front 1 A patient develops acute moderate cardiac failure after myocardial injury. Which immediate hemodynamic pattern is most expected? A. Increased output, venous unloading | back 1 B. Decreased output, venous damming |
front 2 Early compensation for acute heart failure by the sympathetic nervous system produces which two major responses? A. Increased contractility, vasoconstriction | back 2 A. Increased contractility, vasoconstriction |
front 3 Which reflex is one of the major mechanisms that strongly stimulates sympathetic activity in acute heart failure? A. Bainbridge reflex | back 3 C. Baroreceptor reflex |
front 4 Which additional mechanism can strongly activate the sympathetic nervous system in worsening heart failure? A. Chemoreceptor reflex | back 4 A. Chemoreceptor reflex |
front 5 Severe circulatory compromise from heart failure can activate which powerful sympathetic response? A. Bezold-Jarisch reflex | back 5 B. CNS ischemic response |
front 6 In chronic heart failure, reduced cardiac output and blood pressure cause the kidneys to retain: A. bicarbonate and calcium | back 6 C. sodium and water |
front 7 Moderate fluid retention in chronic heart failure can be: A. always harmful | back 7 B. beneficial |
front 8 Excess fluid retention in heart failure can directly cause all of the following except: A. pulmonary edema | back 8 D. improved cardiac reserve |
front 9 Excessive ventricular stretching from fluid retention tends to: A. strengthen the myocardium | back 9 C. weaken the heart |
front 10 In compensated heart failure, which statement is most accurate? A. Pumping returns fully normal, reserves reduced | back 10 C. Output remains depressed, reserves reduced |
front 11 Which best defines decompensated heart failure? A. Normal output restored by SNS | back 11 B. No compensation can normalize output |
front 12 Decompensated heart failure can become fatal largely because the kidneys receive insufficient blood flow to: A. filter proteins | back 12 D. excrete necessary fluid |
front 13 The approximate cardiac output required to maintain normal fluid balance is: A. 2 L/min | back 13 C. 5 L/min |
front 14 A patient with severe pulmonary edema from heart failure is most likely to have which auscultatory finding? A. Wheezes | back 14 B. Rales |
front 15 Severe pulmonary edema in heart failure commonly causes: A. dysphagia | back 15 C. dyspnea |
front 16 Which is a major treatment option for decompensated heart failure? A. Loop diuretic | back 16 A. Loop diuretic |
front 17 Another major treatment option for decompensated heart failure is: A. digoxin | back 17 A. digoxin |
front 18 In a normal heart, digitalis has what effect on contractile strength? A. Large increase always | back 18 B. Little effect |
front 19 In chronic heart failure, digitalis may increase myocardial contractile strength by approximately: A. 10-20% | back 19 C. 50-100% |
front 20 The primary cellular effect of digitalis that improves contraction is increased intracellular: A. potassium | back 20 D. calcium |
front 21 Digitalis increases intracellular calcium largely by inhibiting the: A. L-type calcium channel | back 21 B. sodium-potassium ATPase |
front 22 Inhibition of the sodium-potassium pump by digitalis raises intracellular sodium, which then reduces activity of the: A. sodium-calcium exchanger | back 22 A. sodium-calcium exchanger |
front 23 In the failing heart, digitalis is especially useful because the sarcoplasmic reticulum cannot: A. form gap junctions | back 23 B. accumulate normal calcium |
front 24 Which type of heart failure is more common? A. Right-sided failure | back 24 C. Left-sided failure |
front 25 Left-sided heart failure tends to increase mean pulmonary filling pressure because blood shifts from the systemic to the: A. coronary circulation | back 25 B. pulmonary circulation |
front 26 The most important problem in left-sided heart failure is: A. ascites | back 26 D. pulmonary edema |
front 27 Cardiogenic shock is best defined as circulatory shock caused by: A. systemic vasodilation | back 27 B. inadequate cardiac pumping |
front 28 A major vicious-cycle feature of cardiogenic shock is that reduced blood pressure lowers: A. cerebral venous drainage | back 28 B. coronary blood supply |
front 29 In cardiogenic shock with ventricular deterioration, the classic drug treatment is: A. digoxin | back 29 A. digoxin |
front 30 If cardiogenic shock is associated with coronary thrombosis, which treatment may be used? A. insulin infusion | back 30 C. streptokinase or tPA |
front 31 Another revascularization option for clot-related cardiogenic shock is: A. valve commissurotomy | back 31 B. coronary artery bypass graft |
front 32 Severe acute cardiac failure often causes what change in peripheral capillary pressure? A. Increased markedly | back 32 B. Decreased it is decreased at first bc of sympathetic constriction, will increase down the road and cause that edema |
front 33 Which develops first in acute left-sided heart failure? A. Peripheral edema | back 33 C. Pulmonary edema |
front 34 A patient with compensated heart failure feels stable at rest. Which hidden limitation still remains? A. Increased cardiac reserves | back 34 B. Depressed cardiac reserves |
front 35 Which combination best fits decompensated rather than compensated heart failure? A. Normal output, no edema | back 35 C. Severe edema, inadequate renal flow |
front 36 A patient with congestive heart failure develops worsening fluid retention. Which renal-hemodynamic pattern is most expected? A. Increased GFR, suppressed RAAS | back 36 B. Decreased GFR, activated RAAS |
front 37 In congestive heart failure, RAAS activation most directly increases secretion of: A. Insulin | back 37 C. Aldosterone |
front 38 Which additional neurohumoral response commonly accompanies congestive heart failure? A. Sympathetic activation | back 38 A. Sympathetic activation |
front 39 Atrial natriuretic peptide is released primarily when the: A. Ventricles become ischemic | back 39 B. Atrial walls are stretched |
front 40 ANP helps protect against congestive symptoms of heart failure by increasing renal: A. Potassium retention | back 40 C. Salt and water excretion |
front 41 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 | back 41 B. Limb tourniquets |
front 42 Which drug may be given in pulmonary edema specifically to increase the strength of cardiac contraction? A. Digoxin | back 42 A. Digoxin |
front 43 Which of the following is one of the four main treatments for pulmonary edema due to left-sided heart failure? A. Hypertonic saline | back 43 C. Oxygen supplementation |
front 44 The purpose of oxygen supplementation in pulmonary edema is best described as: A. Raising preload rapidly, vasodilation | back 44 B. Reducing deterioration, vasodilation |
front 45 Cardiac reserve is best defined as the maximum percentage by which cardiac output can increase: A. Below normal | back 45 B. Above normal |
front 46 Normal cardiac reserve is approximately: A. 50-100% | back 46 C. 300-400% |
front 47 Cardiac reserve is usually how in patients with heart failure? A. Increased | back 47 C. Diminished |
front 48 The best test to diagnose low cardiac reserve is an: A. Exercise test | back 48 A. Exercise test |
front 49 A patient with low cardiac reserve is most likely to show which combination during exertion? A. Bradycardia, edema, confusion | back 49 B. Increased heart rate, dyspnea, fatigue |
front 50 Normal cardiac output is closest to: A. 2 L/min | back 50 C. 5 L/min |
front 51 Normal right atrial pressure is closest to: A. 0 mmHg | back 51 A. 0 mmHg |
front 52 During an acute heart attack, right atrial pressure typically: A. Decreases below zero | back 52 B. Rises to about 4 mmHg |
front 53 Decompensation in heart failure occurs because cardiac output never rises to the critical level needed to reestablish: A. Coronary vasodilation | back 53 C. Normal renal fluid excretion |
front 54 After effective digitalis therapy, it takes several days for venous return to decrease because of increased: A. Hemorrhage | back 54 B. Diuresis |
front 55 Beriberi heart disease is associated with greatly increased venous return because systemic vascular resistance is: A. Increased | back 55 B. Diminished |
front 56 The vitamin deficiency classically associated with beriberi heart disease is: A. Vitamin B1 | back 56 A. Vitamin B1 |
front 57 In beriberi, despite high venous return, cardiac output may fall because the heart is: A. Hypercontractile | back 57 C. Weakened |
front 58 An arteriovenous fistula overloads the heart primarily because it causes excessive: A. Afterload | back 58 B. Venous return |
front 59 In the presence of a large arteriovenous fistula, total peripheral vascular resistance is expected to: A. Increase | back 59 C. Decrease |
front 60 In an arteriovenous fistula, venous return typically: A. Decreases | back 60 B. Increases |
front 61 A major hemodynamic consequence of arteriovenous fistula is increased: A. Cardiac output and right atrial pressure | back 61 A. Cardiac output and right atrial pressure |
front 62 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 | back 62 B. Baroreceptor reflex |
front 63 The baroreceptor reflex in severe post-MI low-output states is triggered by: A. Diminished arterial pressure | back 63 A. Diminished arterial pressure |
front 64 Within seconds after a major MI with very low cardiac output, the reflex response is to: A. Suppress sympathetics, increase vagal tone | back 64 C. Stimulate sympathetics, inhibit parasympathetics |
front 65 In the early compensatory response after MI, sympathetic stimulation mainly helps the surviving myocardium by: A. Depressing normal muscle activity | back 65 B. Stimulating intact myocardium |
front 66 Increased venous tone after MI raises the: A. Ejection fraction | back 66 B. Mean systemic filling pressure |
front 67 Raising mean systemic filling pressure has what effect on blood flow from the veins back to the heart? A. Greatly increases it | back 67 A. Greatly increases it |
front 68 If cardiac output falls extremely low, roughly below 50% to 60% of normal, severe renal hypoperfusion may cause: A. Polyuria | back 68 C. Anuria |
front 69 Renal fluid retention after MI directly causes an increase in: A. Blood volume and venous return | back 69 A. Blood volume and venous return |
front 70 Moderate renal fluid retention in cardiac failure increases the: A. Mean systemic filling pressure | back 70 A. Mean systemic filling pressure |
front 71 Moderate fluid retention also causes the veins to: A. Contract | back 71 B. Distend |
front 72 Venous distention from moderate fluid retention tends to ______ venous resistance. A. increase | back 72 C. reduce Simple idea:
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front 73 The overall effect of moderate renal fluid retention in heart failure is to ______ venous return. A. decrease | back 73 D. increase |
front 74 Moderate fluid retention in cardiac failure is generally: A. beneficial | back 74 A. beneficial |
front 75 In severe cardiac failure, excessive fluid retention is generally: A. beneficial | back 75 C. detrimental |
front 76 During recovery after myocardial infarction, the undamaged myocardium tends to: A. atrophy | back 76 B. hypertrophy |
front 77 Another adaptive change after MI is formation of new ______ blood supply around the infarct border. A. portal | back 77 D. collateral |
front 78 Which sequence best summarizes the three stages after an acute moderate heart attack? A. Renal retention, hypertrophy, sympathetic loss | back 78 B. Immediate damage, sympathetic compensation, chronic recovery |
front 79 In compensated heart failure, maximal pumping ability of the partly recovered heart is: A. supranormal | back 79 C. still depressed |
front 80 In compensated heart failure, cardiac output may be normal at rest, but the right atrial pressure is usually: A. slightly increased | back 80 A. slightly increased |
front 81 The slightly increased right atrial pressure in compensated heart failure helps maintain: A. coronary perfusion | back 81 B. normal cardiac output |
front 82 A patient with compensated heart failure becomes dyspneic with heavy exercise because: A. RA pressure falls too low | back 82 B. the heart cannot increase pumping enough |
front 83 The major functional reserve reduced in compensated heart failure is the: A. pulmonary reserve | back 83 C. cardiac reserve |
front 84 Decompensated heart failure commonly leads to severe: A. bradycardia and bradypnea | back 84 B. edema and death |
front 85 Which combination best fits beneficial compensation in moderate cardiac failure? A. Moderate fluid retention, increased venous return | back 85 A. Moderate fluid retention, increased venous return |
front 86 In decompensated heart failure, the fundamental renal problem is failure of the heart to pump enough: A. oxygen | back 86 B. blood |
front 87 Because renal perfusion is inadequate in decompensated heart failure, the kidneys fail to: A. filter glucose | back 87 B. excrete enough fluid |
front 88 Continued renal fluid retention in decompensated heart failure most directly causes increased: A. blood volume and RA pressure | back 88 A. blood volume and RA pressure |
front 89 Heart failure that progressively worsens because compensation cannot restore adequate output is called: A. compensated failure | back 89 D. decompensated failure |
front 90 A classic clinical feature of decompensated heart failure is progressive: A. edema | back 90 A. edema |
front 91 Lung auscultation in decompensated heart failure commonly reveals bubbling: A. wheezes | back 91 B. rales |
front 92 A standard treatment combination for decompensated heart failure includes: A. digoxin and diuretic | back 92 A. digoxin and diuretic |
front 93 In this setting, digitalis is used mainly to: A. slow renal filtration | back 93 B. strengthen cardiac pumping |
front 94 Diuretics help decompensated heart failure mainly by: A. increasing fluid retention | back 94 B. reducing edema |
front 95 Isolated left-sided heart failure causes increased mean ______ filling pressure. A. systemic | back 95 B. pulmonary |
front 96 Left-sided failure raises pulmonary filling pressure because blood backs up into the: A. kidneys | back 96 C. lungs |
front 97 Low cardiac output from acute MI causing inadequate tissue perfusion is: A. septic shock | back 97 C. cardiogenic shock |
front 98 Cardiogenic shock worsens progressively in part because reduced arterial pressure lowers: A. cerebral venous return | back 98 B. coronary blood supply |
front 99 Reduced coronary perfusion during cardiogenic shock causes: A. stronger contraction | back 99 B. further myocardial weakening |
front 100 In a healthy heart, cardiac deterioration begins at ______ coronary arterial pressures than in a heart with major coronary blockage. A. higher | back 100 D. lower |
front 101 In a heart with major coronary vessel blockage, deterioration may begin when coronary pressure falls to about: A. 20–30 mm Hg | back 101 C. 80–90 mm Hg |
front 102 In cardiogenic shock with ventricular damage, a classic medication used to prevent worsening deterioration is: A. digoxin | back 102 A. digoxin |
front 103 Blood transfusion in cardiogenic shock is used mainly to increase: A. potassium excretion and arterial pressure | back 103 B. blood and arterial pressure |
front 104 Raising arterial pressure in cardiogenic shock helps by improving: A. coronary perfusion | back 104 A. coronary perfusion |
front 105 If cardiogenic shock is caused by coronary thrombosis, another treatment is: A. clot removal | back 105 A. clot removal |
front 106 In acute heart failure, aortic pressure typically ______ while right atrial pressure ______. A. increases, decreases | back 106 B. decreases, increases |
front 107 Over the long term, cardiac failure causes ______ peripheral capillary pressure because of renal fluid retention. A. decreased | back 107 C. increased |
front 108 Long-term cardiac failure causes a ______ glomerular filtration rate and a ______ urine output. A. increased, increased | back 108 B. decreased, decreased |
front 109 One mechanism for the reduced GFR in long-term heart failure is: A. dilation of afferent arterioles | back 109 C. reduced arterial pressure |
front 110 Another mechanism contributing to reduced GFR in long-term heart failure is: A. constriction of afferent arterioles | back 110 A. constriction of afferent arterioles |
front 111 In long-term cardiac failure, reduced renal perfusion commonly causes activation of the: A. kallikrein-kinin system | back 111 B. renin-angiotensin system |
front 112 Activation of the renin-angiotensin system in long-term heart failure promotes increased renal reabsorption of: A. glucose and phosphate | back 112 C. water and salt |
front 113 Long-term heart failure often causes increased secretion of: A. cortisol | back 113 B. aldosterone |
front 114 Increased aldosterone contributes to peripheral edema primarily because sodium retention secondarily increases: A. bicarbonate loss | back 114 C. water retention |
front 115 Long-term cardiac failure is associated with ______ of the sympathetic nervous system. A. activation | back 115 A. activation |
front 116 Sympathetic stimulation increases tubular salt and water reabsorption in part by activating: A. beta-2 receptors | back 116 C. alpha receptors |
front 117 Another way sympathetic activation promotes edema is by stimulating: A. calcitonin release and beta receptors | back 117 B. renin and angiotensin II |
front 118 Sympathetic activation also promotes fluid retention by stimulating release of: A. ADH | back 118 A. ADH |
front 119 Atrial natriuretic peptide is released when the atrial walls become: A. calcified | back 119 C. stretched |
front 120 ANP levels rise in severe heart failure mainly because the atria are: A. underfilled | back 120 C. stretched by pressure |
front 121 ANP acts on the kidneys to greatly ______ excretion of salt and water. A. decrease | back 121 B. increase |
front 122 ANP serves an important protective role in heart failure by helping prevent: A. arrhythmias | back 122 C. congestive symptoms |
front 123 Acute progressive pulmonary edema may occur in a patient with longstanding heart failure after an event that further depresses: A. right atrial function | back 123 B. left ventricular function |
front 124 In this setting, reduced blood oxygen levels in peripheral tissues trigger: A. vasoconstriction | back 124 C. vasodilation |
front 125 Peripheral vasodilation during acute progressive pulmonary edema tends to increase: A. venous return | back 125 A. venous return |
front 126 Increased venous return in this situation further raises pulmonary capillary pressure and thereby: A. improves oxygenation | back 126 C. worsens pulmonary edema |
front 127 This sequence of worsening hypoxemia, vasodilation, venous return, and edema represents a: A. compensatory reflex | back 127 D. vicious cycle |
front 128 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 | back 128 A. Hypoxemia causes vasodilation |
front 129 An emergency bedside maneuver to reduce left-heart workload in acute pulmonary edema is: A. carotid massage | back 129 B. limb tourniquets |
front 130 Rapidly acting diuretics help acute progressive pulmonary edema by causing rapid: A. sodium infusion | back 130 C. fluid loss |
front 131 Giving pure oxygen in this setting mainly helps reverse: A. hyperkalemia | back 131 B. oxygen desaturation |
front 132 Oxygen therapy also helps reduce further progression by countering peripheral: A. vasodilation | back 132 A. vasodilation |
front 133 A rapidly acting cardiotonic drug such as digitalis is used here primarily to: A. lower venous tone | back 133 B. strengthen the heart |
front 134 Which of the following is one of the four major acute treatments for progressive pulmonary edema in longstanding heart failure? A. pure oxygen | back 134 A. pure oxygen |
front 135 Which mechanism does not promote edema in long-term heart failure? A. increased aldosterone | back 135 B. ANP-mediated natriuresis |
front 136 In severe heart failure, atrial stretch is most directly caused by blood: A. moving rapidly into capillaries | back 136 B. backing up from ventricles |
front 137 Which treatment list best matches acute progressive pulmonary edema in chronic heart failure? A. tourniquets, diuretic, oxygen, digitalis | back 137 A. tourniquets, diuretic, oxygen, digitalis |
front 138 The dyspnea seen with low cardiac reserve is mainly due to: A. excess oxygen delivery | back 138 B. insufficient tissue perfusion |
front 139 Muscle fatigue in low cardiac reserve is best explained by: A. glycogen depletion | back 139 B. muscle ischemia |
front 140 An acute myocardial infarction most immediately causes the cardiac output curve to: A. shift upward | back 140 D. shift downward |
front 141 Within approximately how many seconds after MI do sympathetic reflexes become very active? A. 5 seconds | back 141 D. 30 seconds |
front 142 Renal retention of salt and water after MI increases the: A. ejection fraction | back 142 B. mean systemic filling pressure |
front 143 In decompensated heart failure, the ______ curve fails to reach the critical level. A. venous return | back 143 C. cardiac output |
front 144 Because the cardiac output curve never reaches the critical level in decompensation, the kidneys continue to: A. excrete excess fluid | back 144 B. retain fluid |
front 145 Continued renal retention in decompensated heart failure progressively increases the: A. stroke volume | back 145 C. heart rate |
front 146 Treatment of decompensated heart failure with digitalis primarily causes the ______ curve to rise. A. venous return | back 146 B. cardiac output |
front 147 When digitalis raises cardiac output to the critical level, the kidneys respond by: A. retaining more sodium | back 147 C. eliminating more fluid |
front 148 An arteriovenous fistula can lead to which type of heart failure? A. low-output | back 148 D. high-output |
front 149 The mechanism of heart failure in an arteriovenous fistula is: A. reduced contractility | back 149 B. excessive venous return |
front 150 In arteriovenous fistula–induced heart failure, the intrinsic pumping ability of the heart is: A. depressed | back 150 C. normal |
front 151 Beriberi heart disease is another cause of: A. low-output failure | back 151 D. high-output failure |
front 152 In beriberi, weakening of the heart leads to decreased blood flow to the: A. lungs | back 152 C. kidneys |
front 153 Reduced renal perfusion in beriberi causes the kidneys to: A. excrete excess fluid | back 153 B. retain fluid |
front 154 Fluid retention in beriberi contributes to an increase in: A. venous return | back 154 A. venous return |