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  • Question 1 - What is the main mechanism of action of dobutamine as an inotropic sympathomimetic:...

    Correct

    • What is the main mechanism of action of dobutamine as an inotropic sympathomimetic:

      Your Answer: Beta1-receptor agonist

      Explanation:

      Dobutamine directly stimulates the beta1-adrenergic receptors in the heart and increases contractility and cardiac output with little effect on the rate. In addition action on beta2-receptors causes vasodilation.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      27.9
      Seconds

  • Question 2 - Regarding the heart sounds in the cardiac cycle, which of the following statements...

    Incorrect

    • Regarding the heart sounds in the cardiac cycle, which of the following statements is INCORRECT:

      Your Answer: The first heart sound is heard in early systole.

      Correct Answer: The third heart sound is caused by filling of an abnormally stiff ventricle in atrial systole.

      Explanation:

      Heart Sound – Phase of Cardiac Cycle – Mechanical Event:First heart sound – Start of systole – Caused by closure of the atrioventricular (mitral & tricuspid) valvesSecond heart sound – End of systole – Caused by closure of the semilunar (aortic and pulmonary) valvesThird heart sound – Early diastole – Caused by rapid flow of blood from the atria into the ventricles during the ventricular filling phaseFourth heart sound – Late diastole – Caused by filling of an abnormally stiff ventricle in atrial systole

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      83
      Seconds

  • Question 3 - The risk of renal impairment in a patient on ACE inhibitor therapy is...

    Correct

    • The risk of renal impairment in a patient on ACE inhibitor therapy is increased by concomitant treatment with which of the following drug classes:

      Your Answer: NSAIDs

      Explanation:

      Concomitant treatment with NSAIDs increases the risk of renal damage, and with potassium-sparing diuretics (or potassium-containing salt substitutes) increases the risk of hyperkalaemia. Hyperkalaemia and other side effects of ACE inhibitors are more common in the elderly and in those with impaired renal function and the dose may need to be reduced.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      7.3
      Seconds

  • Question 4 - Digoxin exhibits its positive inotropic effect by which of the following mechanisms: ...

    Incorrect

    • Digoxin exhibits its positive inotropic effect by which of the following mechanisms:

      Your Answer: Inhibits Ca2+ release channels on the sarcoplasmic reticulum

      Correct Answer: Inhibits the Na+/K+ pump on the myocyte membrane

      Explanation:

      Cardiac glycosides (e.g. digoxin) slow the removal of Ca2+from the cell by inhibiting the membrane Na+pump (Na+/K+ATPase) which generates the Na+gradient required for driving the export of Ca2+by Na+/Ca2+exchange; consequently the removal of Ca2+from the myocyte is slowed and more Ca2+is available for the next contraction.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      12
      Seconds

  • Question 5 - Digoxin is predominantly used for which of the following: ...

    Correct

    • Digoxin is predominantly used for which of the following:

      Your Answer: Rate control in persistent and permanent atrial fibrillation

      Explanation:

      Digoxin is most useful for controlling the ventricular response in persistent and permanent atrial fibrillation and atrial flutter. Digoxin is usually only effective for controlling the ventricular rate at rest, and should therefore only be used as monotherapy in predominantly sedentary patients with non-paroxysmal atrial fibrillation. It is now rarely used for rapid control of heart rate, as even with intravenous administration, response may take many hours. Digoxin is reserved for patients with worsening or severe heart failure due to left ventricular systolic dysfunction refractory to combination therapy with first-line agents. Digoxin is contraindicated in supraventricular arrhythmias associated with accessory conduction pathways e.g. Wolff-Parkinson-White syndrome.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      16
      Seconds

  • Question 6 - An elderly patient presents to ED following a fall after feeling light headed...

    Correct

    • An elderly patient presents to ED following a fall after feeling light headed when standing up. You are reviewing his medication and note that he is taking a high dose of furosemide. Loop diuretics act primarily at which of the following sites in the nephron:

      Your Answer: Thick ascending limb

      Explanation:

      Loop diuretics inhibit the Na+/K+/2Cl- symporter on the luminal membrane in the thick ascending limb of the loop of Henle, thus preventing reabsorption of NaCl and water. These agents reduce reabsorption of Cl- and Na+ and increase Ca2+ excretion and loss of K+ and Mg2+.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      14.6
      Seconds

  • Question 7 - Regarding fibrinolytics, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding fibrinolytics, which of the following statements is INCORRECT:

      Your Answer: Further embolism may occur either due to clots that break away from the original thrombus or to cholesterol crystal emboli.

      Correct Answer: Fibrinolytic drugs act as thrombolytics by directly degrading the fibrin mesh and so breaking up thrombi.

      Explanation:

      Fibrinolytic drugs act as thrombolytics by activating plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      32.6
      Seconds

  • Question 8 - What is the main mechanism of action of flecainide: ...

    Incorrect

    • What is the main mechanism of action of flecainide:

      Your Answer: Blocks Ca2+ channels

      Correct Answer: Blocks Na+ channels

      Explanation:

      Flecainide inhibits the transmembrane influx of extracellular Na+ ions via fast channels on cardiac tissues resulting in a decrease in rate of depolarisation of the action potential, prolonging the PR and QRS intervals. At high concentrations, it exerts inhibitory effects on slow Ca2+ channels, accompanied by moderate negative inotropic effect.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      10.6
      Seconds

  • Question 9 - Which of the following is NOT a benefit of low molecular weight heparin...

    Correct

    • Which of the following is NOT a benefit of low molecular weight heparin (LMWH) over unfractionated heparin therapy:

      Your Answer: Its effects can be rapidly and completely reversed with protamine sulfate.

      Explanation:

      Advantages of LMWHGreater ability to inhibit factor Xa directly, interacting less with platelets and so may have a lesser tendency to cause bleedingGreater bioavailability and longer half-life in plasma making once daily subcutaneous administration possibleMore predictable dose response avoiding the need for routine anticoagulant monitoringLower associated risk of heparin-induced thrombocytopenia or of osteoporosis

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      27.7
      Seconds

  • Question 10 - By which of the following is mean arterial pressure (MAP) primarily determined? ...

    Correct

    • By which of the following is mean arterial pressure (MAP) primarily determined?

      Your Answer: Total peripheral resistance and cardiac output

      Explanation:

      Mean arterial pressure (MAP) = Cardiac output (CO) x Total peripheral resistance (TPR). Cardiac output is dependent on the central venous pressure (CVP). CVP, in turn, is highly dependent on the blood volume. Any alterations of any of these variables will likely change MAP.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      24.7
      Seconds

  • Question 11 - A 72 year old man is brought to ED by ambulance with sudden...

    Incorrect

    • A 72 year old man is brought to ED by ambulance with sudden onset chest pain, palpitations and shortness of breath. His HR is 160 bpm and BP 90/65. ECG demonstrates new-onset fast atrial fibrillation. Which of the following is the first-line treatment option in this case:

      Your Answer: Beta-blocker

      Correct Answer: Synchronised DC cardioversion

      Explanation:

      All patients with adverse features suggesting life-threatening haemodynamic instability (shock, syncope, heart failure, myocardial ischaemia) caused by new onset atrial fibrillation should undergo emergency electrical cardioversion with synchronised DC shock without delaying to achieve anticoagulation.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      19.6
      Seconds

  • Question 12 - What is the recommended dosing regime for amiodarone in the treatment of a...

    Incorrect

    • What is the recommended dosing regime for amiodarone in the treatment of a stable regular broad-complex tachycardia:

      Your Answer: 150 mg IV bolus, followed by two further 300 mg IV boluses if no response

      Correct Answer: 300 mg IV over 10 - 60 minutes, followed by an IV infusion of 900 mg over the next 24 hours

      Explanation:

      A ventricular tachycardia (or broad-complex tachycardia of uncertain origin) should be treated with amiodarone 300 mg IV over 10 – 60 min, followed by an infusion of 900 mg over the next 24 hours.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      29.1
      Seconds

  • Question 13 - Regarding postural hypotension, which of the following statements is INCORRECT: ...

    Correct

    • Regarding postural hypotension, which of the following statements is INCORRECT:

      Your Answer: Postural hypotension usually causes a reflex bradycardia.

      Explanation:

      On standing from a prone position, gravity causes blood to pool in veins in the legs. Central venous pressure (CVP) falls, causing a fall in stroke volume and cardiac output (due to Starling’s law) and thus a fall in blood pressure. Normally this fall in BP is rapidly corrected by the baroreceptor reflex which causes venoconstriction (partially restoring CVP), and an increase in heart rate and contractility, so restoring cardiac output and blood pressure. Impaired autonomic nervous activity in the elderly accounts for the greater likelihood of postural hypotension. Any symptoms of dizziness, blurred vision or syncope is due to a transient fall in cerebral perfusion that occurs before cardiac output and mean arterial pressure (MAP) can be corrected.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      23.9
      Seconds

  • Question 14 - The Frank-Starling curve is shifted downhill in heart failure due to which of...

    Correct

    • The Frank-Starling curve is shifted downhill in heart failure due to which of the following?

      Your Answer: Decrease in contractility

      Explanation:

      The Frank–Starling mechanism states that the left ventricle can increase its force of contraction and hence stroke volume in response to increases in venous return and thus preload. Changes in afterload or inotropy cause the Frank–Starling curve to rise or fall. In heart failure, the Frank–Starling curve is shifted downward (flattened), requiring higher venous return and filling pressure to enhance contractility and stroke volume.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      11.7
      Seconds

  • Question 15 - Cardiac myocytes are connected to each other by which of the following: ...

    Incorrect

    • Cardiac myocytes are connected to each other by which of the following:

      Your Answer: Tight junctions

      Correct Answer: Intercalated discs

      Explanation:

      Adjacent cardiac myocytes are connected to each other by intercalated discs. The intercalated discs provide both a structural attachment by ‘glueing’ cells together at desmosomes and an electrical contact made up of proteins called connexons, called a gap junction, which essentially creates a low-resistance pathway between cells.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      7.1
      Seconds

  • Question 16 - Intracellular [Ca2+] rise in cardiac excitation-contraction coupling is mainly as a result of:...

    Incorrect

    • Intracellular [Ca2+] rise in cardiac excitation-contraction coupling is mainly as a result of:

      Your Answer: Ca 2+ influx through Na + /Ca 2+ exchange

      Correct Answer: Ca 2+ release from sarcoplasmic reticulum

      Explanation:

      Although Ca2+entry during the action potential (AP) is essential for contraction, it only accounts for about 25% of the rise in intracellular Ca2+. The rest is released from Ca2+stores in the sarcoplasmic reticulum (SR). APs travel down invaginations of the sarcolemma called T-tubules, which are close to, but do not touch, the terminal cisternae of the SR. During the AP plateau, Ca2+enters the cell and activates Ca2+sensitive Ca2+release channels in the sarcoplasmic reticulum allowing stored Ca2+to flood into the cytosol; this is called Ca2+-induced Ca2+release. The amount of Ca2+released is dependent on how much is stored, and on the size of the initial Ca2+influx during the AP.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      15.7
      Seconds

  • Question 17 - Which of the following does NOT predispose to digoxin toxicity in a patient...

    Correct

    • Which of the following does NOT predispose to digoxin toxicity in a patient taking digoxin:

      Your Answer: Hyponatraemia

      Explanation:

      Hypoxia, hypercalcaemia, hypokalaemia and hypomagnesaemia predispose to digoxin toxicity. Care should also be taken in the elderly who are particularly susceptible to digoxin toxicity. Hypokalaemia may be precipitated by use of diuretics. Although hyponatremia can result in the development of other pathological disturbances, it does not potentiate digoxin toxicity.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      20.9
      Seconds

  • Question 18 - For a tachyarrhythmia caused by hypovolaemic shock, which of the following is the...

    Incorrect

    • For a tachyarrhythmia caused by hypovolaemic shock, which of the following is the first-line treatment:

      Your Answer: Intravenous magnesium

      Correct Answer: Synchronised DC shock

      Explanation:

      If there are any adverse symptoms, immediate cardioversion with synchronized DC shock is recommended. If cardioversion fails to stop the arrhythmia and the symptoms persist, amiodarone 300 mg IV over 10–20 minutes should be administered before attempting another cardioversion. The loading dosage of amiodarone is followed by a 24-hour infusion of 900 mg administered into a large vein.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      24.4
      Seconds

  • Question 19 - When a person changes from a supine to an upright position, which of...

    Incorrect

    • When a person changes from a supine to an upright position, which of the followingcompensatory mechanismsoccurs:

      Your Answer: Decreased total peripheral resistance (TPR)

      Correct Answer: Increased contractility

      Explanation:

      On standing from a prone position, gravity causes blood to pool in veins in the legs. Central venous pressure (CVP) falls, causing a fall in stroke volume and cardiac output (due to Starling’s law) and thus a fall in blood pressure. Normally this fall in BP is rapidly corrected by the baroreceptor reflex which causes venoconstriction (partially restoring CVP), and an increase in heart rate and contractility, so restoring cardiac output and blood pressure. Impaired autonomic nervous activity in the elderly accounts for the greater likelihood of postural hypotension. Any symptoms of dizziness, blurred vision or syncope is due to a transient fall in cerebral perfusion that occurs before cardiac output and mean arterial pressure (MAP) can be corrected.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      13.4
      Seconds

  • Question 20 - What is the direct mechanism of action of digoxin as a positive inotrope:...

    Incorrect

    • What is the direct mechanism of action of digoxin as a positive inotrope:

      Your Answer: Beta-adrenoceptor agonist

      Correct Answer: Inhibition of Na+/K+ ATPase pump

      Explanation:

      Digoxin directly inhibits membrane Na+/K+ ATPase, which is responsible for Na+/K+ exchange across the myocyte cell membrane. This increases intracellular Na+ and produces a secondary increase in intracellular Ca2+ that increases the force of myocardial contraction. The increase in intracellular Ca2+ occurs because the decreased Na+ gradient across the membrane reduces the extrusion of Ca2+ by the Na+/Ca2+ exchanger that normally occurs during diastole. Digoxin and K+ ions compete for the receptor on the outside of the muscle cell membrane, and so the effects of digoxin may be dangerously increased in hypokalaemia.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      7.7
      Seconds

  • Question 21 - Which of the following is NOT a common side effect of adenosine: ...

    Incorrect

    • Which of the following is NOT a common side effect of adenosine:

      Your Answer: Angina

      Correct Answer: Yellow vision

      Explanation:

      Common side effects of adenosine include:ApprehensionDizziness, flushing, headache, nausea, dyspnoeaAngina (discontinue)AV block, sinus pause and arrhythmia (discontinue if asystole or severe bradycardia occur)

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      11.9
      Seconds

  • Question 22 - A patient who is taking ramipril for high blood pressure complains of a...

    Incorrect

    • A patient who is taking ramipril for high blood pressure complains of a dry persistent cough. What is the mechanism of cough in ACE inhibitor therapy:

      Your Answer: Direct stimulation of irritant receptors

      Correct Answer: Decreased bradykinin breakdown

      Explanation:

      Blocking ACE also diminishes the breakdown of the potent vasodilator bradykinin which is the cause of the persistent dry cough. Angiotensin-II receptor blockers do not have this effect, therefore they are useful alternative for patients who have to discontinue an ACE inhibitor because of persistent cough.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      31.3
      Seconds

  • Question 23 - In adult advanced life support, which of the following best describes the correct...

    Correct

    • In adult advanced life support, which of the following best describes the correct administration of adrenaline for a non-shockable rhythm:

      Your Answer: Give 1 mg of adrenaline as soon as intravenous access is achieved and every 3 - 5 minutes thereafter

      Explanation:

      IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be given after 3 shocks and every 3 – 5 minutes/after alternate shocks thereafter.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      34.2
      Seconds

  • Question 24 - Nitric oxide release from endothelium is stimulated by all of the following EXCEPT...

    Incorrect

    • Nitric oxide release from endothelium is stimulated by all of the following EXCEPT for:

      Your Answer: Histamine

      Correct Answer: Noradrenaline

      Explanation:

      Nitric oxide (NO) production by the endothelium is increased by factors that elevate intracellular Ca2+, including local mediators such as bradykinin, histamine and serotonin, and some neurotransmitters (e.g. substance P). Increased flow (shear stress) also stimulates NO production and additionally activates prostacyclin synthesis. The basal production of NO continuously modulates vascular resistance; increased production of nitric oxide acts to cause vasodilation. Nitric oxide also inhibits platelet activation and thrombosis.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      15.8
      Seconds

  • Question 25 - Which of the following conditions require IV Lidocaine administration? ...

    Incorrect

    • Which of the following conditions require IV Lidocaine administration?

      Your Answer: Terminating paroxysmal supraventricular tachycardia

      Correct Answer: Refractory ventricular fibrillation in cardiac arrest

      Explanation:

      IV Lidocaine is indicated in Ventricular Arrhythmias or Pulseless Ventricular Tachycardia (after defibrillation, attempted CPR, and vasopressor administration)

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      21.6
      Seconds

  • Question 26 - Which of the following increases the tendency for oedema to occur? ...

    Correct

    • Which of the following increases the tendency for oedema to occur?

      Your Answer: Increased venous pressure

      Explanation:

      When more fluid is filtered out of the capillaries than can be returned to the circulation by the lymphatics, oedema occurs. Changes that increase capillary hydrostatic pressure or decrease plasma oncotic pressure will increase filtration. Arteriolar constriction reduces hydrostatic capillary pressure and transiently increase absorption of fluid. Dehydration increases plasma protein concentration and therefore increases plasma oncotic pressure and absorption. Capillary hydrostatic pressure and filtration are increased when there is increased venous pressure.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      18.6
      Seconds

  • Question 27 - Lidocaine's antiarrhythmic mode of action is as follows: ...

    Incorrect

    • Lidocaine's antiarrhythmic mode of action is as follows:

      Your Answer: Opens ACh-sensitive K+ channels

      Correct Answer: Blocks inactivated Na+ channels

      Explanation:

      Lidocaine is a class 1B antidysrhythmic; combines with fast Na channels and thereby inhibits recovery after repolarization, resulting in decreasing myocardial excitability and conduction velocity. However, in ischaemic areas, where anoxia causes depolarisation and arrhythmogenic activity, many Na+ channels are inactivated and therefore susceptible to lidocaine.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      12.3
      Seconds

  • Question 28 - What is the mechanism of action of captopril: ...

    Correct

    • What is the mechanism of action of captopril:

      Your Answer: Angiotensin-converting enzyme inhibitor

      Explanation:

      Captopril is an angiotensin-converting enzyme (ACE) inhibitor, which inhibits the conversion of angiotensin I to angiotensin II.

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      12.3
      Seconds

  • Question 29 - Which of the following is NOT an adverse effect associated with statin therapy:...

    Incorrect

    • Which of the following is NOT an adverse effect associated with statin therapy:

      Your Answer: Hyperglycaemia

      Correct Answer: Aplastic anaemia

      Explanation:

      Adverse effects of statins include:, Headache, Epistaxis, Gastrointestinal disorders (such as constipation, flatulence, dyspepsia, nausea, and diarrhoea), Musculoskeletal and connective tissue disorders (such as myalgia, arthralgia, pain in the extremity, muscle spasms, joint swelling, and back pain), Hyperglycaemia and diabetes, Myopathy and rhabdomyolysis, Interstitial lung disease and Hepatotoxicity

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      10.3
      Seconds

  • Question 30 - Which of the following is NOT a typical side effect of digoxin: ...

    Incorrect

    • Which of the following is NOT a typical side effect of digoxin:

      Your Answer: Yellow vision

      Correct Answer: Hypokalaemia

      Explanation:

      Digoxin does not cause hypokalaemia, but hypokalaemia does potentiate digoxin toxicity. The adverse effects of digoxin are frequently due to its narrow therapeutic window and include: Cardiac adverse effects – Sinoatrial and atrioventricular block, Premature ventricular contractions, PR prolongation and ST-segment depressionNausea, vomiting and diarrhoeaBlurred or yellow visionCNS effects – weakness, dizziness, confusion, apathy, malaise, headache, depression, psychosisThrombocytopenia and agranulocytosis (rare)Gynaecomastia in men in prolonged administration

    • This question is part of the following fields:

      • Cardiovascular
      • Pharmacology
      11
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular (12/30) 40%
Pharmacology (8/20) 40%
Physiology (4/10) 40%
Passmed
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