[MCQ] Heart Failure and Cor Pulmonale- Part 1

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Heart Failure and Cor Pulmonale- Part 1

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Congratulations - you have completed Heart Failure and Cor Pulmonale- Part 1. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

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Question 1

What percentage of patients who develop Heart failure (HF) have normal or preserved EF ?

A	10 %
B	20 %
C	35 %
D	50 %

Question 1 Explanation:

Epidemiologic studies show that approximately one-half of patients who develop HF have a normal or preserved EF (EF 40 - 50%) i.e. diastolic failure

Question 2

Which of the following is a cadiac cytoskeletal protein ?

A	Desmin
B	Myosin
C	Vinculin
D	All of the above

Question 3

Which of the following is not a cadiac cytoskeletal protein ?

A	Desmin
B	Myosin
C	Vinculin
D	Laminin

Question 3 Explanation:

Cytoskeletal proteins include desmin, cardiac myosin & vinculin. Laminin is a nuclear membrane protein

Question 4

Which of the following condition does not lead to HF in a normal heart ?

A	Hypertension
B	Infiltrative disorders
C	Chagas’ disease
D	Arteriovenous fistula

Question 4 Explanation:

Conditions that lead to a high cardiac output like arteriovenous fistula and anemia seldom lead to HF in a normal heart.

Question 5

In heart failure, which of the following compensatory mechanisms is activated after an index event ?

A	Adrenergic nervous system
B	Renin-angiotensin-aldosterone system
C	Cytokine system
D	All of the above

Question 5 Explanation:

Heart failure begins after an index event produces an initial decline in the heart’s pumping capacity. After this initial decline in pumping capacity, a compensatory mechanisms are activated that includes adrenergic nervous system, renin-angiotensin-aldosterone system and cytokine system.

Question 6

Which of the following is a vasodilatory molecule ?

A	Atrial and brain natriuretic peptides (ANP & BNP)
B	Prostaglandins (PGE2 & PGI2)
C	Nitric oxide (NO)
D	All of the above

Question 6 Explanation:

In HF, there is activation of a family of compensatory vasodilatory molecules like atrial & brain natriuretic peptides (ANP & BNP), prostaglandins (PGE2 & PGI2) and nitric oxide (NO), that oppose excessive peripheral vascular vasoconstriction

Question 7

Baroreceptors are located in which of the following locations ?

A	Left ventricle
B	Carotid sinus
C	Aortic arch
D	All of the above

Question 7 Explanation:

High-pressure baroceptors are located in left ventricle, carotid sinus and aortic arch.

Question 8

Which of the following mechanism may be responsible in the development of HF with preserved EF ?

A	Diastolic dysfunction
B	Increased vascular stiffness
C	Impaired renal function
D	All of the above

Question 9

Which of the following contribute to LV remodeling ?

A	Myocyte hypertrophy
B	Altered contractile properties of myocyte
C	Progressive loss of myocytes
D	All of the above

Question 9 Explanation:

Adaptive changes within the myocardium is collectively referred to as LV remodeling. LV remodeling is a result of myocyte hypertrophy, altered contractile properties of myocyte, progressive loss of myocytes through necrosis, apoptosis, and autophagic cell death, betaadrenergic desensitization, abnormal myocardial energetics and metabolism and reorganization of extracellular matrix (organized structural collagen around myocytes being replaced by interstitial collagen matrix that is unable to provide structural support to myocytes).

Question 10

Which of the following act as a biologic stimuli in LV remodeling ?

A	Mechanical stretch of myocyte
B	Circulating neurohormones
C	Circulating inflammatory cytokines
D	All of the above

Question 10 Explanation:

All of the above

Question 11

Which of the following is best related to a failing cardiac myocyte ?

A	NCK-adaptor protein
B	SERCA2A
C	CD2-associated protein (CD2AP)
D	Giant cell line-derived neutrophilic factor (GDNF)

Question 11 Explanation:

Changes that regulate excitation-contraction include decreased function of sarcoplasmic reticulum Ca2+ adenosine triphosphatase (SERCA2A), resulting in decreased calcium uptake into SR, and hyperphosphorylation of ryanodine receptor, leading to calcium leakage from SR.

Question 12

Left ventricular remodeling refers to changes in which of the following ?

A	LV mass
B	LV volume
C	LV shape
D	All of the above

Question 12 Explanation:

Left ventricular remodeling refers to changes in LV mass, volume, and shape and the composition of heart that occur after cardiac injury and/or abnormal hemodynamic loading conditions.

Question 13

Dyspnea in HF is best related to ?

A	Juxtacapillary J receptors
B	Juxtacapillary K receptors
C	Juxtacapillary L receptors
D	Juxtacapillary M receptors

Question 13 Explanation:

Most important mechanism of dyspnea in HF is pulmonary congestion with accumulation of interstitial or intra-alveolar fluid, which activates juxtacapillary J receptors, which in turn stimulate the rapid, shallow breathing characteristic of cardiac dyspnea

Question 14

Dyspnea in HF may become less frequent with the onset of ?

A	Mitral regurgitation
B	Tricuspid regurgitation
C	Aortic regurgitation
D	Pulmonary regurgitation

Question 14 Explanation:

Dyspnea in HF may become less frequent with the onset of right ventricular (RV) failure and tricuspid regurgitation.

Question 15

Which of the following is a symptom of HF ?

A	Nocturia
B	Nocturnal cough
C	Early satiety
D	All of the above

Question 16

Orthopnea is caused due to redistribution of fluid from ?

A	Coronary circulation
B	Pulmonary circulation
C	Splanchnic circulation
D	Cerebral circulation

Question 16 Explanation:

Orthopnea (dyspnea occurring in recumbent position), results from redistribution of fluid from splanchnic circulation and lower extremities into central circulation during recumbency, with a resultant increase in pulmonary capillary pressure.

Question 17

In HF, paroxysmal nocturnal dyspnea (PND) occurs how many hours after the patient retires ?

A	15 - 30 minutes
B	1 - 3 hours
C	3 - 4 hours
D	5 - 6 hours

Question 18

In bedridden HF patients, edema may be found in ?

A	Interscapular region
B	Scrotum
C	Nape of the neck
D	All of the above

Question 18 Explanation:

In bedridden HF patients, edema may be found in sacral area (presacral edema) and scrotum.

Question 19

Which of the following statements is false ?

A	A normal ECG excludes LV systolic dysfunction
B	Majority of patients with chronic HF do not have evidence of pulmonary hypertension, interstitial edema, and/or pulmonary edema
C	Magnetic resonance imaging (MRI) is the gold standard for assessing LV mass & volumes
D	None of the above

Question 19 Explanation:

Majority of patients with chronic HF do not have evidence of pulmonary hypertension, interstitial edema, and/or pulmonary edema due to increased capacity of the lymphatics to remove interstitial and/or pulmonary fluid.

Question 20

Which of the following is useful in HF patients with a preserved EF ?

A	B-type natriuretic peptide (BNP)
B	N-terminal pro-BNP
C	Left atrial dilation by 2D Echo
D	All of the above

Question 20 Explanation:

By 2-D echocardiogram/Doppler, presence of left atrial dilation and LV hypertrophy, together with abnormalities of LV diastolic filling is useful for the assessment of HF with a preserved EF. B-type natriuretic peptide (BNP) and N-terminal pro-BNP are elevated in HF patients with a preserved EF, although to a lesser degree.

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See all quizzes of the Heart Failure and Cor Pulmonale at here:

Heart Failure and Cor Pulmonale- Part 1 | Heart Failure and Cor Pulmonale- Part 2

1.What percentage of patients who develop Heart failure (HF) have normal or preserved EF ?
A. 10 %
B. 20 %
C. 35 %
D. 50 %

2. Which of the following is a cadiac cytoskeletal protein ?
A. Desmin
B. Myosin
C. Vinculin
D. All of the above

3. Which of the following is not a cadiac cytoskeletal protein ?
A. Desmin

B. Myosin
C. Vinculin
D. Laminin

4. Which of the following condition does not lead to HF in a normal heart ?
A. Hypertension
B. Infiltrative disorders
C. Chagas’ disease
D. Arteriovenous fistula

5. In heart failure, which of the following compensatory mechanisms is activated after an index event ?
A. Adrenergic nervous system
B. Renin-angiotensin-aldosterone system
C. Cytokine system
D. All of the above

6. Which of the following is a vasodilatory molecule ?
A. Atrial and brain natriuretic peptides (ANP & BNP)
B. Prostaglandins (PGE2 & PGI2)
C. Nitric oxide (NO)
D. All of the above

7. Baroreceptors are located in which of the following locations ?
A. Left ventricle
B. Carotid sinus
C. Aortic arch
D. All of the above

8. Which of the following mechanism may be responsible in the development of HF with preserved EF ?
A. Diastolic dysfunction
B. Increased vascular stiffness
C. Impaired renal function
D. All of the above
9. Which of the following contribute to LV remodeling ?
A. Myocyte hypertrophy
B. Altered contractile properties of myocyte

C. Progressive loss of myocytes
D. All of the above

10. Which of the following act as a biologic stimuli in LV remodeling ?
A. Mechanical stretch of myocyte
B. Circulating neurohormones
C. Circulating inflammatory cytokines
D. All of the above

11. Which of the following is best related to a failing cardiac myocyte ?
A. NCK-adaptor protein
B. SERCA
2A
C. CD2-associated protein (CD2AP)
D. Giant cell line-derived neutrophilic factor (GDNF)

12. Left ventricular remodeling refers to changes in which of the following ?
A. LV mass
B. LV volume
C. LV shape
D. All of the above
.
13. Dyspnea in HF is best related to ?
A. Juxtacapillary J receptors
B. Juxtacapillary K receptors
C. Juxtacapillary L receptors
D. Juxtacapillary M receptors

14. Dyspnea in HF may become less frequent with the onset of ?
A. Mitral regurgitation
B. Tricuspid regurgitation
C. Aortic regurgitation
D. Pulmonary regurgitation

15. Which of the following is a symptom of HF ?
A. Nocturia
B. Nocturnal cough
C. Early satiety
D. All of the above

16. Orthopnea is caused due to redistribution of fluid from ?
A. Coronary circulation
B. Pulmonary circulation
C. Splanchnic circulation
D. Cerebral circulation

17. In HF, paroxysmal nocturnal dyspnea (PND) occurs how many hours after the patient retires ?
A. 15 – 30 minutes
B. 1 – 3 hours
C. 3 – 4 hours
D. 5 – 6 hours

18. In bedridden HF patients, edema may be found in ?
A. Interscapular region
B. Scrotum
C. Nape of the neck
D. All of the above

19. Which of the following statements is false ?
A. A normal ECG excludes LV systolic dysfunction
B. Majority of patients with chronic HF do not have evidence of pulmonary hypertension, interstitial edema, and/or pulmonary edema
C. Magnetic resonance imaging (MRI) is the gold standard for assessing LV mass & volumes
D. None of the above

20. Which of the following is useful in HF patients with a preserved EF ?
A. B-type natriuretic peptide (BNP)
B. N-terminal pro-BNP
C. Left atrial dilation by 2D Echo
D. All of the above

Heart Failure and Cor Pulmonale

[MCQ] Heart Failure and Cor Pulmonale- Part 1

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Heart Failure and Cor Pulmonale- Part 1

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