Cardio:

ANATOMY
1. If the right coronary artery supplies the inferior portion of the left ventricle via
the posterior descending artery, is the heart right or left dominant? (p. 280)
_____________________________
2. A patient has a myocardial infarction that damages the anterior
interventricular septum and the apex. Which coronary artery is occluded? (p.
280) ______________________________________
3. The posterior descending artery arises from the circumflex artery in _____
(20%/50%/80%) of cases. Is this heart right or left dominant? (p. 280)
______________________________________
4. Enlargement of the left atrium can compress the recurrent laryngeal nerve to
cause ____________ or the esophageal nerve to cause __________. (p. 280)
PHYSIOLOGY
5. Cardiac output = heart rate x _______________. (p. 280)
6. With an increase in stroke volume, the heart would be expected to increase
(decrease/increase) in preload, to decrease (decrease/increase) in afterload, and
to increase (decrease/increase) in contractility. (p. 281)
7. A 60-year-old man mistakenly receives triple the amount of maintenance
intravenous fluids for 24 hours. Would his preload increase or decrease? (p. 281)
_________________________________
8. The cardiac ejection fraction is normally greater than what percentage of the
total end-diastolic volume? (p. 282)
________________________________________________________________
9. Which blood vessels account for most of total peripheral resistance? (p. 282)
______________________________________________________________________________
10. Which parameter does the viscosity of blood mostly depend on? (p. 282)
______________________________________________________________________________
11. A 23-year-old man has significant blood loss after a motor vehicle accident. A
decrease in blood volume leads to _______________ (increased/decreased) right
atrial pressure and to _______________ (increased/decreased) cardiac output. (p.
282)
12. A 76-year-old man with congestive heart failure is given digoxin as a positive
inotrope. An increase in inotropy leads to _______________ (increased/decreased)
cardiac output and to _______________ (increased/decreased) right atrial pressure.
(p. 282)
13. A 10-year-old boy presents with dehydration following acute diarrhea. He
receives 2 L of normal saline. An increase in blood volume leads to
_________________________ (increased/decreased) right atrial pressure and to
__________________________ (increased/decreased) cardiac output. (p. 282)

14. On auscultation of a patient with an atrial septal defect during inspiration,

does the time between pulmonic and aortic valvular closure increase, decrease,
or stay the same? __________________
(p.283)_________________________________________________________________________
15. During physical examination, what diagnostic sign might be observed in the
neck of a patient with right heart failure? (p. 283)
_________________________________________________________
16. In normal splitting of the S2 heart sound, the pulmonic valve closes later
during inspiration due to _______________ (increased/decreased) blood flow in
lungs, and the aortic valve closes earlier during inspiration due to _______________
(increased/decreased) venous return to the left heart. (p. 283)
17. Fill in the blanks A-D with the correct valvular event that occurs at each stage
of the left ventricular cardiac cycle. Then fill in the blanks 1-5 with the correct
phase of the left ventricular cardiac cycle. (p. 283)
A. MV closes 1. Isovolumetric contraction
B. AV opens 2. Systolic ejection
C. AV closes 3. Isovolumetric relaxation
D. MV opens 4. Rapid filling
5.Reduced filling
18. Fill in the blanks A-N with the correct heart sound, jugular venous pulse
waveform, or ECG waveform. Specify the cause of each. (p. 283)

A. ____________________________ H. ____________________________
B. ____________________________ I. _____________________________
C. ____________________________ J. _____________________________
D. ____________________________ K. _____________________________
E. ____________________________ L. _____________________________
F. ____________________________ M. _____________________________
G. ____________________________ N. _____________________________
19. Fill in the blanks A-E with the correct auscultation site. (p. 284)

A. ____________________________ D. ______________________________
B. ____________________________ E. ____________________________
C. ____________________________

20. Name three pathological processes that can cause mitral regurgitation. (p.
285) _______________
______________________________________________________________________________
21. Name three pathological processes that can cause aortic regurgitation. (p.
285) _______________
______________________________________________________________________________
22. What is meant by pulsus parvus et tardus? (p. 285)
____________________________________
______________________________________________________________________________
23. Which murmur is often caused by age-related calcification? (p. 285)
________________________
24. How is cardiac myocyte physiology different from that in skeletal muscle? (p.
285) _____________
______________________________________________________________________________

25. Fill in the blanks (A-E) with the correct phase of the ventricular action
potential and the ionic current responsible for each phase. (p. 286)

A. ____________________________ D. ______________________________
B. ____________________________ E. ____________________________
C. ____________________________
26. Fill in the blanks A-C with the correct phase of the pacemaker action potential
and the ionic current responsible for each phase. (p. 287)

A. ____________________________ C. ______________________________
B. _____________________________
27. As compared with the myocardial action potential, which phases are absent
from the pacemaker potential? (p. 287)
_______________________________________________________________
______________________________________________________________________________
28. What is the physiologic benefit of atrioventricular delay? (p. 288)
___________________________
______________________________________________________________________________
29. What are the most dangerous sequelae of torsades de pointes? (p. 288)
_____________________
______________________________________________________________________________

30. Patients with Wolff-Parkinson-White syndrome have a higher risk for which
type of arrhythmia?
(p. 288) ________________________________________________________________________
31. A 67-year-old man has an irregularly irregular ECG tracing during a routine
visit to his doctor. Which drug can decrease his risk of stroke? Which drug can
control his heart rate? (pp. 289)
______________________________________________________________________________
32. The ECG tracing of a 73-year-old woman shows a "sawtooth" pattern. Which
three classes of drugs could be given to treat her condition? (pp. 289)
____________________________________
______________________________________________________________________________
33. Progressive lengthening of the PR interval take place in _______________
(Mobitz type I/Mobitz type II/both Mobitz type I and type II) heart block. (p. 289)
________________________________
34. An ECG shows no identifiable waves. What is the most likely diagnosis? (p.
290) ______________
______________________________________________________________________________
35. A 65-year-old man presents with an ECG tracing that displays P waves and
QRS complexes that occur independently of each other. Which therapeutic
intervention would be most appropriate?
(p. 290) ________________________________________________________________________
36. Which infectious disease can cause third-degree heart block? (p. 290)
______________________
37. What chemical changes of blood elicit a response from peripheral
chemoreceptors? How do central chemoreceptors differ? (p. 290)
_____________________________________________________
38. A 25-year-old athlete begins training for the Olympics. As she runs her
standard 3 miles, is the increased oxygen demand of the heart met by increased
coronary blood flow or by increased extraction of oxygen? (p. 291)
______________________________________________________
39. In the lungs, what is the physiologic advantage of vasoconstriction in
response to hypoxia?
(p. 291) ________________________________________________________________________
40. An 80-year-old man with a history of right-sided heart failure presents with
bilateral ankle edema. In terms of capillary fluid exchange, what is the
mechanism by which his edema developed? (p. 291)
_______________________________________________________________________________
41. A 55-year-old man with longstanding alcoholic cirrhosis presents with
bilateral pedal edema and ascites. In terms of capillary fluid exchange, what is
the mechanism by which his edema developed? (p. 291)
______________________________________________________________

42. A 43-year-old woman presents with bilateral pitting leg edema and laboratory
results remarkable for high low-density lipoprotein, low albumin, and proteinuria
(likely nephrotic syndrome). In terms of capillary fluid exchange, what is the
mechanism by which her edema developed? (p. 291)
______________________________________________________________________________
43. A 50-year-old Ethiopian man presents with severe bilateral leg and scrotal
edema due to elephantiasis (lymphatic obstruction caused by filarial
nematodes). In terms of capillary fluid exchange, what is the mechanism by
which his edema developed? (p. 291)
______________________________________________________________________________
44. Describe the pressures in the left ventricle and aorta for a patient with aortic
stenosis. (p. 291)
_____________________________________________________________________________
PATHOLOGY
45. How do neonates with tricuspid atresia remain viable given their severely
compromised circulation? (p. 292)
________________________________________________________________________
46. What are the four clinical features of tetralogy of Fallot? (p. 292)
___________________________
______________________________________________________________________________
47. What must be present for a fetus with D-transposition of great vessels to
remain viable?
(p. 293) ________________________________________________________________________
48. What physical exam findings are associated with adult-type coarctation of
the aorta?
(p. 293) ________________________________________________________________________
49. Describe the murmur of patent ductus arteriosus. (p. 293)
________________________________
______________________________________________________________________________
50. Which three cardiac defects are associated with Down syndrome? (p. 294)
___________________
______________________________________________________________________________
51. List the five general risk factors for hypertension. (p. 294)
_________________________________
______________________________________________________________________________
52. An 80-year-old veteran is told by his physician that he has calcification of his
radial arteries and that the condition is relatively benign. What disease does he
have? (p. 294) _______________
______________________________________________________________________________

53. What are the six common complications of atherosclerosis? (p. 295)
________________________
______________________________________________________________________________
54. A patient presents to the emergency department with tearing chest pain
radiating to the back and dies soon after presentation. What vascular pathology
would most likely be seen at autopsy? What would most likely be seen on x-ray
of the chest? (p. 295) _________________________________
______________________________________________________________________________
55. At what point is ischemic heart disease given the term "myocardial
infarction" rather than "unstable angina"? (p. 296)
________________________________________________________________
______________________________________________________________________________

56. List the nine common symptoms of myocardial infarction. (p. 297)
__________________________
______________________________________________________________________________
______________________________________________________________________________
57. Describe the time frame for events after a myocardial infarction. (p. 297)
A. Coagulative necrosis becomes apparent
_________________________________________
B. Contraction bands become apparent
____________________________________________
C. Tissue around infarct shows acute inflammation
___________________________________
D. Hyperemia develops _________________________________________________________
E. Granulation tissue appears
____________________________________________________
F. Contracted scar complete
_____________________________________________________
58 After a myocardial infarction, when is the risk for arrhythmia greatest? The
risk for free wall rupture or interventricular septal rupture? The risk for
ventricular aneurysm? (p. 298) _________________
______________________________________________________________________________
59. Six days after having a myocardial infarction, a patient presents with a newonset murmur. Which type of murmur is the most likely? (p. 298)
____________________________________________
60. ST-segment elevation on an ECG indicates _______________
(subendocardial/transmural) infarction of the myocardium, while ST-segment

depression indicates _______________ (subendocardial/transmural) infarction. (p.

298)
61. Which ECG leads are best for diagnosing an infarct of the LAD? (p. 298)
____________________
______________________________________________________________________________
62. A 16-year-old boy presents for a school physical. Physical examination
reveals a 2/6 systolic murmur at the left sternal border. Upon questioning, he
mentions that he has had several fainting episodes. His father, a former Italian
soccer player, had similar episodes and died suddenly at the age of 25 years.
What is this patient's most likely diagnosis? What would a cardiac biopsy
specimen reveal? (p. 299) _______________________________________________________
______________________________________________________________________________
63. In congestive heart failure, _______________ (increased/decreased) cardiac
output leads to _______________ (increased decreased) activity of reninangiotensin-aldosterone, which leads to _______________ (increased/decreased)
systemic venous pressure, and ultimately the physical finding of ______________
(peripheral/pulmonary) edema. (p. 300)
64. In congestive heart failure, _______________ (increased/decreased) left
ventricular contractility leads to _______________ (increased/decreased) pulmonary
venous pressure, ultimately leading to _______________ (peripheral/pulmonary)
edema. (p. 300)
65. With respect bacterial endocarditis, what symptoms and signs are
represented by the mnemonic FROM JANE? (p. 301)
___________________________________________________________
______________________________________________________________________________
66. Rheumatic fever is caused by infection with which organism? (p. 302)
_______________________

67. List the components of the FEVERSS mnemonic for rheumatic heart disease.
(p. 302)
______________________________________________________________________________
______________________________________________________________________________
68. What six physical findings are commonly associated with cardiac
tamponade? (p. 302)
______________________________________________________________________________
______________________________________________________________________________
69. A 70-year-old former prostitute presents with chest pain radiating to the back
and worsening shortness of breath on exertion. Her cardiac enzymes are
negative and she has no ST changes on ECG. An echocardiogram shows aortic
regurgitation and a dilated aortic root. Laboratory tests are significant for a

positive rapid plasma reagin. What is the most likely cause of her pain and
shortness of breath? (p. 302)
______________________________________________________
______________________________________________________________________________
70. Which cardiac tumor may present with multiple syncopal episodes? (p. 303)
__________________
71. A 60-year-old woman with varicose veins experiences chest pain and
shortness of breath in the hospital after left knee replacement surgery. A CT
angiogram shows multiple pulmonary emboli. What is the most likely cause of
her pulmonary emboli? (p. 303)
______________________________________________________________________________
72. Raynaud's disease may be associated with which rheumatologic diseases? (p.
303)
______________________________________________________________________________
73. List eight signs or symptoms of Wegener's granulomatosis. (p. 304)
________________________
______________________________________________________________________________
74. In microscopic polyangiitis, the patient will test positively for __________ (pANCA/c-ANCA) in the serum. In Wegener's granulomatosis, the patient will test
positively for __________ (p-ANCA/c-ANCA). (p. 304)
75. Patients with Churg-Strauss syndrome usually present with which signs or
symptoms? (p. 304)
______________________________________________________________________________
76. A patient is diagnosed with Sturge-Weber disease. What neurologic
manifestation are most likely to be seen? (p. 304)
________________________________________________________________
______________________________________________________________________________
77. A 7-year-old boy has a viral urinary tract infection followed by worsening
abdominal and joint pain. Purpura develops on his legs. What is the most likely
diagnosis? (p. 304)
______________________________________________________________________________
78. Which four clinical findings are associated with Buerger's disease? (p. 304)
__________________
______________________________________________________________________________
______________________________________________________________________________

79. A 7-year-old Japanese child has 1 week of fever, palpable lymph nodes,
erythema of the conjunctiva and tongue, and desquamation of the palms of the
hands. What is the most likely diagnosis? What is the preferred treatment? (p.
304) ____________________________________

______________________________________________________________________________
80. Which infectious disease is strongly associated with polyarteritis nodosa? (p.
304) _____________
______________________________________________________________________________
81. Which arteriographic findings are seen with polyarteritis nodosa? (p. 304)
____________________
______________________________________________________________________________
82. A 75-year-old woman presents with new-onset right jaw pain and headache
at the right temple. What is the most likely diagnosis? (p. 304)
____________________________________________
______________________________________________________________________________
83. Temporal arteritis is associated with what laboratory finding? (p. 304)
_______________________
______________________________________________________________________________
84. What is a strawberry hemangioma? (p. 305)
___________________________________________
85. What is a cherry hemangioma? (p. 305)
______________________________________________
86. What is Kaposis sarcoma? (p. 305)
__________________________________________________
PHARMACOLOGY
87. Why are ACE inhibitors especially important for patients with diabetes
mellitus? (p. 306)
______________________________________________________________________________
88. What two agents are first-line therapy for hypertension in pregnancy? (p.
306) ________________
______________________________________________________________________________
89. A patient is started on antihypertensive therapy. One week later he returns,
complaining of swollen ankles and flushed skin. Which class of medication was
he likely prescribed?
(p. 306) ________________________________________________________________________
90. List four adverse effects of nitroglycerin. (p. 306)
_______________________________________
______________________________________________________________________________
91. What is an adverse effect of diazoxide? (p. 306)
________________________________________
92. What is the mechanism by which medications can reduce angina? (p. 307)
___________________

______________________________________________________________________________
93. A 50-year-old man with hypercholesterolemia is deficient in vitamins A, D, E,
and K. He also complains of gastrointestinal discomfort since starting a lipidlowering agent. Which lipid-lowering agent is the most likely cause? (p. 308)
_______________________________________________

94. A patient who recently started taking lovastatin presents with diffuse muscle
pain and weakness. Which laboratory test should be ordered? (p. 308)
_____________________________________
______________________________________________________________________________
95. Digoxin inhibits which mechanism of transport in the cell membrane? (p.
309) _________________
96. List six ECG findings characteristic of digoxin toxicity. (p. 309)
_____________________________
______________________________________________________________________________
97. What are the mechanisms of action of cardiac glycosides? (p. 309)
_________________________
______________________________________________________________________________
98. Facial rash and joint pain develop in a patient who is taking procainamide for
an arrhythmia. Antihistone antibodies are present in her serum. What is the most
likely diagnosis? (p. 310)
______________________________________________________________________________
99. Quinidine causes symptoms of headache and tinnitus, which collectively are
known as _______________. (p. 310)
100. Fill in the blanks A-F with the correct subclass of class I antiarrhythmics, and
give examples of each subclass. (p. 310)

(Adapted, with permission, from Katzung BG, Trevor AJ. Pharmacology:

Examination & Board Review, 5th ed. New York: McGraw-Hill, 2011: 284.)
A. ____________________________ C. ______________________________
B. ____________________________ D. ____________________________
101. What are the toxicities of -blockers? (p. 311)
__________________________________________
______________________________________________________________________________
102. What is the mechanism of action of -blockers? (p. 311)
_________________________________
______________________________________________________________________________

103. What three types of testing must be performed periodically for patients who
take amiodarone?
(p. 311) ____________________________________________________________________
______________________________________________________________________________
104. What is a potentially fatal adverse effect of ibutilide? (p. 311)
______________________________
105. What are the adverse effects of calcium channel blockers? (p. 312)
_________________________
______________________________________________________________________________
106. What do calcium channel blockers work? (p. 312)
_______________________________________
______________________________________________________________________________
107. Which antiarrhythmic is a first-line drug for diagnosing and abolishing
supraventricular tachycardia? (p. 312)
_____________________________________________________________________
108. Which ion is infused to treat torsades de pointes and digoxin toxicity? (p.
312) ________________
______________________________________________________________________________
109. Name three toxicities of the antiarrhythmic drug adenosine. (p. 312)
________________________
______________________________________________________________________________