Question # 1 (Multiple Choice) Most important acute factor in changing the position of the force-velocity and ventricular function curves:

A) circulating catecholamines -- adrenal medullary release
B) reduced parasympathetic tone
C) increased adenosine release
D) increased cardiac adrenergic nerve activity

Question # 2 (Multiple Choice) Drug used in treating CHF: associated with a reversible thrombocytopenia:

A) dopamine (Intropin)
B) hydralazine (Apresoline)
C) methyldopa (Aldomet)
D) amrinone (Inocor)
E) digoxin (Lanoxin, Lanoxicaps)

Question # 3 (Multiple Answer) First-line agents used in treating congestive heart failure:

A) hydralazine (Apresoline)
B) dobutamine (Dobutrex)
C) ACE inhibitors
D) thiazide diuretics
E) calcium channel blockers

Question # 4 (Multiple Choice) Left ventricular stroke volume: relationship to afterload

A) direct
B) inverse

Question # 5 (Multiple Choice) Most important digitalis-mediated cardiac effect:

A) tachycardia
B) improved real perfusion
C) decreased AV transmission
D) shift of the force-velocity relationship upward

Question # 6 (Multiple Answer) Short-term inotropic support of the failing myocardium:

A) furosemide (Lasix)
B) diltiazem (Cardiazem)
C) dobutamine (Dobutrex)
D) milrinone (Primacor)
E) dopamine (Intropin)

Question # 7 (Multiple Answer) Exogenous agents that improve ventricular performance,

A) isoproterenol (Isuprel)
B) theophylline
C) diltiazem (Cardiazem)
D) nifedipine (Procardia, Adalat)
E) caffeine

Question # 8 (Multiple Answer) Appropriate interventions in the management of cardiogenic shock:

A) supplemental oxygen
B) surgery to repair valve pathologies or to revascularize
C) intra-aortic balloon pump
D) IV nitroglycerin

Question # 9 (Multiple Choice) Perhaps more useful in a CHF patient with marginal GFR due to poor renal perfusion:

A) dopamine (Intropin)
B) dobutamine (Dobutrex)
C) methoxamine (Vasoxyl)

Question # 10 (Multiple Choice) Less arrhythmogenic; less tachycardia

A) dopamine (Intropin)
B) dobutamine (Dobutrex)

Question # 11 (Multiple Answer) Drugs used in the management of congestive heart failure:

A) torsemide (Demadex)
B) dobutamine (Dobutrex)
C) milrinone (Primacor)
D) ramipril (Altace)
E) digoxin (Lanoxin, Lanoxicaps)

Question # 12 (Multiple Choice) Vasoconstrictors:

A) endothelin I
B) angiotensin II
C) both
D) neither

Question # 13 (Multiple Choice) Mechanism by which vasodilators improve myocardial performance in CHF:

A) increase heart rate
B) promote diuresis
C) reduce afterload
D) reduce pulmonary blood flow

Question # 14 (Multiple Answer) Physiological effects associated with acute pulmonary edema:

A) elevation of pulmonary capillary pressures
B) alveolar edema
C) rales
D) expectoration of blood-tinged fluid
E) pretibial edema

Question # 15 (Multiple Choice) Agent of choice among phosphodiesterase inhibitors for short-term parenteral support in severe heart failure patients:

A) dopamine (Intropin)
B) milrinone (Primacor)
C) dobutamine (Dobutrex)
D) IV isoproterenol (Isuprel)
E) IV epinephrine

Question # 16 (Multiple Answer) Agents which depress ventricular performance:

A) dopamine (Intropin)
B) general anesthetics
C) disopyramide (Norpace)
D) procainamide (Procan SR, Pronestyl-SR)

Question # 17 (Multiple Choice) Inhibitors and Na/K ATPase: used in management of CHF:

A) enalapril (Vasotec)
B) amrinone (Inocor)
C) dobutamine (Dobutrex)
D) digoxin (Lanoxin, Lanoxicaps)
E) minoxidil (Loniten)

Question # 18 (Multiple Choice) Effective exercise on intrathoracic blood volume:

A) increased
B) decreased
C) no effect

Question # 19 (Multiple Choice) State of neurohumoral activation in CHF:

A) highly activated
B) generally suppressed

Question # 20 (Multiple Choice) Primarily excreted in the urine; digitalis glycosides with half-life of 1.6 days:

A) digoxin (Lanoxin, Lanoxicaps)
B) digitoxin
C) both
D) neither

Question # 21 (Multiple Choice) Most significant factor in blood flow resistance

A) vessel length
B) blood viscosity
C) vessel radius

Question # 22 (Multiple Choice) Consequences of renin-angiotensin system activation:

A) reduced circulating angiotensin II
B) reduced aldosterone
C) reduced vasoconstriction
D) none of the above

Question # 23 (Multiple Answer) Physiological depressants of left ventricular function (depression of myocardial force-velocity curves)

A) hypercapnea
B) hypoxia
C) ischemia
D) acidosis
E) increased adrenal medullary epinephrine

Question # 24 (Multiple Choice) Clinical efficacy of digitalis glycosides is based on --

A) decreased transmission through the AV node
B) increased myocardial contractility
C) both
D) neither

Question # 25 (Multiple Answer) Tissue perfusion dependencies:

A) cardiac
B) vascular
C) microcirculatory
D) humoral

Question # 26 (Multiple Answer) Factors that can cause congestive heart failure:

A) systemic hypertension
B) arrhythmias
C) pulmonary emboli
D) myocardial infarction

Question # 27 (Multiple Answer) Associated with cardiac cachexia:

A) impairment of intestinal absorption
B) anorexia
C) vomiting
D) hepatomegaly
E) increased tumor necrosis factor (circulating)

Question # 28 (Multiple Choice) Atrial contraction (atrophic) is more likely to be important in:

A) the normal ventricle
B) the hypertrophic ventricle
C) no difference

Question # 29 (Multiple Choice) Most common symptom of heart failure:

A) tachycardia
B) oligouria
C) splenomegaly
D) hepatomegaly
E) dyspnea

Question # 30 (Multiple Choice) Component of digitalis responsible for Na/K ATPase binding --

A) genin or aglycone moiety
B) sugar residues
C) steroid component

Question # 31 (Multiple Choice) Increase respiratory muscle work of breathing in CHF due to:

A) interstitial pulmonary edema
B) vessel enlargement
C) both
D) neither

Question # 32 (Multiple Choice) Even in low doses does not increase renal blood flow:

A) dopamine (Intropin))
B) dobutamine (Dobutrex)

Question # 33 (Multiple Choice) Has vasodilator properties: causes a decrease in afterload as well as positive inotropism:

A) dopamine (Intropin)
B) dobutamine (Dobutrex)
C) phenylephrine (Neo-Synephrine)

Question # 34 (Multiple Choice) Beta-receptor number and congestive heart failure:

A) increased
B) decreased
C) no change

Question # 35 (Multiple Answer) Factors that promote movement of fluid into extravascular spaces:

A) hypoxic states -- precapillary arteriolar vasodilatation; postcapillary venule vasoconstriction
B) circulating toxins
C) reduced intravascular plasma protein

Question # 36 (Multiple Choice) Sudden-onset of severe shortness-of-breath and coughing -- awakening the patient

A) orthopnea
B) paroxysmal dyspnea (nocturnal)

Question # 37 (Multiple Choice) Fundamental abnormality and heart failure -- embodied in:

A) depression of the myocardial force-glossy relationship
B) abnormality in length-active muscle tension curves
C) both
D) neither

Question # 38 (Multiple Answer) Precipitating causes of congestive heart failure:

A) AV dissociation
B) severe bradycardia
C) reduce synchrony of ventricular contraction
D) tachyarrhythmias

Question # 39 (Multiple Answer) Factors influencing end-diastolic volumes:

A) volume depletion
B) body position
C) venous tone
D) skeletal muscle activity
E) uterine contraction

Question # 40 (Multiple Choice) Factor(s) affecting microvascular blood flow:

A) colloid forces
B) capillary hydrostatic pressures
C) both
D) neither

Question # 41 (Multiple Choice) Bipyridines -- phosphodiesterase inhibitors used in CHF:

A) dobutamine (Dobutrex)
B) amrinone (Inocor)
C) hydralazine (Apresoline)
D) minoxidil (Loniten)
E) furosemide (Lasix)

Question # 42 (Multiple Choice) Cardiac output is directly dependent upon:

A) peripheral vascular resistance
B) intravascular blood volume
C) heart rate alone
D) heart rate and stroke volume
E) stroke volume and peripheral vascular systems