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Question 1
Incorrect
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Regarding endothelin-1, which of the following statements is INCORRECT:
Your Answer: Endothelin-1 production may be increased in hypoxia.
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.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 2
Incorrect
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All of the following are indications for beta-blockers EXCEPT for:
Your Answer: Thyrotoxicosis
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
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 3
Incorrect
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Which of the following is NOT a typical electrolyte disturbance caused by furosemide:
Your Answer: Hypokalaemia
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
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Question 4
Incorrect
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What is the main mechanism of action of dobutamine as an inotropic sympathomimetic:
Your Answer: Beta2-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.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 5
Incorrect
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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: 40 mL
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
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Question 6
Incorrect
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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: Nitrates
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.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 7
Incorrect
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What is the recommended dosing regime for amiodarone in the treatment of a stable regular broad-complex tachycardia:
Your Answer: 150 mg IV bolus, followed by an IV infusion of 300 mg over next 20 - 60 minutes
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.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 8
Incorrect
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Regarding fibrinolytics, which of the following statements is INCORRECT:
Your Answer: Further embolism may occur either due to clots that break away from the original thrombus or to cholesterol crystal emboli.
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.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 9
Incorrect
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All of the following statement about the microcirculation are correct except:
Your Answer: The crystalloid osmotic pressure is the same either side of the capillary wall.
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.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 10
Incorrect
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Regarding loop diuretics, which of the following statements is INCORRECT:
Your Answer: Intravenous furosemide has a peak effect within 30 minutes.
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.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 11
Incorrect
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Which of the following is NOT an adverse effect associated with statin therapy:
Your Answer: Hepatotoxicity
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
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 12
Incorrect
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Which of the following is NOT a pharmacological effect of beta-blockers:
Your Answer: Reduced cardiac contractility
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 automaticityEye:
Reduce intraocular pressureRespiratory system:
Cause bronchoconstriction -
This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 13
Correct
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What is the earliest physiological effect that causes postural hypotension:
Your 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.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 14
Incorrect
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Oedema can occur as a result of any of the following WITH THE EXCEPTION OF:
Your Answer: Decreased plasma oncotic pressure
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.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 15
Incorrect
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Which of the following is NOT a common side effect of amiodarone:
Your Answer: Slate grey skin discolouration
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.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 16
Incorrect
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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.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 17
Incorrect
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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.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 18
Incorrect
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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:
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.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 19
Incorrect
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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.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 20
Incorrect
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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 bleedingOther 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
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 21
Incorrect
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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.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 22
Incorrect
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Which of the following best describes digoxin:
Your Answer:
Correct Answer: A positive inotrope and negative chronotrope
Explanation:Digoxin is a cardiac glycoside used in the treatment of atrial fibrillation and flutter, and congestive cardiac failure. It acts by inhibiting the membrane Na/K ATPase in cardiac myocytes. This raises intracellular sodium concentration and increases intracellular calcium availability indirectly via Na/Ca exchange. The increase in intracellular calcium levels causes an increases the force of myocardial contraction (positive inotrope), and slows the heart rate (negative chronotrope).
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 23
Incorrect
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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.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 24
Incorrect
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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
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Question 25
Incorrect
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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.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 26
Incorrect
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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.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 27
Incorrect
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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.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 28
Incorrect
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As a response to low blood pressure, the baroreceptor reflex will facilitate vasoconstriction by activating which receptor?
Your Answer:
Correct 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.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 29
Incorrect
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A 68-year-old man is being treated with digoxin for atrial fibrillation. When serum digoxin levels are above the therapeutic range, he is at highest risk for developing digoxin toxicity if he also develops which of the following?
Your Answer:
Correct Answer: Hypokalaemia
Explanation:Predisposing factors for digoxin toxicity include hypoxia, hypercalcaemia, hypokalaemia and hypomagnesaemia There should also be care taken in the elderly who are particularly susceptible to digoxin toxicity. Hypokalaemia may be precipitated by use of diuretics. Hyponatremia can result in the development of other pathological disturbances, but it does not make digoxin toxicity worse.
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This question is part of the following fields:
- Cardiovascular
- Pharmacology
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Question 30
Incorrect
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The Frank-Starling curve is shifted downhill in heart failure due to which of the following?
Your Answer:
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.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
