Question bank – CVS pathophysiology and pharmacology

For Quiz 2, 2015

Hypertension
1. Primary hypertension is the most common type among hypertensive patients. True/false
2. You can also find a underlying disease for secondary hypertension. True/false
3. Secondary hypertension can be reversed by .
Treatment of underlying cause reverses hypertension

4. Malignant Hypertension is manifested by intense spasm of arteries. True/false

-Malignant – intense spasm of arteries - MEDICAL EMERGENCY

5. What are the impacts of Malignant Hypertension on eye, brain and kidney?
The eyes may show retinal hemorrhage, or exudate. A diagnosis of malignant hypertension must show a papilledema

The brain shows manifestations of increased intracranial pressure, such as headache, vomiting, subarachnoid, and
cerebral haemorrhage

The kidneys will be affected, resulting in haematuria, proteinuria, and acute renal failure

6. The clinical manifestations normally appear quite early in patients with hypertension. True/false
Unless measurement of blood pressure is taken, normally no evidence by patient of early hypertension

Shock
7. Low stroke volume can cause by what types of shock?
LOW STROKE VOLUME CAUSES Hypovolaemic shock (Hypo = under) + (volaemic = blood volume), brought on by a
sudden reduction in blood volume

8. Shock due to vasodilation can been seen in conditions such as , , and .

Septic shock- inflammation

Anaphylactic shock - Allergens

Neurogenic shock - Central nervous system damage

9. What are the Clinical manifestations of non-progressive shock?

faintness, rapid pulse, sweaty and anxious, pale with cool hands and feet, lower urine output, increased thirst,
increased respiration rate

10. In patients with progressive shock, blood pressure can be maintained. True/false
falling BP

11. In patients with irreversible shock, tachycardia may lead to cardiac arrest. True/false
tachycardia and the person may go into cardiac arrest

12. Urine output is normally reduced in patients with shock. True/false

Heart valve and conductive pathway lesions

13. Stenosis is the condition that .
Stenosis: valve will not open all the way; it is harder to force blood through it

14. Regurgitation is the condition that the .

Regurgitation: valve will not close all the way; it leaks when it should be closed
15. Please give an example of the complications of mitral valve stenosis.
Complications： palpitations, chest pain, paroxysmal nocturnal dyspnea

16. The heart murmur occurs after S2, is a typical characteristic of .

If the murmur occurs after S2, when the aortic and pulmonary valves are supposed to close, then the sound is
coming from backflow through the aortic valve, characteristic of aortic regurgitation.

17. The condition in the heart valves below is commonly caused by .

Rheumatic fever is an inflammatory disease that occurs following a streptococcal infection

18. Aortic valve stenosis can lead to decrease in systolic pressures, and in the long term angina, syncope,
dyspnoea. True/false
Significant obstruction -> decrease in Systolic pressures -> Eventually symptoms of angina, syncope, dyspnoea and
heart failure develop.

19. Aortic valve regurgitation can lead to

a. Systemic oedema
b. Pulmonary oedema
c. Angina
d. Atrial fibrillation
Incompetent aortic valve that allows blood to flow back into LV during diastole,

Increase LV end-diastolic pressures -> pulmonary oedema

20. An “artificial pacemaker” is commonly used in patient with tachycardia / bradycardia.

An “artificial pacemaker” is a small, battery-operated device that helps the heart to beat in a regular rhythm.
Implanted in patients with abnormally slow heart rates. They operate on demand i.e. only when required
21. This is a block.

22. This is a block.

Angina and MI
1. Atherosclerosis is a progressive disease characterized by of arteries caused by formation
of that harden with time leading to narrowing of the blood vessel producing a decrease/increase
in blood flow.
Atherosclerosis: Progressive disease characterized by thickening and hardening of arteries caused by formation of
fibrofatty plaques that harden with time leading to narrowing of the blood vessel producing a decrease in blood flow
2. In the atherosclerotic necrosis core, the accumulation of cholesterol crystals in the macrophages forms the
cells.
The development of an atherosclerotic plaque：Macrophages consume the lipoproteins and oxidised cholesterol
(Ox-LDL), resulting in cell death and the deposition of dead cell debris, cholesterol crystals (foam cells) and cellular
contents into a growing necrotic core

3. Angina is chest pain due to ischemia, due to .

Angina - is chest pain due to ischemia, due to a lack of oxygen to the heart muscle

4. Heart attack is when

Heart attack- when blood flow to a part of your heart is blocked for a long enough time that part of the heart muscle
is damaged or dies

5. Conduction defects are problems in

Conduction defects – problems in fibers which carry electrical signals to heart muscle

6. Heart failure is the

Heart failure – inability of the heart to supply sufficient blood flow to meet the needs of the body

7. Which of the follow are NOT the factors that can lead to ischemic injury?
a) Atherosclerosis
b) Vasospasm
c) Thrombosis
d) Cold
e) Sleep
8. Stable plaques can easily rupture or burst, leading to blood clotting inside the artery. True/false
plaques are unstable and can rupture or burst leading to blood clotting inside the artery. If a blood clot totally blocks
the artery, it stops blood flow completely. This is what happens in most heart attacks and strokes

9. Stable plaques partially block vessels. True/false

10. Stable angina is due to increase in .

Stable Angina–Pain when heart’s oxygen demand increases e.g. exercise

11. Unstable angina can occur at with sudden onset of pain

Unstable angina can occur at rest with sudden onset of pain. Unpredictable course, frequency and duration of pain –
usual indicator of atherosclerotic plaque

12. Silent myocardial ischemia is a type of myocardial ischemia .

Silent myocardial ischemia–Myocardial ischemia without pain–Could be due to defects in pain threshold or pain
transmission or autonomic neuropathy causing sensory loss

13. Variant/Prinzmetal angina is due to .

Variant or Vasospastic Angina (Prinzmetal angina)–Due to vasospasm

14. Ischaemia is a restriction in blood supply to tissues, causing a shortage of and

needed for cellular metabolism.
Ischaemia is a restriction in blood supply to tissues, causing a shortage of oxygen and glucose needed for cellular
metabolism

15. Infarction is due to .

Infarction is cell death due to prolonged starvation of oxygen
16. What’s the typical pain pattern in a patient with MI? What’s the typical ECG shape for such patient?
Acute Myocardial Infarction：Chest pain - Severe, crushing, constrictive, OR like heartburn

In a NSTEMI, the blood clot only partly occludes the artery, and as a result only a portion of the heart muscle being
supplied by the affected artery dies. This means that in a NSTEMI, the artery is only partially blocked.

In contrast to the more severe form of heart attack (the STEMI), produce characteristic elevation in the "ST segment"
portion of the ECG. ST segment elevation (STEMI) indicates that a relatively large amount of heart muscle damage is
occurring, because the coronary artery is totally blocked.

17. Which of the following tests would provide biochemical evidence of myocardial necrosis?
(1) Troponin, (2) Creatine kinase myocardial band (CK-MB), (3) Cholesterol, (4) LDL .
a. 1 only
b. 2 and 3
c. 1 and 4
d. 1 and 2
Serum markers – creatine kinase (CK-MB), troponin, lactic dehydrogenase (LDH), aspartate aminotransferase (AST)

18. Dilated cardiomyopathy is a condition in which the heart becomes without any obvious
cause and hence cannot .
Dilated cardiomyopathies - a condition in which the heart becomes weakened and enlarged without any obvious
cause and hence cannot pump blood efficiently.

19. What are the possible causes (CVS disorders) of dilated cardiomyopathies? Please list 3.
Other possible causes are coronary heart disease, heart attack, hypertension

20. Hypertrophic cardiomyopathy is .

Hypertrophic cardiomyopathies (genetic disorder) – A disease in which a portion of the myocardium is hypertrophied
(thickened) without any obvious cause e.g. sudden death in young athletes

21. Restrictive cardiomyopathy is due to abnormally walls and ventricles lack as they fill
with blood
Restrictive cardiomyopathies - abnormally rigid walls and ventricles lack the flexibility to expand as they fill with
blood.

Heart failure
22. Heart failure denotes
Heart Failure denotes the failure of the heart to pump enough blood to meet the metabolic needs of the body.

23. In patients with Class I heart failure, the physical activities are limited. True/false
Heart failure classified into 4 classes based on level of patient activity: Class I – Patient with heart disease but with no
limitations in physical activity

24. Usually the left heart failure can cause pulmonary edema. True/false
Left heart failure – inability of heart to pump oxygenated blood into arterial circulation leading to decrease in
peripheral blood flow and accumulation of blood in pulmonary circulation (congestive heart failure and pulmonary
edema)

25. Usually the right heart failure can cause systemic edema. True/false
Right heart failure - inability of heart to pump blood through the pulmonary circulation with engorgement of the
systemic and hepatic venous systems i.e. systemic oedema
26. Productive cough with pink frothy sputum is usually observed in patients with left/right heart failure.
Left heart failure –Dyspnea/Productive cough with pink frothy sputum/Wheezes/Clammy and cold skin

27. Low output heart failure is caused by heart failure and characterised by skins.
Low output failure caused by disorders that impair pumping ability of heart and characterised by systemic
vasoconstriction with cold, pale and sometimes cyanotic extremities

28. Urine output is normally ↑/ due to low cardiac output in patients with heart failure. This is normally
due to ↑/ ADH release from the posterior pituitary.
Posterior pituitary releases ADH which causes reabsorption of water from collecting ducts in kidney

29. Right heart failure usually occurs as a result of left heart failure. True/false
Usually the left side is affected first, Right Heart Failure Usually occurs as a result of left heart failure

30. Please list 3 manifestations of left heart failure.

Left heart failure –Dyspnea/Productive cough with pink frothy sputum/Wheezes/Clammy and cold skin

Treatment of Angina and Myocardial Infarction

β1-receptors mainly heart and kidney. β1 stimulation will increase HR, contractility and renin release

β2 -receptors mainly lung, liver, pancreas, arteriolar SMC.

Stimulation causes bronchodilation and vasodilation

31. What are the mechanisms of organic nitrates?

treatment of angina and promotes redistribution of coronary blood flow towards ischaemic areas via collaterals

* Enzymatic reduction of organic nitrates produces nitric oxide

* Nitric oxide facilitate SMC relaxation in the vascular wall via:

32. What are the commonly seen side effects of organic nitrates?
Main side-effects: postural hypotension and headache

33. Aspirin inhibits irreversibly and blocks conversion of to .

Aspirin Inhibits COX-1 irreversibly

Prevents conversion of arachidonic acid (AA) to thromboxane A2

34. Clopidogrel blocks induced .

Clopidogrel (and ticlopidine) Irreversibly blocks ADP receptors on platelets, thus preventing platelet activation and
conformational change in GpIIb/IIIa receptors

35. Tirofiban blocks receptor for which forms bridges between platelets
Abciximab, eptifibatide, and tirofiban Blocks receptor for fibrinogen which forms bridges between platelets

36. Heparin inhibits to prevent activation of .

37. Fibrinolytic drugs converts to which breaks fibrin threads, which is associated
with the risk of bleeding.
Converts plasminogen to PLASMIN which breaks fibrin threads

38. are the first-line therapy option for patients with stable angina. If it is ineffective, it can be
combined with or .
Nitrates are the first-line therapy option, β-adrenoceptor blockers or Ca+2 channel blockers taken

in combination with nitrates

39. Please describe the mechanisms of the treatment options for patients with acute coronary syndromes
(MI)
• Oxygen -
• Opioids -
• Anti-platelets, antithrombins and thrombolytics -
• β-Adrenoceptor blockers/ACE Inhibitors –
40. Percutaneous coronary intervention is performed within upon patient presentation.
Performed within 90 minutes upon patient presentation

Antihypertensive drugs
41. Which is the most commonly prescribed ‘first-line’ therapy in younger (under 55 year old) patients with
hypertension?
a. alpha 2 receptor agonists
b. calcium channel blockers
c. beta blockers
d. ACE inhibitors
e. loop diuretics
(ACE) angiotensin converting enzyme

42. A stepped approach, in which new medication is added to current therapy until the target blood pressure
is achieved, has the advantage of
a. reducing the cost of therapy
b. minimising adverse events and increasing patient compliance
c. providing more rapid control of blood pressure
d. increasing morbidity
e. preventing dry cough

43. Which ONE of the following effects CANNOT be attributed to angiotensin II?
a. vasodilation
b. salt retention
c. stimulation of aldosterone release from the adrenal glands
d. hypertrophy
e. hyperplasia
angiotensin：a protein whose presence in the blood promotes aldosterone secretion and tends to raise blood
pressure 血管收缩素

44. Release of renin from the granular cells in the kidney in response to a fall in blood pressure results in?
a. the conversion of angiotensinogen to angiotensin I
b. the conversion of angiotensin I to angiotensin II
c. conversion of angiotensin II to angiotensin I
d. inhibition of angiotensin II
e. inhibition of ACE

renin：an enzyme secreted by and stored in the kidneys which promotes the production of angiotensin
45. Which ONE of the following drugs would be the safest to use to treat hypertension in pregnancy?
a. captopril
b. losartan
c. methyldopa
d. ramipril
e. candesartan

Centrally-Acting Agents – methyldopa - Main use is in the treatment of hypertension of pregnancy

ACE Inhibitors – pril - Contraindications: Pregnancy - foetal toxicity

Angiotensin II Receptor Antagonists – sartan - Contraindications: Pregnancy

46. For which class of antihypertensive drugs are the following adverse effects most common? Flushing and
ankle oedema (due to vasodilation) and constipation (due to effects on GIT nerves and smooth muscle).
a. beta blockers
b. calcium channel blockers
c. ACE inhibitors
d. angiotensin II receptor antagonists
e. thiazide diuretics

Calcium Channel Blockers –Adverse Reactions - Flushing, headache and ankle oedema due to vasodilation

47. Which of the following statements is INCORRECT regarding angiotensin converting enzyme (ACE)
a. ACE is present in the lungs
b. ACE is inhibited by captopril
c. ACE is inhibited by losartan
d. ACE converts angiotensin I to angiotensin II
e. ACE degrades bradykinin
‘prils’ competitively inhibit the actions of angiotensin converting enzyme (ACE) in RAAS system

ACE Inhibitors - Adverse reactions: dry cough - accumulation of bradykinin (degradation via ACE)

48. What would be the recommended treatment for a patient with systolic blood pressure of 185 mm Hg,
diastolic blood pressure of 115 mm Hg, a low cardiovascular risk (<10% risk) and no evidence of
end organ damage? (Grade 3 hypertension)
a. lifestyle changes and assess in 6 months
b. lifestyle changes and assess in 12 months
c. start an antihypertensive immediately
d. lifestyle changes and assess in 2 years
e. lifestyle changes and assess in 3 years

Start antihypertensives immediately in conjunction with lifestyle changes

49. Which of the following can induce/aggravate hypertension?

(1) pseudoephedrine (2) monoamine oxidase inhibitors (3) excessive salt intake (4) nifedipine [5] cocaine
a. 1 and 2 only
b. 1 and 3 only
c. 1, 2 and 3 only
d. 1, 2, 3, and 4
e. 1, 2, 3 and 5

Calcium Channel Blockers – dipine

50. An elderly patient (70 years old) was given a thiazide diuretic for the treatment of hypertension. After 6
weeks the doctor decided a second drug was required to reduce her blood pressure to the target level.
Which one of the following drugs would be the most likely to be used if there were no other
complications?
 a. an ACE inhibitor
b. a calcium channel blocker
c. a beta blocker
d. a direct acting vasodilator
e. a loop diuretic

thiazide: drugs that increase the excretion of sodium and chloride and are used as diuretics and to assist in lowering
the blood pressure - Commonly the first line treatment in mild-moderate

hypertension in elderly patients

β-Adrenoceptor Antagonists: used if there is an additional indication eg. angina, heart failure

Calcium Channel Blockers – dipine: benefit in the elderly patient with systolic hypertension

Treatment of Heart Failure

51. Activation of the renin-angiotensin-aldosterone system (RAAS) in heart failure can be reduced by
which of the following drugs
a. ACE inhibitors
b. angiotensin receptor blockers
c. aspirin
d. diuretics
e. both A or B

52. Which ONE of the following statements is FALSE regarding the major cardiac effects of digoxin?
Digoxin:
a. inhibits the Na+/K+ ATPase pump
b. increases the force of contraction of the heart
c. is a cardiac glycoside （Many drugs derived from plants are glycosides ）
d. increases intracellular calcium levels
 e. decreases cardiac output

digoxin: used in small doses as a cardiac stimulant

53. Which class of drugs is used in the treatment of angina and promotes redistribution of coronary blood
flow towards ischaemic areas via collaterals?
a. organic nitrates
b. calcium channel blockers
c. ACE inhibitors
d. cardiac glycosides
e. beta-blockers