Congestive heart failure exam

Congestive Heart Failure Exam 1

1- Potassium sparing diuretic:
1. furosemide (Lasix) 2. triamterene (Dyrenium) 3. chlorothiazide (Diuril) 4. mannitol (Osmitrol) 5. torsemide (Demadex)
2- Increased urinary output in a congestive heart failure patient who has been
started on digoxin (Lanoxin, Lanoxicaps) is most likely due to:
1. renovascular dilatation 2. increased renal perfusion 3. decreased post glomerular arteriolar tone 4. a direct effect on renal sodium transport 5. a decrease in vagal tone to the kidney
3- Potassium sparing diuretic:
1. chlorothiazide (Diuril) 2. bumetanide (Bumex) 3. amiloride (Midamor) 4. mannitol (Osmitrol) 5. furosemide (Lasix)
4- Primarily an arterial vasodilator that may be useful in management of
congestive heart failure:
1. isosorbide dinitrate (Isordil, Sorbitrate) 2. minoxidil (Loniten) 3. lisinopril (Prinvivil, Zestril)
5- Digitalis-induced bradycardia in the normal heart is due to:
1. decreased conduction through the AV node 2. increased vagal tone 3. increased sympathetic tone 4. decrease in fluid load 5. peripheral vasodilation
6- Digitalis-effect on vascular resistance in congestive heart failure patients:
1. vascular resistance increases 2. vascular resistance decreases
7- Digitalis-induced diuresis in edematous patients is mainly due to:
1. renal vasodilation 2. increased post-glomerular arteriolar tone 3. increased cardiac output 4. decreased heart rate 5. blockade of the sodium-potassium transporter ACADIMYA Center; www.acadimyacenter@gmail.com; 054-5993618
8- Drug interaction that may reduce digitalis absorption:
1. quinidine gluconate (Quinaglute, Quinalan) 2. cholestyramine (Questran, Questran Light) 3. norepinephrine
9- An example of a positive inotropic drug that acts by inhibiting myocardial
phosphodiesterase.
1. triamcinolone (Aristocort) 2. amrinone (Inocor) 3. ouabain 4. tranylcypromine (Parnate) 5. dopamine (Intropin)
10- Cardiac effects of. digoxin (Lanoxin, Lanoxicaps) include:
1. increased heart rate 2. increased automaticity 3. decreased velocity of contraction 4. increased conduction through the AV node 5. decreased cardiac output
11- Angiotensin II receptor antagonist:
1. captopril (Capoten) 2. isosorbide dinitrate (Isordil, Sorbitrate) 3. losartin (Cozaar) 4. nitroprusside sodium (Nipride) 5. hydralazine (Apresoline)
12- Calcium channel blocker with marked negative inotropic cardiac effects:
1. nifedipine (Procardia, Adalat) 2. diltiazem (Cardiazem) 3. amlodipine (Norvasc) 4. amrinone (Inocor) 5. labetalol (Trandate, Normodyne)
13- Positive inotropic agent that not only stimulates beta-1, beta-2, alpha-1,
alpha-2 receptors but also acts as a vasodilator to reduce aortic impedance
(afterload).
1. isoproterenol (Isuprel) 2. norepinephrine 3. dopamine (Intropin) 4. dobutamine (Dobutrex) 5. phenylephrine (Neo-Synephrine)
14- Loop diuretic useful both in acute and chronic management of congestive heart
failure:
1. chlordiazepoxide (Librium) 2. chlorthalidone (Hygroton) 3. bumetanide (Bumex) 4. ethacrynic acid (Edecrin) 5. spironolactone (Aldactone) ACADIMYA Center; www.acadimyacenter@gmail.com; 054-5993618
15- Digoxin (Lanoxin, Lanoxicaps) clinical uses:
1. atrial fibrillation 2. atrial flutter 3. congestive heart failure 4. A & C 5. A, B & C
16- Useful in treating arrhythmias associated with digitalis toxicity:
1. lidocaine (Xylocaine) 2. potassium 3. both 4. neither
17- Effects of digitalis glycosides on the heart include:
1. increased conduction velocity through the AV node 2. decreased refractory period of the AV node 3. positive inotropic effects 4. positive chronotropic effects 5. A & C
18- Positive inotropic drug are not classified as a cardiac glycoside:
1. metoprolol (Lopressor) 2. prazosin (Minipress) 3. amrinone (Inocor) 4. methacholine (Provocholine) 5. quinidine gluconate (Quinaglute, Quinalan) ACADIMYA Center; www.acadimyacenter@gmail.com; 054-5993618
------------------ CORRECT ANSWERS: 1-B 2-B 3-C 4-B 5-B 6-B 7-C 8-B 9-B 10-B 11-C 12-B 13-D 14-C 15-E 16-C 17-C 18-C ACADIMYA Center; www.acadimyacenter@gmail.com; 054-5993618
Congestive Heart Failure CHF-Exam # 2

1- 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
2- 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)
3- 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
F) C+D
4- Left ventricular stroke volume: relationship to afterload

A) direct
B) inverse
5- Most important digitalis-mediated cardiac effect:
A) tachycardia
B) improved real perfusion
C) decreased AV transmission
D) shift of the force-velocity relationship upward
6- Short-term inotropic support of the failing myocardium:
A) furosemide (Lasix)
B) diltiazem (Cardiazem)
C) dobutamine (Dobutrex)
D) milrinone (Primacor)
E) dopamine (Intropin)
F) C+D+E
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7- Exogenous agents that improve ventricular performance,
A) isoproterenol (Isuprel)
B) theophylline
C) diltiazem (Cardiazem)
D) nifedipine (Procardia, Adalat)
E) caffeine
F)A+B+E
8- 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
E) all of above
9- Perhaps more useful in a CHF patient with marginal GFR due to poor renal
perfusion:

A) dopamine (Intropin)
B) dobutamine (Dobutrex)
C) methoxamine (Vasoxyl)
10- Less arrhythmogenic; less tachycardia
A) dopamine (Intropin)
B) dobutamine (Dobutrex)
11- 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)
F) all of above
12- Vasoconstrictors:
A) endothelin I
B) angiotensin II
C) both
D) neither
13- Mechanism by which vasodilators improve myocardial performance in CHF:
A) increase heart rate
B) promote diuresis
C) reduce afterload
D) reduce pulmonary blood flow
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14- 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
F) A+B+C+D
15- 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
16) Agents which depress ventricular performance:
A) dopamine (Intropin)
B) general anesthetics
C) disopyramide (Norpace)
D) procainamide (Procan SR, Pronestyl-SR)
F) B+C+D
17) 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)
18) Effective exercise on intrathoracic blood volume:
A) increased
B) decreased
C) no effect
19) State of neurohumoral activation in CHF:
A) highly activated
B) generally suppressed
20) Primarily excreted in the urine; digitalis glycosides with half-life of 1.6 days:
A) digoxin (Lanoxin, Lanoxicaps)
B) digitoxin
C) both
D) neither
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21) Most significant factor in blood flow resistance

A) vessel length
B) blood viscosity
C) vessel radius
22) Consequences of renin-angiotensin system activation:
A) reduced circulating angiotensin II
B) reduced aldosterone
C) reduced vasoconstriction
D) none of the above
23) 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
F) all of above
24) Clinical efficacy of digitalis glycosides is based on --

A) decreased transmission through the AV node
B) increased myocardial contractility
C) both
D) neither
25) Tissue perfusion dependencies:
A) cardiac
B) vascular
C) microcirculatory
D) humoral
E) all of above
26) Factors that can cause congestive heart failure:
A) systemic hypertension
B) arrhythmias
C) pulmonary emboli
D) myocardial infarction
E) all of above


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27) Associated with cardiac cachexia:
A) impairment of intestinal absorption
B) anorexia
C) vomiting
D) hepatomegaly
E) increased tumor necrosis factor (circulating)
F) all of above
28) Atrial contraction (atrophic) is more likely to be important in:
A) the normal ventricle
B) the hypertrophic ventricle
C) no difference
29) Most common symptom of heart failure:
A) tachycardia
B) oligouria
C) splenomegaly
D) hepatomegaly
E) dyspnea
30) Component of digitalis responsible for Na/K ATPase binding --
A) genin or aglycone moiety
B) sugar residues
C) steroid component
31) Increase respiratory muscle work of breathing in CHF due to:
A) interstitial pulmonary edema
B) vessel enlargement
C) both
D) neither
32) Even in low doses does not increase renal blood flow:

A) dopamine (Intropin))
B) dobutamine (Dobutrex)
33) Has vasodilator properties: causes a decrease in afterload as well as positive
inotropism:

A) dopamine (Intropin)
B) dobutamine (Dobutrex)
C) phenylephrine (Neo-Synephrine)
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34) Beta-receptor number and congestive heart failure:
A) increased
B) decreased
C) no change
35) 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
E) all of above
36) Sudden-onset of severe shortness-of-breath and coughing -- awakening the
patient

A) orthopnea
B) paroxysmal dyspnea (nocturnal)
37) 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
38) Precipitating causes of congestive heart failure:
A) AV dissociation
B) severe bradycardia
C) reduce synchrony of ventricular contraction
D) tachyarrhythmias
E) all of above
39) Factors influencing end-diastolic volumes:
A) volume depletion
B) body position
C) venous tone
D) skeletal muscle activity
E) uterine contraction
F) all of above
40) Factor(s) affecting microvascular blood flow:

A) colloid forces
B) capillary hydrostatic pressures
C) both
D) neither
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41) Bipyridines -- phosphodiesterase inhibitors used in CHF:
A) dobutamine (Dobutrex)
B) amrinone (Inocor)
C) hydralazine (Apresoline)
D) minoxidil (Loniten)
E) furosemide (Lasix)
42) 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
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Correct Answersף
1-D
2-D
3-F
4-B
5-D
6-F
7-F
8-E
9-A
10-B
11-F
12-C
13-C
14-F
15-B
16-F
17-D
18-A
19-A
20-A
21-C
22-D
23-F
24-C
25-E
26-E
27-F
28-B
29-E
30-A
31-C
32-B
33-B
34-B
35-E
36-B
37-C
38-E
39-F
40-C
41-B
42-D
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Source: http://www.acadimya.org/UserFiles/File/PHARMACY%202009/Congestive%20Heart%20Failure%20Exam%201.pdf