Phys 22 Flashcards

A patient develops acute moderate cardiac failure after myocardial injury. Which immediate hemodynamic pattern is most expected?

A. Increased output, venous unloading
B. Decreased output, venous damming
C. Increased output, arterial pooling
D. Decreased output, arterial dilation

Early compensation for acute heart failure by the sympathetic nervous system produces which two major responses?

A. Increased contractility, vasoconstriction
B. Bradycardia, venodilation
C. Decreased afterload, natriuresis
D. Increased diuresis, vasodilation

Which reflex is one of the major mechanisms that strongly stimulates sympathetic activity in acute heart failure?

A. Bainbridge reflex
B. Oculocardiac reflex
C. Baroreceptor reflex
D. Cushing triad

Which additional mechanism can strongly activate the sympathetic nervous system in worsening heart failure?

A. Chemoreceptor reflex
B. Frank-Starling mechanism
C. Hering-Breuer reflex
D. Diving reflex

Severe circulatory compromise from heart failure can activate which powerful sympathetic response?

A. Bezold-Jarisch reflex
B. CNS ischemic response
C. Vasovagal response
D. Pupillary reflex

In chronic heart failure, reduced cardiac output and blood pressure cause the kidneys to retain:

A. bicarbonate and calcium
B. glucose and phosphate
C. sodium and water
D. potassium and urea

Moderate fluid retention in chronic heart failure can be:

A. always harmful
B. beneficial
C. never compensatory
D. unrelated to output

Excess fluid retention in heart failure can directly cause all of the following except:

A. pulmonary edema
B. peripheral edema
C. increased cardiac workload
D. improved cardiac reserve

Excessive ventricular stretching from fluid retention tends to:

A. strengthen the myocardium
B. increase coronary flow only
C. weaken the heart
D. prevent pulmonary edema

In compensated heart failure, which statement is most accurate?

A. Pumping returns fully normal, reserves reduced
B. Cardiac reserves normalize
C. Output remains depressed, reserves reduced
D. Edema cannot occur

Which best defines decompensated heart failure?

A. Normal output restored by SNS
B. No compensation can normalize output
C. Renal perfusion is excessive
D. Pumping exceeds metabolic demand

Decompensated heart failure can become fatal largely because the kidneys receive insufficient blood flow to:

A. filter proteins
B. secrete renin
C. activate vitamin D
D. excrete necessary fluid

The approximate cardiac output required to maintain normal fluid balance is:

A. 2 L/min
B. 3.5 L/min
C. 5 L/min
D. 7 L/min

A patient with severe pulmonary edema from heart failure is most likely to have which auscultatory finding?

A. Wheezes
B. Rales
C. Pleural rub
D. Silent lungs

Severe pulmonary edema in heart failure commonly causes:

A. dysphagia
B. hemoptysis
C. dyspnea
D. stridor

Which is a major treatment option for decompensated heart failure?

A. Loop diuretic
B. Calcium channel blocker
C. Thiazide
D. Acetazolamide

Another major treatment option for decompensated heart failure is:

A. digoxin
B. atropine
C. adenosine
D. lidocaine

In a normal heart, digitalis has what effect on contractile strength?

A. Large increase always
B. Little effect
C. Marked depression
D. Stops contraction

The primary cellular effect of digitalis that improves contraction is increased intracellular:

A. potassium
B. chloride
C. magnesium
D. calcium

Digitalis increases intracellular calcium largely by inhibiting the:

A. L-type calcium channel
B. sodium-potassium ATPase
C. ryanodine receptor
D. funny current channel

Inhibition of the sodium-potassium pump by digitalis raises intracellular sodium, which then reduces activity of the:

A. sodium-calcium exchanger
B. sodium-hydrogen exchanger
C. SERCA pump
D. potassium leak channel

In the failing heart, digitalis is especially useful because the sarcoplasmic reticulum cannot:

A. form gap junctions
B. accumulate normal calcium
C. generate ATP
D. repolarize membranes

Which type of heart failure is more common?

A. Right-sided failure
B. Equal frequency
C. Left-sided failure
D. Isolated biventricular failure

Left-sided heart failure tends to increase mean pulmonary filling pressure because blood shifts from the systemic to the:

A. coronary circulation
B. pulmonary circulation
C. portal circulation
D. lymphatic system

The most important problem in left-sided heart failure is:

A. ascites
B. hepatomegaly
C. peripheral cyanosis
D. pulmonary edema

Cardiogenic shock is best defined as circulatory shock caused by:

A. systemic vasodilation
B. inadequate cardiac pumping
C. excessive renal diuresis
D. adrenal insufficiency

A major vicious-cycle feature of cardiogenic shock is that reduced blood pressure lowers:

A. cerebral venous drainage
B. coronary blood supply
C. portal vein flow
D. pulmonary venous tone

In cardiogenic shock with ventricular deterioration, the classic drug treatment is:

A. digoxin
B. mannitol
C. heparin
D. verapamil

If cardiogenic shock is associated with coronary thrombosis, which treatment may be used?

A. insulin infusion
B. methimazole
C. streptokinase or tPA
D. protamine sulfate

Another revascularization option for clot-related cardiogenic shock is:

A. valve commissurotomy
B. coronary artery bypass graft
C. carotid endarterectomy
D. pacemaker insertion

Severe acute cardiac failure often causes what change in peripheral capillary pressure?

A. Increased markedly
B. Decreased
C. Unchanged always
D. Becomes pulsus paradoxus

Which develops first in acute left-sided heart failure?

A. Peripheral edema
B. Ascites
C. Pulmonary edema
D. Anasarca

A patient with compensated heart failure feels stable at rest. Which hidden limitation still remains?

A. Increased cardiac reserves
B. Depressed cardiac reserves
C. Normal renal perfusion
D. No sympathetic tone

Which combination best fits decompensated rather than compensated heart failure?

A. Normal output, no edema
B. Full recovery, normal reserves
C. Severe edema, inadequate renal flow
D. Improved pumping, stable balance

A patient with congestive heart failure develops worsening fluid retention. Which renal-hemodynamic pattern is most expected?

A. Increased GFR, suppressed RAAS
B. Decreased GFR, activated RAAS
C. Increased GFR, reduced aldosterone
D. Normal GFR, absent SNS tone

In congestive heart failure, RAAS activation most directly increases secretion of:

A. Insulin
B. Thyroxine
C. Aldosterone
D. Glucagon

Which additional neurohumoral response commonly accompanies congestive heart failure?

A. Sympathetic activation
B. Parasympathetic dominance
C. Suppressed catecholamines
D. Decreased renin release

Atrial natriuretic peptide is released primarily when the:

A. Ventricles become ischemic
B. Atrial walls are stretched
C. Aortic valve closes
D. AV node depolarizes

ANP helps protect against congestive symptoms of heart failure by increasing renal:

A. Potassium retention
B. Glucose reabsorption
C. Salt and water excretion
D. Calcium secretion

A patient with acute pulmonary edema from left-sided heart failure receives a bedside intervention that traps blood in the veins of the limbs to reduce left-heart workload. This intervention is:

A. Intra-aortic balloon pump
B. Limb tourniquets
C. Trendelenburg positioning
D. Carotid massage

Which drug may be given in pulmonary edema specifically to increase the strength of cardiac contraction?

A. Digoxin
B. Furosemide
C. Morphine
D. Nitroglycerin

Which of the following is one of the four main treatments for pulmonary edema due to left-sided heart failure?

A. Hypertonic saline
B. Fluid bolus
C. Oxygen supplementation
D. β-blocker loading

The purpose of oxygen supplementation in pulmonary edema is best described as:

A. Raising preload rapidly, vasodilation
B. Reducing deterioration, vasodilation
C. Increasing renal sodium retention, vasodilation
D. Enhancing atrial stretch, vasodilation

Cardiac reserve is best defined as the maximum percentage by which cardiac output can increase:

A. Below normal
B. Above normal
C. During systole only
D. During diastole only

Normal cardiac reserve is approximately:

A. 50-100%
B. 100-200%
C. 300-400%
D. 500-600%

Cardiac reserve is usually how in patients with heart failure?

A. Increased
B. Unchanged
C. Diminished
D. Inverted

The best test to diagnose low cardiac reserve is an:

A. Exercise test
B. Resting spirometry
C. Tilt table test
D. EEG

A patient with low cardiac reserve is most likely to show which combination during exertion?

A. Bradycardia, edema, confusion
B. Increased heart rate, dyspnea, fatigue
C. Decreased heart rate, cyanosis, syncope
D. Normal heart rate, weakness, cough

Normal right atrial pressure is closest to:

A. 0 mmHg
B. 4 mmHg
C. 8 mmHg
D. 12 mmHg

During an acute heart attack, right atrial pressure typically:

A. Decreases below zero
B. Rises to about 4 mmHg
C. Remains fixed at zero
D. Falls with venous pooling

Decompensation in heart failure occurs because cardiac output never rises to the critical level needed to reestablish:

A. Coronary vasodilation
B. Normal AV conduction
C. Normal renal fluid excretion
D. Normal ventricular hypertrophy

After effective digitalis therapy, it takes several days for venous return to decrease because of increased:

A. Hemorrhage
B. Diuresis
C. Vasoconstriction
D. Bradycardia

Beriberi heart disease is associated with greatly increased venous return because systemic vascular resistance is:

A. Increased
B. Diminished
C. Unchanged
D. Variable only

The vitamin deficiency classically associated with beriberi heart disease is:

A. Vitamin B1
B. Vitamin B6
C. Vitamin B12
D. Vitamin C

In beriberi, despite high venous return, cardiac output may fall because the heart is:

A. Hypercontractile
B. Electrically blocked
C. Weakened
D. Severely hypertrophied

An arteriovenous fistula overloads the heart primarily because it causes excessive:

A. Afterload
B. Venous return
C. Coronary resistance
D. Atrial refractoriness

In the presence of a large arteriovenous fistula, total peripheral vascular resistance is expected to:

A. Increase
B. Stay unchanged
C. Decrease
D. Oscillate only

In an arteriovenous fistula, venous return typically:

A. Decreases
B. Increases
C. Stops
D. Normalizes

A major hemodynamic consequence of arteriovenous fistula is increased:

A. Cardiac output and right atrial pressure
B. Pulmonary resistance and wedge pressure
C. Left atrial standstill and bradycardia
D. Coronary thrombosis and afterload

A patient has a massive myocardial infarction with a sharp drop in cardiac output. Which reflex is activated by the resulting fall in arterial pressure?

A. Chemoreceptor reflex
B. Baroreceptor reflex
C. Stretch reflex
D. Bainbridge reflex

The baroreceptor reflex in severe post-MI low-output states is triggered by:

A. Diminished arterial pressure
B. Increased venous pressure
C. Elevated right atrial pressure
D. Increased pulse pressure

Within seconds after a major MI with very low cardiac output, the reflex response is to:

A. Suppress sympathetics, increase vagal tone
B. Increase both autonomic limbs
C. Stimulate sympathetics, inhibit parasympathetics
D. Inhibit sympathetics, inhibit parasympathetics

In the early compensatory response after MI, sympathetic stimulation mainly helps the surviving myocardium by:

A. Depressing normal muscle activity
B. Stimulating intact myocardium
C. Blocking AV conduction
D. Reducing coronary extraction

Increased venous tone after MI raises the:

A. Ejection fraction
B. Mean systemic filling pressure
C. Pulmonary diffusion capacity
D. Coronary sinus pressure

Raising mean systemic filling pressure has what effect on blood flow from the veins back to the heart?

A. Greatly increases it
B. Slightly decreases it
C. Abolishes it
D. Makes it pulsatile only

If cardiac output falls extremely low, roughly below 50% to 60% of normal, severe renal hypoperfusion may cause:

A. Polyuria
B. Glycosuria
C. Anuria
D. Hematuria

Renal fluid retention after MI directly causes an increase in:

A. Blood volume and venous return
B. Afterload and heart rate
C. Coronary resistance
D. Pulmonary compliance

Moderate renal fluid retention in cardiac failure increases the:

A. Mean systemic filling pressure
B. Ventricular refractory period
C. Pulmonary capillary membrane
D. Atrial conduction time

Moderate fluid retention also causes the veins to:

A. Contract
B. Distend
C. Calcify
D. Spasm

Venous distention from moderate fluid retention tends to ______ venous resistance.

A. increase
B. abolish
C. reduce
D. not change

The overall effect of moderate renal fluid retention in heart failure is to ______ venous return.

A. decrease
B. normalize instantly
C. block
D. increase

Moderate fluid retention in cardiac failure is generally:

A. beneficial
B. lethal
C. irrelevant
D. maladaptive only

In severe cardiac failure, excessive fluid retention is generally:

A. beneficial
B. neutral
C. detrimental
D. anti-edematous

During recovery after myocardial infarction, the undamaged myocardium tends to:

A. atrophy
B. hypertrophy
C. calcify
D. fibrose completely

Another adaptive change after MI is formation of new ______ blood supply around the infarct border.

A. portal
B. lymphatic
C. coronary sinus
D. collateral

Which sequence best summarizes the three stages after an acute moderate heart attack?

A. Renal retention, hypertrophy, sympathetic loss
B. Immediate damage, sympathetic compensation, chronic recovery
C. Sympathetic compensation, infarction, renal failure
D. Chronic dilation, acute recovery, vagal rebound

In compensated heart failure, maximal pumping ability of the partly recovered heart is:

A. supranormal
B. normal
C. still depressed
D. absent

In compensated heart failure, cardiac output may be normal at rest, but the right atrial pressure is usually:

A. slightly increased
B. markedly negative
C. exactly zero
D. decreased

The slightly increased right atrial pressure in compensated heart failure helps maintain:

A. coronary perfusion
B. normal cardiac output
C. normal ejection fraction
D. normal arterial oxygen

A patient with compensated heart failure becomes dyspneic with heavy exercise because:

A. RA pressure falls too low
B. the heart cannot increase pumping enough
C. the kidneys immediately fail
D. vagal tone becomes excessive

The major functional reserve reduced in compensated heart failure is the:

A. pulmonary reserve
B. renal reserve
C. cardiac reserve
D. metabolic reserve

Decompensated heart failure commonly leads to severe:

A. bradycardia and bradypnea
B. edema and death
C. hypertension and renal collapse
D. erythrocytosis and heart collapse

Which combination best fits beneficial compensation in moderate cardiac failure?

A. Moderate fluid retention, increased venous return
B. Severe edema, reduced renal flow
C. Increased vagal tone, lower contractility
D. Distended veins, higher venous resistance

In decompensated heart failure, the fundamental renal problem is failure of the heart to pump enough:

A. oxygen
B. blood
C. lymph
D. plasma

Because renal perfusion is inadequate in decompensated heart failure, the kidneys fail to:

A. filter glucose
B. excrete enough fluid
C. secrete potassium
D. retain sodium

Continued renal fluid retention in decompensated heart failure most directly causes increased:

A. blood volume and RA pressure
B. GFR and urine output
C. contractility and reserve
D. aortic pressure and EF

Heart failure that progressively worsens because compensation cannot restore adequate output is called:

A. compensated failure
B. isolated right failure
C. acute valvular failure
D. decompensated failure

Lung auscultation in decompensated heart failure commonly reveals bubbling:

A. wheezes
B. rales
C. stridor
D. rubs

A standard treatment combination for decompensated heart failure includes:

A. digoxin and diuretic
B. insulin and nitrate
C. adenosine and steroid
D. atropine and β-blocker

In this setting, digitalis is used mainly to:

A. slow renal filtration
B. strengthen cardiac pumping
C. dilate pulmonary veins
D. suppress aldosterone

Diuretics help decompensated heart failure mainly by:

A. increasing fluid retention
B. reducing edema
C. increasing SVR
D. depressing contractility

Isolated left-sided heart failure causes increased mean ______ filling pressure.

A. systemic
B. pulmonary
C. portal
D. coronary

Left-sided failure raises pulmonary filling pressure because blood backs up into the:

A. kidneys
B. systemic veins
C. lungs
D. liver

Low cardiac output from acute MI causing inadequate tissue perfusion is:

A. septic shock
B. hypovolemic shock
C. cardiogenic shock
D. neurogenic shock

Cardiogenic shock worsens progressively in part because reduced arterial pressure lowers:

A. cerebral venous return
B. coronary blood supply
C. portal resistance
D. lymphatic drainage

Reduced coronary perfusion during cardiogenic shock causes:

A. stronger contraction
B. further myocardial weakening
C. immediate renal recovery
D. pulmonary vasodilation

In cardiogenic shock with ventricular damage, a classic medication used to prevent worsening deterioration is:

A. digoxin
B. lidocaine
C. atropine
D. nitroprusside

Blood transfusion in cardiogenic shock is used mainly to increase:

A. potassium excretion and arterial pressure
B. blood and arterial pressure
C. vagal tone and arterial pressure
D. ventricular compliance and arterial pressure

Raising arterial pressure in cardiogenic shock helps by improving:

A. coronary perfusion
B. atrial depolarization
C. pulmonary compliance
D. venous capacitance

If cardiogenic shock is caused by coronary thrombosis, another treatment is:

A. clot removal
B. insulin infusion
C. dialysis
D. adenosine

In acute heart failure, aortic pressure typically ______ while right atrial pressure ______.

A. increases, decreases
B. decreases, increases
C. decreases, decreases
D. increases, increases

Over the long term, cardiac failure causes ______ peripheral capillary pressure because of renal fluid retention.

A. decreased
B. oscillating
C. increased
D. normalized

Long-term cardiac failure causes a ______ glomerular filtration rate and a ______ urine output.

A. increased, increased
B. decreased, decreased
C. increased, decreased
D. decreased, increased

One mechanism for the reduced GFR in long-term heart failure is:

A. dilation of afferent arterioles
B. increased renal venous oxygen
C. reduced arterial pressure
D. decreased aldosterone

Another mechanism contributing to reduced GFR in long-term heart failure is:

A. constriction of afferent arterioles
B. dilation of efferent arterioles only
C. increased renal plasma flow
D. reduced sympathetic tone

Sympathetic stimulation increases tubular salt and water reabsorption in part by activating:

A. beta-2 receptors
B. muscarinic receptors
C. alpha receptors
D. nicotinic receptors

Another way sympathetic activation promotes edema is by stimulating:

A. calcitonin release and beta receptors
B. renin and angiotensin II
C. ANP secretion and alpha receptors
D. NO release and angiotensin II

Sympathetic activation also promotes fluid retention by stimulating release of:

A. ADH
B. prolactin
C. glucagon
D. ANP

Atrial natriuretic peptide is released when the atrial walls become:

A. calcified
B. constricted
C. stretched
D. ischemic

ANP levels rise in severe heart failure mainly because the atria are:

A. underfilled
B. ischemic
C. stretched by pressure
D. denervated

ANP acts on the kidneys to greatly ______ excretion of salt and water.

A. decrease
B. increase
C. normalize
D. delay

ANP serves an important protective role in heart failure by helping prevent:

A. arrhythmias
B. valve calcification
C. congestive symptoms
D. myocardial rupture

Acute progressive pulmonary edema may occur in a patient with longstanding heart failure after an event that further depresses:

A. right atrial function
B. left ventricular function
C. AV nodal conduction
D. renal tubular function

In this setting, reduced blood oxygen levels in peripheral tissues trigger:

A. vasoconstriction
B. fibrinolysis
C. vasodilation
D. bradycardia

Peripheral vasodilation during acute progressive pulmonary edema tends to increase:

A. venous return
B. renal filtration
C. systemic resistance
D. coronary thrombosis

Increased venous return in this situation further raises pulmonary capillary pressure and thereby:

A. improves oxygenation
B. reduces edema formation
C. worsens pulmonary edema
D. lowers atrial pressure

This sequence of worsening hypoxemia, vasodilation, venous return, and edema represents a:

A. compensatory reflex
B. protective adaptation
C. closed-loop recovery
D. vicious cycle

A patient with longstanding heart failure develops sudden severe pulmonary edema after extreme emotional stress. Which mechanism best explains the rapid progression?

A. Hypoxemia causes vasodilation
B. ANP suppresses salt loss
C. Hyperoxia increases preload
D. ADH falls abruptly

Rapidly acting diuretics help acute progressive pulmonary edema by causing rapid:

A. sodium infusion
B. arterial vasospasm
C. fluid loss
D. platelet inhibition

Giving pure oxygen in this setting mainly helps reverse:

A. hyperkalemia
B. oxygen desaturation
C. renal ischemia
D. aldosterone release

Oxygen therapy also helps reduce further progression by countering peripheral:

A. vasodilation
B. thrombosis
C. fibrosis
D. bradycardia

A rapidly acting cardiotonic drug such as digitalis is used here primarily to:

A. lower venous tone
B. strengthen the heart
C. inhibit ANP release
D. suppress diuresis

Which of the following is one of the four major acute treatments for progressive pulmonary edema in longstanding heart failure?

A. pure oxygen
B. fluid bolus
C. beta-blocker loading
D. vasopressin infusion

In severe heart failure, atrial stretch is most directly caused by blood:

A. moving rapidly into capillaries
B. backing up from ventricles
C. bypassing the lungs
D. pooling in arteries only

Which treatment list best matches acute progressive pulmonary edema in chronic heart failure?

A. tourniquets, diuretic, oxygen, digitalis
B. insulin, dialysis, oxygen, aspirin
C. nitrates, heparin, atropine, bicarbonate
D. steroids, calcium, fluids, lidocaine

The dyspnea seen with low cardiac reserve is mainly due to:

A. excess oxygen delivery
B. insufficient tissue perfusion
C. airway obstruction
D. increased hemoglobin

Muscle fatigue in low cardiac reserve is best explained by:

A. glycogen depletion
B. muscle ischemia
C. electrolyte excess
D. increased lactate clearance

An acute myocardial infarction most immediately causes the cardiac output curve to:

A. shift upward
B. flatten only
C. disappear
D. shift downward

Renal retention of salt and water after MI increases the:

A. ejection fraction
B. mean systemic filling pressure
C. coronary resistance
D. pulmonary compliance

In decompensated heart failure, the ______ curve fails to reach the critical level.

A. venous return
B. pulmonary pressure
C. cardiac output
D. arterial oxygen

Because the cardiac output curve never reaches the critical level in decompensation, the kidneys continue to:

A. excrete excess fluid
B. retain fluid
C. normalize GFR
D. increase filtration

Continued renal retention in decompensated heart failure progressively increases the:

A. stroke volume
B. arterial compliance
C. heart rate
D. venous return curve

Treatment of decompensated heart failure with digitalis primarily causes the ______ curve to rise.

A. venous return
B. cardiac output
C. pulmonary resistance
D. renal filtration

When digitalis raises cardiac output to the critical level, the kidneys respond by:

A. retaining more sodium
B. decreasing filtration
C. eliminating more fluid
D. increasing aldosterone

An arteriovenous fistula can lead to which type of heart failure?

A. low-output
B. right-sided only
C. diastolic only
D. high-output

The mechanism of heart failure in an arteriovenous fistula is:

A. reduced contractility
B. excessive venous return
C. coronary occlusion
D. valve stenosis

In arteriovenous fistula–induced heart failure, the intrinsic pumping ability of the heart is:

A. depressed
B. absent
C. normal
D. hypercontractile

Beriberi heart disease is another cause of:

A. low-output failure
B. obstructive shock
C. restrictive cardiomyopathy
D. high-output failure

In beriberi, weakening of the heart leads to decreased blood flow to the:

A. lungs
B. brain
C. kidneys
D. liver

Reduced renal perfusion in beriberi causes the kidneys to:

A. excrete excess fluid
B. retain fluid
C. reduce sodium reabsorption
D. increase GFR