremor
      Glaucoma

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 96 - Which of the following is NOT a typical side effect of digoxin: ...

    Incorrect

    • Which of the following is NOT a typical side effect of digoxin:

      Your Answer:

      Correct Answer: Hypokalaemia

      Explanation:

      Digoxin does not cause hypokalaemia, but hypokalaemia does potentiate digoxin toxicity. The adverse effects of digoxin are frequently due to its narrow therapeutic window and include:
      Cardiac adverse effects – Sinoatrial and atrioventricular block, Premature ventricular contractions, PR prolongation and ST-segment depression
      Nausea, vomiting and diarrhoea
      Blurred or yellow vision
      CNS effects – weakness, dizziness, confusion, apathy, malaise, headache, depression, psychosis
      Thrombocytopenia and agranulocytosis (rare)
      Gynaecomastia in men in prolonged administration

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 97 - Adenosine is primarily indicated for which of the following: ...

    Incorrect

    • Adenosine is primarily indicated for which of the following:

      Your Answer:

      Correct Answer: Paroxysmal supraventricular tachycardia

      Explanation:

      Adenosine is usually the treatment of choice for terminating paroxysmal supraventricular tachycardia including those associated with accessory conduction pathways e.g. Wolff-Parkinson-White syndrome.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      0
      Seconds

  • Question 98 - What is the effect of a positive inotrope on the Starling curve: ...

    Incorrect

    • What is the effect of a positive inotrope on the Starling curve:

      Your Answer:

      Correct Answer: Shifts the curve upwards

      Explanation:

      Contractility (inotropy) is the intrinsic ability of cardiac muscle to develop force at a given muscle length. It is determined by the intracellular [Ca2+] and can be estimated by the ejection fraction. Increases in contractility cause an increase in stroke volume/cardiac output for any level of right atrial pressure or end-diastolic volume, and hence shift the Starling curve upwards. Decreases in contractility cause a decrease in stroke volume/cardiac output for any level of right atrial pressure or end-diastolic volume and hence shift the Starling curve downwards.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 99 - Oedema can occur as a result of any of the following WITH THE...

    Incorrect

    • Oedema can occur as a result of any of the following WITH THE EXCEPTION OF:

      Your Answer:

      Correct Answer: Increased interstitial hydrostatic pressure

      Explanation:

      Oedema is defined as a palpable swelling produced by the expansion of the interstitial fluid volume. A variety of clinical conditions are associated with the development of oedema, including heart failure, cirrhosis, and nephrotic syndrome. The development of oedema requires an alteration in capillary dynamics in a direction that favours an increase in net filtration and also inadequate removal of the additional filtered fluid by lymphatic drainage. Oedema may form in response to an elevation in capillary hydraulic pressure (which increases the delta hydraulic pressure) or increased capillary permeability, or it can be due to disruption of the endothelial glycocalyx, decreased interstitial compliance, a lower plasma oncotic pressure (which reduces the delta oncotic pressure), or a combination of these changes. Oedema can also be induced by lymphatic obstruction since the fluid that is normally filtered is not returned to the systemic circulation.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 100 - When an elderly dehydrated patient is moved from a supine to a standing...

    Incorrect

    • When an elderly dehydrated patient is moved from a supine to a standing position, her heart rate increases. Which of the following accounts for the increase in heart rate upon standing:

      Your Answer:

      Correct Answer: Decreased venous return

      Explanation:

      On standing from a prone position, gravity causes blood to pool in veins in the legs. Central venous pressure (CVP) falls, causing a fall in stroke volume and cardiac output (due to Starling’s law) and thus a fall in blood pressure. Normally this fall in BP is rapidly corrected by the baroreceptor reflex which causes venoconstriction (partially restoring CVP), and an increase in heart rate and contractility, so restoring cardiac output and blood pressure. Impaired autonomic nervous activity in the elderly accounts for the greater likelihood of postural hypotension. Any symptoms of dizziness, blurred vision or syncope is due to a transient fall in cerebral perfusion that occurs before cardiac output and mean arterial pressure (MAP) can be corrected.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular (9/24) 38%
Physiology (3/10) 30%
Pharmacology (6/14) 43%
Passmed
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