Patho: Hormones, Cardio, Lymphatic Flashcards
(285 cards)
1
Q
2 adrenal cortex issues:
A
Excess androgens and excess aldosterone
2
Q
What secretes the most important factor in calcium regulation?
A
Parathyroid gland: PTH is the most important regulator of Ca++. While there are two pairs of parathyroid glands normally present, there may be two to six. They are small and located behind the thyroid gland. Thyroid hormone is produced by the thyroid gland and is unaffected by the parathyroid gland.
3
Q
ADH (aka ____) does what to blood pressure?
A
vasopressin, arginine vasopressin; increases peripheral resistance=increases vasoconstriction=increases BP
4
Q
Mineralocorticoid hormones cause sodium___ and loss of __ and ___.
A
retention; K+ and hydrogen
5
Q
What is needed for PTH (parathyroid hormone) function?
A
Vitamin D (cofactor)
6
Q
A disease where ACTH, TSH, FSH, LH, and GH are deficient due to ischemia, tumor, etc:
A
Panhypopituitarism
7
Q
The posterior portion of the pituitary is also known as ____ while the anterior is known as ____.
A
Neurohypophysis; Adenohypophysis
8
Q
Are water-soluble hormones hydrophilic or hydrophobic?
A
Hydrophilic
9
Q
ADH is realeased in response to __ level of sodium, __ level of water, or ___ blood pressure.
A
High sodium; low water; low BP
10
Q
How does the anterior pituitary regulate the thyroid gland?
A
The anterior pituitary synthesizes and releases thyroid-stimulating hormone (TSH), which travels in the bloodstream to the thyroid gland. It binds to a membrane receptor on thyroid cells and stimulates increased production and release of thyroid hormone. If the level of thyroid hormone is low, TSH synthesis is increased; if it is high, TSH synthesis is decreased.
11
Q
Where is the thyroid gland located?
A
The thyroid is a butterfly-shaped gland that sits low on the front of the neck on either side of the trachea. Your thyroid lies below your Adam’s apple, along the front of the windpipe. The thyroid has two side lobes, connected by a bridge (isthmus) in the middle.
12
Q
Hormone that causes an increase in progesterone in women and affects sertoli cells in men:
A
LH (luteinizing hormone)
13
Q
Affects growth and maturation of tissues, cell metabolism, heat production, and oxygen consumption.
A
Thyroid hormone
14
Q
3 effects of glucocorticoids:
A
Metabolic, anti-inflammatory, growth suppression
15
Q
What cells secrete glucagon?
A
Alpha cells in pancreas/islets of Langerhans
16
Q
With ___ disease, antibodies activate and produce T3/T4, whereas with ___, they destroy them
A
Grave’s; Hashimoto’s
17
Q
What are the parts of the adrenal glands?
A
Adrenal cortex–outer portion (has 3 layers) and Adrenal medulla–inner portion
18
Q
The posterior pituitary gland secretes:
a. ADH
b. PRF
c. TRH
d. GnRH
A
a. ADH
19
Q
How does Diabetes insipidus relate to ADH?
A
Insufficiency of ADH
20
Q
______ occurs when high concentrations of a hormone decrease the number of receptors.
A
Downregulation
21
Q
Complication of DM, usually in type 2’s, that leads to hyperosmolar state, hyperglycemia, can lead to CNS depression, and potential for coma
A
HHNKS (Hyperosmolar hyperglycemic nonketotic syndrome)
22
Q
What are the islets of Langerhans? Where are they located?
A
The islets of Langerhans are cellular masses lying in the interstitial tissue of the pancreas. They are endocrine glands composed of several cell types: alpha, beta, delta, and F.
23
Q
____-soluble hormones circulate in free, unbound forms and have a ___-acting response.
A
water-soluble; short
24
Q
Parathyroid hormone (PTH) increases serum ___ and decreases serum ___
A
Calcium; Phosphate
25
A symptom of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is:
a. Hyponatremia (diluational)
b. Hypernatremia (concentration)
c. Hyperosmolality (serum)
d. Hypoosmolality (urine)
a. Hyponatremia (dilutional)
The cardinal features of SIADH are symptoms of water intoxication. These include hyponatremia (low serum sodium), serum hypoosmolality, and urine that is inappropriately concentrated (hyperosmolar) with respect to serum osmolality.
26
3 hormones that are altered during Type 1 DM:
insulin, amylin, glucagon:
Lose insulin and amylin, but also lose regulation of glucagon b/c insulin and amylin both help to suppress glucagon normally; b/c they are both reduced, glucagon levels rise, which leads to hyperglycemia
27
__-soluble hormones don't need surface receptors while ___-soluble ones do bind to surface receptors.
Lipid-soluble; water-soluble
28
What is Addison disease?
A disorder in which the adrenal glands do not produce enough of the hormones cortisol and aldosterone; caused by an autoimmune response
29
Manifestations of Type 2 DM:
fatigue, pruritus, recurrent infections, visual changes, symptoms of neuropathy, often overweight, dyslipidemia, HTN, and hyperinsulinemic
30
Disease with signature "moon face" and "buffalo hump"
Cushing disease
31
What cells secrete pancreatic polypeptide?
F cells in pancreas/islets of Langerhans
32
Hypopituitarism (decreased functioning of the pituitary gland), caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth.
Sheehan Syndrome
33
Manifestations of hypoparathyroidism include ___calcemia, ___phosphatemia, and ___kalemia.
Hypocalcemia, Hyperphosphatemia, and Hypokalemia
34
Who is affected by Hyperaldosteronism?
people in their 30's-50's; females>males; african americans have a greater risk of fatality; rare in kids
35
What cells secrete calcitonin?
Parafollicular cells (C cells) of thyroid
36
What cells secrete insulin and amylin?
Beta cells in pancreas/islets of Langerhans
37
What does the Anterior Pituitary secrete:
```
ACTH
MSH
GH
LH
TSH
FSH
PRL
```
"All male giraffes like to feel pretty."
38
What are hormones? By what mechanisms do they function?
Hormones are chemical substances synthesized and secreted by endocrine glands and carried to other parts of the body in the blood. They are messengers that alter the function of the target organs by binding to receptors on the cell membranes or in the nuclei of target cells. The hormone-receptor binding initiates a signal to intracellular effectors that changes the function of the target cell.
39
Insulin secretion is promoted by what?
Increased blood levels of glucose, amino acids, GI hormones
40
What is the action of antidiuretic hormone (ADH)?
The primary action of ADH is the regulation of plasma osmolality by increasing the permeability of the distal tubules and collecting ducts of the kidneys and thus promoting reabsorption of water and decrease in osmolality. High doses of ADH also cause vasoconstriction. Although ADH and oxytocin have very different actions, they differ in structure by only two amino acids. They are both synthesized by the hypothalamus and move down the nerve axons of the pituitary stalk in vesicles to the posterior pituitary gland, where they are stored until needed. The release of both hormones is mediated by cholinergic neurotransmitters.
41
A symptom of a prolactinoma includes:
a. Galactorrhea
b. Alopecia
c. Excessive menses
d. Pregnancy
a. Galactorrhea
Galactorrhea is the spontaneous flow of milk from the breast, unassociated with childbirth or nursing. Amenorrhea (absence of menses), hirsutism (excessive body hair), and osteopenia can all be caused by a prolactinoma. Pregnancy is a normal cause of galactorrhea.
42
Where are the receptors located for lipid-soluble hormones?
Steroid hormone receptors are located primarily in the cytosol and nucleus but can be in the plasma membrane.
43
Where are hormone receptors located?
in the plasma membrane or in the intracellular compartment of the target cell
44
Are lipid-soluble hormones hydrophobic or hydrophilic?
Hydrophobic
45
Major part of the pituitary gland where hormones are produced and secreted:
Pars distalis (in Anterior Pituitary)
46
What is the most potent naturally occurring glucocorticoid, and how is its secretion related to that of adrenocorticotropic hormone (ACTH)?
Cortisol is the most potent naturally occurring glucocorticoid. It is secreted by the adrenal cortex in response to ACTH, an anterior pituitary hormone. There is a negative feedback relationship between the two hormones. If the cortisol level is elevated, ACTH release is inhibited; if the cortisol level is low, the anterior pituitary increases secretion of ACTH.
47
What is metabolic syndrome?
A grouping of health conditions associated with increased risk for heart disease and type 2 diabetes. Conditions include HTN, a large waist, high triglyceride levels, low HDL (good cholesterol-"highly desired"), and above normal blood glucose levels
48
An autoimmune disorder that causes hyperthyroidism. With this disease, your immune system attacks the thyroid and causes it to make more thyroid hormone than your body needs.
Grave's disease
49
Where are the adrenal glands located?
Close to the upper pole of each kidney
50
Manifestations resulting from excess cortisol:
Cushing syndrome
51
Which has greater potency, T3 or T4?
T3 has ten times greater potency
52
Are hormones released mostly with a negative or positive feedback system?
Negative
53
Hypocalcemia leads to ____ excitability of muscles/nerves
Increased
54
What is one of the first signs/symptoms of a pituitary tumor? Why?
Vision issues; not much room to grow and presses on the optic chiasma
55
Hormone secreted by parafollicular cells of the thyroid gland. It acts to reduce blood calcium, opposing the effects of parathyroid hormone
Calcitonin
56
Anabolic hormone made by the pancreas:
insulin: synthesis of proteins, lipids, and nucleic acids
57
What are some symptoms of Acromegaly?
Bones will become thicker/wider, especially the forehead, chin, larynx (voice changes), hands, and feet
58
Symptoms of this in females include amenorrhea, galactorrhea, hirsutism, and osteopenia:
Prolactinoma:
Prolactinoma is a benign noncancerous tumor of the pituitary gland that produces a hormone called prolactin. Prolactinomas are the most common type of pituitary tumor. Symptoms of prolactinoma are caused by hyperprolactinemia—too much prolactin in the blood—or by pressure of the tumor on surrounding tissues
59
What does oxytocin do?
Oxytocin is produced in the hypothalamus and is secreted into the bloodstream by the posterior pituitary gland. The two main actions of oxytocin in the body are contraction of the womb (uterus) during childbirth and lactation. Oxytocin stimulates the uterine muscles to contract and also increases production of prostaglandins, which increase the contractions further..
60
Class of corticosteroids produced in the adrenal cortex and influence salt and water balances.
Mineralocorticoids
61
Excessive secretion of ACTH, leading to excess cortisol is what disease?
Cushing disease
62
What is Conn disease?
Primary hyperaldosteronism
63
As calcium levels rise, ___ typically fall.
Phosphate levels
64
What does monoamine oxidase do?
Involved in removing the neurotransmitters norepinephrine, serotonin and dopamine from the brain
65
Signs/Symptoms of SIADH:
Related to enhanced renal water retention, hyponatremia (cerebral edema, decreased neuron and muscle excitability) and serum hypoosmolality; No peripheral edema but can see dyspnea upon exertion, weight gain and confusion, muscle twitching with decreasing levels of Na+ in plasma
66
Hormone produced by the Anterior Pituitary; affects neural cells and has analgesic effect (to reduce pain):
Beta-endorphins
67
If the outer two layers of the adrenal cortex are removed, the patient will experience:
a. Hypernatremia
b. Hyperkalemia
c. Hyperglycemia
d. Decreased Epinephrine
b. Hyperkalemia:
The outer two layers of the adrenal cortex produce aldosterone and glucocorticoids. Aldosterone deficiency would cause hyponatremia and hyperkalemia. A deficiency in glucocorticoids would result in hypoglycemia. Epinephrine would only decrease if the adrenal medulla was damaged or removed.
68
Hormone released from Anterior Pituitary that's involved in milk production:
Prolactin
69
____ is secreted in response to TSH. 90%__ and 10% ___.
Thyroid hormone; T4; T3
70
What form of thyroid hormone is biologically active?
Most thyroid hormone is transported in the blood bound to proteins (bound form). It is only the unbound form (free form) of the hormone that can interact with target cell receptors and be biologically active. Of the two types of thyroid hormones, T3 and T4, T3 is more biologically active. Most T4 is converted to T3 in the tissues for an effective target cell response to thyroid hormone.
71
What is the thinnest layer of the adrenal cortex and produces androgens?
Zona reticularis
72
Two siblings are diagnosed with a thyroid disorder due to destruction of thyroid tissue by lymphocytes and circulating thyroid autoantibodies. This pathology is likely the result of:
a. Subacute thyroiditis
b. Hashimoto disease
c. Painless thyroiditis
d. Postpartum thyroiditis
B. Hashimoto:
Hashimoto disease is also called autoimmune thyroiditis. It results in the gradual destruction of thyroid tissue by infiltration or lymphocytes and circulating thyroid autoantibodies. This disorder is linked with several genetic risk factors. Painless thyroiditis has a similar course to subacute thyroiditis, but is pathologically identical to Hashimoto disease. Subacute thyroiditis is a nonbacterial inflammation of thyroid often preceded by a viral infection. Postpartum thyroiditis generally occurs within 6 months of delivery and occurs in up to 7% of all women.
73
Disorder of the adrenal medulla caused by tumors derived from the chromaffin cells of the adrenal medulla and cause excess catecholamines:
Pheochromocytomas
74
Part of anterior pituitary that plays a large role in infancy but is less important as adults:
Pars intermedia
75
A patient is diagnosed with type 1 diabetes and is unable to produce insulin. The pancreatic cells that are most likely damaged are the:
a. Beta
b. Alpha
c. C-peptide
d. Delta
A. Beta
76
T4 is ___ bound to 4 ____; same with T3
Thyroglobulin bound to 4 iodine; T3 is thyroglobulin bound to 3 iodine
77
Severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs. It is a medical emergency with a high mortality rate
Myxedema coma
78
Steroid hormones are examples of ___-soluble hormones.
Lipid
79
How does aldosterone influence fluid and electrolyte balance?
Aldosterone causes reabsorption of sodium and water in the distal tubule of the kidneys. In exchange, potassium and hydrogen ions are excreted. An increase in aldosterone secretion, then, acts to increase blood volume.
80
Symptoms of Grave's disease:
Whole body: excess sweating, fatigue, heat intolerance, or high blood pressure
Heart: fast heart rate, irregular heart rate, or palpitations
Mood: anxiety or nervousness
Eyes: abnormal protrusion of eyes (exophthalmos) or puffy eyes
Also common: absence of menstruation, diarrhea, enlarged thyroid, hair loss, hand tremor, insomnia, irritability, muscle weakness, puffy skin changes on the shin, weight loss, Pretibial myxedema (edema in shin area)
81
DKA usually occurs in Type __ diabetics and HHNKS usually occurs in Type __ diabetics
type 1; type 2
82
An acute, life-threatening, hypermetabolic state induced by excessive release of thyroid hormones (THs)
Thyrotoxic crisis (thyroid storm)
83
Risk factors for Type 2 DM:
Age, obesity, hypertension, physical activity, and family history
84
What are 4 types of cells in the islets of pancreas?
Alpha, Beta, Delta, F cells
85
Manifestations of Hyperparathyroid include __calcemia, ___phosphatemia, kidney stones, and pathologic fractures.
Hypercalcemia; Hypophosphatemia
86
Autoimmune disease from macrophages and CD8 cytotoxic T cells attacking the pancreas' beta cells:
Type 1 DM
87
Which term describes “obvious changes in cell function that result from stimulation by a particular hormone”?
a. Upregulation
b. Downregulation
c. Direct effects
d. Permissive effects
c. Direct Effects:
Direct effects are obvious changes in cell function that specifically result from stimulation by a particular hormone. Permissive effects are less obvious and facilitate the maximal response or functioning of a cell. Upregulation is when low concentrations of a hormone increase the number of receptors per cell. Downregulation occurs when high concentrations of a hormone decrease the number of receptors.
88
Hypersecretion of GH (growth hormone) during adulthood=
Acromegaly
89
What is amylin?
Amylin is a peptide hormone that is cosecreted with insulin from the pancreatic β-cell and is thus deficient in diabetic people. It suppresses glucagon secretion, delays gastric emptying into duodenum, delays nutrient uptake, and acts as a satiety agent.
90
What are two different types of somatostatin?
Somatostatin from the hypothalamus inhibits the pituitary gland's secretion of growth hormone and thyroid stimulating hormone. In addition, somatostatin is produced in the pancreas and inhibits the secretion of other pancreatic hormones such as insulin and glucagon
91
Rare tumor of adrenal gland tissue. It results in the release of too much epinephrine and norepinephrine, hormones that control heart rate, metabolism, and blood pressure.
Pheochromocytoma
92
Name three parts of the Posterior Pituitary:
Median eminence, Stalk, Pars nervosa
93
What cells secrete somatostatin and gastrin?
Delta cells in pancreas/islets of Langerhans
94
____ and ___ are produced in neuronal cell bodies of the supraoptic and paraventricular nuclei in the hypothalamus. They are then transported along the axons of the hypothalamo-hypophyseal tract to the posterior pituitary, where they are stored.
ADH and oxytocin
95
Compare and contrast the actions of alpha, beta, delta, and F cells of the pancreas.
The alpha cells, located on the periphery of the islets of Langerhans, secrete glucagon, which increases blood glucose levels. The beta cells, in the middle of the islets, secrete insulin, which decreases blood glucose levels and promotes glucose uptake and use by target cells. The delta cells secrete gastrin (somatostatin), which regulates alpha- and beta-cell function. Finally, the F cells secrete pancreatic polypeptide, which inhibits gallbladder contraction and exocrine pancreas secretion of enzymes. All the pancreatic hormones participate in the regulation of carbohydrate, fat, and protein metabolism.
96
Most potent naturally occurring glucocorticoid =
Cortisol
97
A system of blood vessels in the microcirculation at the base of the brain, connecting the hypothalamus with the anterior pituitary. Its main function is to quickly transport and exchange hormones between the hypothalamus arcuate nucleus and anterior pituitary gland.
Hypothalamic hypophyseal portal system
98
Type of diabetes in adolescence/early adulthood with major genetic factor:
Maturity onset diabetes of youth (MODY)
99
Symptoms of Hyperthyroid:
```
Thin hair
Exopthalamos
Enlarged thyroid (warm on palpation, nodular, or solitary "toxic" nodule
Heart failure
Tachycardia
Weight loss
Diarrhea
Warm skin, sweaty palms
Hyperreflexia
Pretibial edema (in shins)
Heat intolerance
```
100
5 examples of Second messengers:
Calcium, cAMP, cGMP, Tyrosine kinase system, IP3
101
__-soluble hormones can pass through a membrane and bind to a receptor inside the cell while __-soluble cannot cross the membrane.
Lipid-soluble; water-soluble
102
What are catecholamines?
Catecholamines are the hormones epinephrine and norepinephrine, which are synthesized and secreted by the adrenal medulla. They have adrenergic actions similar to those of the sympathetic nervous system.
103
Hormone involved in increasing estrogen production in the ovaries and increased testosterone production in men:
FSH (follicle-stimulating hormone)
104
Name hormones secreted by the Posterior Pituitary:
ADH and Oxytocin
105
Symptoms of hypothyroid:
```
Loss of hair
Coarse, brittle hair
Periorbital edema
Puffy face
Normal or small thyroid
Heart failure
Bradycardia
Constipation
Cold intolerance
Muscle weakness
Edema of extremities
```
106
What is Adrenal/Addisonian crisis?
Acute adrenal crisis is a life-threatening condition that occurs when there is not enough cortisol/glucocorticoid/mineralocorticoid
107
What is the substance called that's inside follicles?
Colloid
108
Glucagon secretion is promoted by ___ blood glucose.
Decreased
109
Where are the islets of Langerhans located? What do they do?
Pancreas; Secretion of insulin and glucagon
110
Name the three parts of the Anterior pituitary:
1) Pars distalis (the major part)
2) Pars tuberalis
3) Pars intermedia
111
What is the relationship between the hypothalamus and the pituitary?
The hypothalamus is located at the base of the brain. It is connected to the pituitary gland by the pituitary stalk. The hypothalamus is connected to the anterior pituitary by way of the hypophysial portal blood vessels and to the posterior pituitary by way of a nerve tract referred to as the hypothalamohypophysial tract. Neurosecretory cells in the hypothalamus synthesize and secrete the hypothalamic-releasing hormones that regulate the release of hormones from the anterior pituitary and synthesize the hormones antidiuretic hormone and oxytocin that are released from the posterior pituitary gland.
112
The ____ is part of the epithalamus and secretes melatonin.
Pineal Gland
113
Symptoms of this in men include hypogonadism and erectile dysfunction:
Prolactinoma:
A prolactinoma is a benign noncancerous tumor of the pituitary gland that produces a hormone called prolactin. Prolactinomas are the most common type of pituitary tumor. Symptoms of prolactinoma are caused by hyperprolactinemia—too much prolactin in the blood—or by pressure of the tumor on surrounding tissues
114
A disease where you lose water at an excess rate. Manifestations are related to enhanced water excretion, hypernatremia, and serum hyperosmolality; polyuria and polydipsia
Diabetes insipidus
115
With Diabetes insipidus, will the urine be concentrated or unconcentrated?
Partial or total inability to concentrate the urine
116
Parathyroid causes ___ lysis and ___ release of calcium from bone, but at low levels will stimulate the incorporation of calcium into bone and plasma; used to treat osteoporosis, but at high levels can cause osteoporosis.
increased; increased
117
Hypersecretion of GH (growth hormone) during childhood/adolescence=
Giantism
118
What is meant by a negative-feedback regulation of hormone release?
Negative feedback occurs because the changing chemical, neural, or endocrine response to a stimulus negates the initiating change that triggered the release of the hormone. For example, thyroid-stimulating hormone (TSH) secretion from the anterior pituitary is stimulated by thyrotropin-releasing hormone (TRH) from the hypothalamus and by decreased serum levels of the thyroid hormones thyroxine (T4) and triiodothyronine (T3). Secretion of TSH stimulates the synthesis and secretion of thyroid hormones. Increasing levels of T4 and T3 feed back negatively on the pituitary and hypothalamus to inhibit TRH and TSH synthesis. Negative-feedback systems are important in maintaining hormones within physiologic ranges. The lack of negative-feedback inhibition on hormonal release often results in pathologic excessive hormone production.
119
What are the three layers of the adrenal cortex?
1) Zona glomerulosa: outermost layer (aldosterone is completed and released)
2) Zona fasciculata (aldosterone matures)
3) Zona reticularis (aldosterone starts here)
Remember: "GFR" (like kidneys' GFR)
120
How do first messengers differ from second messengers?
In water-soluble hormone-receptor interactions, the hormone itself is the first messenger. It binds to a receptor on the cell membrane of the target cell, initiating a signal that activates a second messenger located inside the cell. It is the second messenger that then signals the changes to be made in target cell function.
121
The adrenal medulla is innervated by _____ and contains ___ cells
the SNS; Chromaffin cells (pheochromocytes) (act like ganglion; secrete epinephrine and norepinephrine)
122
___-soluble hormones are primarily circulating bound to a carrier and have a ___-acting response.
Lipid-soluble; long-acting response
123
Small glands located behind the upper and lower poles of the thyroid gland:
Parathyroid glands
124
What hormone are steroids like Prednisone, dexamethasone, etc., based on?
Cortisol
125
Hyperaldosteronism can lead to ___ retention and excretion of ____
Sodium retention; excretion of K+
126
The antagonist of calcitonin =
PTH (parathyroid hormone)
127
Catecholamines promote __glycemia.
hyperglycemia
128
Hypophysiotropic hormone produced by neurons in the hypothalamus that stimulates the release of thyroid-stimulating hormone (TSH) and prolactin from the anterior pituitary
TRH (thyrotropin-releasing hormone)
129
Water-soluble hormones have a __-molecular weight.
high
130
Commonly caused by a benign, slow-growing pituitary adenoma; manifestations include headache, fatigue, Visual changes, and hyposecretion of neighboring anterior pituitary hormones:
Hyperpituitarism
131
Manifestations of Type one DM:
Hyperglycemia, Polydipsia, Polyuria, Polyphagia, Weight loss, fatigue
132
What is the most common endocrine malignancy? How is it treated?
Thyroid carcinoma; thyroidectomy, suppression therapy, radiation, and chemo
133
What is the most potent naturally occurring mineralocorticoid?
Aldosterone
134
Also known as chronic lymphocytic thyroiditis is the most common cause of hypothyroidism in the United States. It is an autoimmune disorder in which antibodies directed against the thyroid gland lead to chronic inflammation.
Hashimoto disease
135
Hormone released by the Anterior Pituitary; affects adipocytes and stimulates release of lipids into the blood:
Beta-lipotropin
136
What does the posterior pituitary arise from?
Neuron cell bodies in the hypothalamus
137
Which hormone is secreted by the anterior pituitary?
a. Androgen
b. Prolactin
c. Oxytocin
d. Thyroid
b. Prolactin:
Prolactin is secreted by the anterior pituitary. Androgen is secreted by the adrenal glands and gonads. Thyroid hormone is secreted by the thyroid gland. Oxytocin is secreted by the posterior pituitary
138
Largest layer of adrenal cortex, where cortisol is produced:
Zona fasciculata
139
Gastrin stimulates what?
Acid production in the stomach
140
Medication used to treat thyrotoxic crisis includes:
a. iodine
b. epinephrine
c. thyroid hormone
d. synthroid
a. iodine
Beta blockers, PTU (propylthiouracil), iodine, and supportive care are used to treat thyrotoxic crisis. The remaining options would not be considered therapeutic for this condition.
141
Hormones that have endocrine glands as their target are called ___ hormones.
Tropic
142
What can cause Secondary Hyperaldosteronism?
CHF, liver failure, dehydration, diuretics, fludrocortisone, BCP's, or pregnancy
143
Thyroid hormone is ___-soluble.
Lipid
144
A patient experiences nausea, vomiting, loss of body hair, fatigue, weakness, and hypoglycemia. The hormone deficiency the patient is most likely experiencing is that of:
a. TSH
b. ACTH
c. FSH
d. LH
b. ACTH
Within 2 weeks of complete absence of ACTH, symptoms of nausea, vomiting, anorexia, fatigue, and weakness develop. With absence of TSH, there is cold intolerance, dry skin, mild myxedema, lethargy, and decreased metabolic rate. FSH and LH deficiencies are associated with amenorrhea, atrophic vagina, uterus, breasts, decrease in body hair, and diminished libido.
145
T3's name is ___; T4 also known as ___
triiodothyronine; thyroxine
146
Chronic ____ can lead to secondary hyperparathyroidism
Chronic hypocalcemia: PTH is released to try to fix Ca++ problem
147
Hormone that is produced and released mainly by the stomach with small amounts also released by the small intestine, pancreas and brain; has numerous functions. It is termed the 'hunger hormone' because it stimulates appetite, increases food intake and promotes fat storage.
Ghrelin
148
The ___ secretes tropic hormones.
Anterior pituitary
149
T3 and T4 are __philic and __phobic.
Lipophilic; hydrophobic
150
Growth hormone needs an adequate amount of ___ hormone to have its full effects; this is called ___ effects.
Thyroid; permissive
151
SIADH is a disease of the ___pituitary. It causes ADH to be ____
Posterior; oversecreted
152
These hormones have direct effects on carbohydrate metabolism and Anti-inflammatory and growth-suppressing effects
Glucocorticoid hormones
153
The pancreas is both a ___ and ____ gland.
endocrine and exocrine
154
Which hormone is secreted by the posterior pituitary?
a. Oxytocin
b. Calcitonin
c. TSH
d. PTH
a. Oxytocin:
Oxytocin is secreted by the posterior pituitary. Calcitonin is secreted by the thyroid gland. TSH is secreted by the anterior pituitary. PTH is secreted by the parathyroid glands.
155
What the two physical tests for Hypocalcemia?
Chvostek's sign is the twitching of the facial muscles in response to tapping over the area of the facial nerve. Trousseau's sign is carpopedal spasm caused by inflating the blood pressure cuff to a level above systolic pressure for 3 minutes.
156
______ is when low concentrations of a hormone increase the number of receptors per cell.
Upregulation
157
___-soluble hormones need a carrier protein in the bloodstream.
lipid-soluble
158
A condition in which women develop male-pattern hair growth and other masculine physical traits due to adrenal glands producing excess testosterone
Virilization
159
What two organs are the sites of action of parathyroid hormone (PTH)?
PTH acts directly on bone to cause calcium and phosphate resorption and on the kidneys to cause calcium reabsorption and phosphate excretion.
160
_____ stimulates the production of cortisol.
ACTH
161
What is the role of melatonin?
Regulates circadian rhythms and reproductive systems; role in onset of puberty
162
```
A hormone not involved in sugar metabolism is:
A. Insulin
B. Glucagon
C. Aldosterone
D. Cortisol
```
C. Aldosterone
163
```
A possible symptom of an expanding pituitary tumor not related to hormones includes:
A. Visual disturbances
B. Muscle weakness
C. Respiratory depression
D. Hearing disturbances
```
A: visual disturbances
164
```
The regulation shown by a hormone feeding back on the organ that released it, in addition to the physiologic effect feeding back on that same producing/secreting organ that released the hormone is termed:
A. Long feedback loop
B. Positive feedback
C. Ultra short feedback loop
D. Short feedback loop
```
C
165
```
Besides having anti-inflammatory effects, cortisol (and thus most glucocorticoids) will also:
A. lower glucose levels in the blood
B. Stimulate growth of cells
C. Promote Na loss by the kidneys
D. Reduce protein synthesis in cells
```
D
166
Hyperthyroidism resulting from Graves disease will present with all of the following EXCEPT:
Exopthalmos
Increased levels of TSH (thyroid-stimulating hormone)
Pretibial myxedema
Increased heart rate and metabolism
B
167
```
Chromafin cells are found in the:
Anterior pituitary gland
Adrenal gland
Parathyroid gland
Pineal gland
```
B
168
```
Which of the following characteristics is typical of rapid and long lasting response hormones?
A. Binds to surface receptors
B. Carrier bound and lipid soluble
C. Dissolved in plasma, water soluble
D. High molecular weight
```
B
168
Which of the following is not a chronic complication of diabetes mellitus?
A. Retinopathy
B. Increased risk of infection
C. Paresthesias and neuropathy
D. All of the above are chronic complications of diabetes mellitus
E. Microvessel and peripheral vascular disease
D
168
```
Panhypopituitarism will result in a decrease in all of the following EXCEPT:
A. Oxytocin
B. Follicle-stimulating hormone
C. Thyroid-stimulating hormone
D. Growth hormone
```
A
169
Acromegaly, first developed as a 25 yo adult, will over time result in:
A. Decreased connective tissue and weakness of tendons/bones
B. Thickened bones, especially forehead and hands, plus proximal myopathy
C. Decreased blood levels of glucose
D. Increasing height leading to gigantism
B
170
11. Cytokines are chemical messengers that act on nearby cells and are thereby
Said to have ________ effects.
a. Hormonal
b. Neurohormonal
c. Autocrine
d. Paracrine
D
171
If anterior pituitary secretion is deficient in a growing child, the child will:
a. Mature sexually at an earlier than normal age.
b. Become a dwarf, but have fairly normal body proportions
c. Develop acromegaly
d. Be in constant danger of dehydration
B
172
13. The anterior pituitary secretes all of the following except:
a. Antidiuretic Hormone (ADH)
b. Growth Hormone
c. Thyroid stimulating hormone (TSH)
d. Gonadotropins
A
173
Negative feedback that T3 and T4 hormones of the thyroid gland have on
the hyopothalamus is an example of:
a. Long loop inhibition
b. Tropic inhibition
c. Somatic inhibition
d. Short loop inhibition
A
174
Which of the following is an accurate statement regarding regulation of
Pituitary hormone secretion by the hypothalamus?
A. All anterior hormones are regulated by a releasing hormones and a
release inhibiting hormone from the hypothalamus.
B. All posterior pituitary hormones are regulated by a releasing hormone
from the hypothalamus.
C. None of the above are correct.
D. All pituitary hormones are tropic hormones
E. All pituitary hormones are regulated by tropic hormones from the
Hypothatlamus
C
175
What percentage of the total beta cell population in the pancreas must
be destroyed before noticeable hyperglycemia occurs?
a.About 10%
b. About half (50%)
c. Between 80-90%.
d. Between 10-30
C
176
Gestational diabetes mellitus is best described as:
a. Diabetes caused by a viral infection
b.Subclinical damage to the beta cells that preceded onset of diabetes
c.Any degree of glucose intolerance with onset or first recognition during
pregnancy
d. Beta cell function or action affected by autosomal dominant mutations
C
177
Excessive levels of cortisol as a result of excessive anterior pituitary
a. Secretion is ACTH is termed:
b. Cushing syndrome
c. Addison disease
d. Cushing Disease
e. Graves disease
D
178
Insulin has effects on electrolytes as well, such as stimulating the movement of:
A. K+, PO4, Mg++ and amino acids into the cell
B. Na+ out of the cell
C. Ca++ into the cell
D. Cl- out of the cell
A
179
```
Which of the following stimulates the release of oxytocin?
A. Dehydration
B. Rising blood calcium levels
C. Rise in estrogen levels
D. Stimulation of the nipples
```
D
180
```
An important anabolic hormone which has many of its effects mediated by IGF’s is:
A. Growth hormone
B. Aldosterone
C. Cortisol
D. Luteinizing hormone
```
A
181
```
22. The alpha cells of the islets of Langerhans secretes:
A. Pancreatic polypeptide
B. Somatostatin and gastrin
C. Insulin
D. Glucagon
```
D
182
```
Hypocalcemia will result in all of the following EXCEPT:
A. Spasms, tetany, hyperreflexia
B. Hyperphosphatemia
C. Positive Chvostek and trousseau sign
D. Decreased neuromuscular excitability
```
D
183
```
Which of the following is NOT associated with hypothyroidism?
A. Constipation
B. Heat intolerance
C. Hashmoto’s thyroiditis
D. Myxedema coma
```
B
184
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) will result in all of the following EXCEPT:
A. Enhanced water retention
B. Increased plasma osmolarity (hyperosmolarity)
C. Hypersecretion of ADH
D. No peripheral edema, but muscle twitching may occur if increasing sensitivity
B
185
A hypodermic injection of epinephrine would:
A. Increase heart rate, increase blood pressure, dilate the bronchi and increase peristalsis
B. Increase heart rate, increase blood pressure, dilate the bronchi and decrease peristalsis
C. Decrease heart rate, increase blood pressure, constrict that bronchi and increase peristalsis
D. Decrease heart rate,decrease blood pressure, constrict bronchi and increase peristalsis
B
186
```
A secondary effect of the hormone is to inhibit release of gonadotropin releasing hormone, which decreases libido and fertility, and may be why there is some measure of birth control while exclusively breastfeeding a baby
A. Cortisol
B. T3 and T4
C. Oxytocin
D. Prolactin
```
D
187
Diabetes insipidus will show all of the following sign and symptoms EXCEPT:
A. Glucose in urine
B. Frequent urination
C. All of the above are found in diabetes insipidus
D. Stimulation of thirst reflex
A
188
All of the following are clinical effects of primary hyperaldosteronism EXCEPT:
A. Hypertension often resistant to treatment
B. Low K+ levels and increased K+ excreted in the urine
C. Increase renal Na+ retention and thus hypervolemia
D. Decreased neuromuscular excitability
D
189
```
A clinical feature of addison disease is:
A. Truncal (abdominal) obesity
B. Muscle wasting and thin extremities
C. Cardiac hypertrophy and hypertension
D. Hyperpigmentation
```
D
190
```
Decreased hypothalamic function of all associated hormones will result in a increase in the anterior pituitary production/release of:
A. Prolactin
B. Luteinizing hormone (LH)
C. Growth hormone (GH)
D. Thyroid stimulating hormone (TSH
```
A
191
In primary hyposecretion of the thyroid hormones,
A. None of the above are true
B. Levels of thyroid hormones in the blood decrease
C. All of the above are true
D. Levels of TSH in the blood decrease
B
192
Hormones affect only specific tissues because:
A. The blood carried to the specific tissues affected
B. The cells allow the hormones to cross their plasma membrane
C. Only cells with the matching receptor will be affected
D. Hormones are not specific and affect every cell
C
193
Which of the following statements is INCORRECT?
A. Metabolic syndrome is often described as a condition of hypertension, dyslipidemia (high triglycerides, low HDL) and above normal glucose levels
B. Type I diabetes is more commonly associated with diabetic ketoacidosis
C. Type II diabetes is more commonly associated with hyperosmolar non-ketotic syndrome
D. Type I diabetes develops rapidly and is not associated with obesity
D
194
Thyroid carcinoma is the most common endocrine cancer, and is most commonly caused by:
A. Parasite infection
B. Ionizing radiation, usually as a child or teen
C. Insufficient oxygen around the time of birth
D. Genetics and family history
B
195
```
Decreased hypothalamic function of all associated hormones will result in an anterior pituitary production/release of:
A. Thyroid stimulating hormone (TSH)
B. Prolactin
C. Luteinizing Hormone (LH)
D. Growth Hormone (GH
```
B
196
Absence of thyroxine would result in:
A. Increased heart rate and increased force of contraction
B. High metabolic
C. Exopthalmos
D. Depression of the CNS and lethargy
D
197
```
Calcitonin is secreted by the ___________ gland.
A. Adrenal
B. Parathyroid
C. Pituitary
D. Thyroid
```
D
198
The pineal gland is responsible for secretion of:
a. Insulin
b. Melatonin
c. ACTH
d. Prolactin
B
199
Which of the following is an example of permissiveness?
a. Glucagon increases blood glucose levels and insulin decreases blood glucose levels
b. All of the above
c. Estrogen stimulates the synthesis of progesterone receptors in the endometrium
d. None of the above
e. Glucagon, epinephrine and cortisol all increase blood glucose levels
D
200
Diabetic ketoacidosis occurs most directly as a result of _____ leading to increased lipolysis and formation of ketone bodies.
a. Increased stress hormones
b. Profound insulin insufficiency
c. Insulin resistance with a mild decrease in insulin
d. Hyperglycemia
B
201
Diabetes insipidus is best described as:
a. An inability to be able to dilute the urine
b. Water retention and weight gain
c. An insufficiency in ADH amount or response
d. Hyponatremia and decreased plasma osmolarity
C
202
While the primary stimulation of aldosterone secretion is angiotensin II, __________ can also directly stimulate secretion.
A. A drop in Na+ or rise in K+ plasma levels
B. Growth Hormone
C. Increased plasma glucose levels
D. Thyroid Hormone
A
203
If a cell undergoes up-regulation, its response to that matching hormone is:
A. More sensitive due to increase number or affinity of receptors
B. Reduced because of blockage of signaling mechanisms
C. Increased because of higher concentrations of hormone
D. Less sensitive due to decreased number or affinity of receptors
A
204
Primary hyperparathyroidism will result in:
A. Strengthening and widening of bones
B. Decrease in red blood cells production
C. Excessive PTH release and increased levels of plasma Ca++
D. Hyperphosphatemia
C
205
ADH and oxytocin are usually released from the pituitary in response to:
A. G protein mediated receptor binding
B. Rise in blood calcium levels
C.Direct stimulation by synapsing neurons
D. Release of hypothalamic releasing hormones
C
206
```
The hormone that causes reabsorption of Na+ irons in the kidneys is:
A. Growth hormone
B. Follicle stimulating hormone
C. Aldosterone
D. T3 and t4
E. Luteinizing hormone
```
C
207
```
Which of the following conditions is the most immediately at risk for serious complications?
A. Unstable angina
B. Prinzmetal angina
C. STEMI
D. NSTEMI
```
C
208
Thromboangiitis obliterans (Buergers disease) is an autoimmune condition that is:
A. A result of over activation of the intrinsic and extrinsic clotting system systemically
B. Characterized by attacks of vasospasm in the small arteries and arterioles of the fingers and toes
C. Strongly associated with smoking
D. Associated with janeway lesions and Oslers Nodes
C
209
Which of the following is not a systemic disease that is associated with Raynauds Phenomenon?
A. Congestive heart failure
B. Collagen vascular diseases such as scleroderma
C. Pulmonary hypertension
D. Myxedema or smoking
A
210
Rheumatic fever, and subsequent heart complications in 10% of individuals is left untreated arises from:
A. Bacteria, fungi, rickettes or viral infections
B. Sterile, autoimmune reaction (no infection involved)
C. Dyslipidemia
D. Group A beta-hemolytic strep pharyngitis
D
211
Which of the following is NOT a primary factor in determining preload?
A. Venous return during diastole
B. End systolic volume
C. Total peripheral (systemic) resistance
D. All of the above are primary factors of preload
C
212
Which of the following statements are incorrect?
A. The mean arterial pressure is the average force of pushing blood through the systemic circuit.
B. The pulse pressure is the difference between systolic and diastolic pressures
C. A decrease in aortic compliance increases its stiffness and thus can lead to an increase in pulse pressures
D. Prostacyclins, which are diminished by NSAIDs, are vasoconstrictors
D
213
Which of the following is incorrect regarding the isometric contraction phase of the cardiac cycle?
A. Blood does not flow through the heart at this time
B. The atria are contracting
C. The valves are closed
D. It occurs during ventricular systole
B
214
```
The resistance of movement of blood from the left ventricle to the aorta is termed the:
A. Ejection fraction
B. Compliance
C. Preload
D. Afterload
```
D
215
Natriuretic peptides act by:
A. Stimulates the retention of Na+ (and thus decreases urine volume) from the kidneys
B. Stimulated the release of Na+ (thus increases urine volume) from the kidneys
C. Increases vascular smooth muscle contraction (vasoconstriction
D. Stimulates increased heart rate, contractility, and cardiac output
B
216
```
The double layered serous membrane surrounding the heart that functions to minimize friction from the heart movement is the:
A. Myocardium
B. Endocardium
C. Peritoneum
D. Pericardium
```
D
217
Prinzmetal angina is
A. A transient ischemia of the myocardium that occurs unpredictably
B. Myocardial ischemia that may not cause detectable symptoms
C. Ischemia that occurs after a predictable amount of exercise
D. The rupture of an unstable plaque
A
218
```
Progressive venous distension of the head and upper extremities resulting from growth of a cancerous tumor on the right mainstem bronchus is best described clinically as:
A. Deep vein thrombosis
B. Spinal shock
C. Superior vena cava syndrome
D. Carcinoid syndrome
```
C
219
```
The most common cause of aneurysm is:
A. External Hematoma
B. Atherosclerosis
C. Genetics
D. Congestive heart failure
```
B
220
```
An atherosclerotic area that has ruptured is termed
A. Fibrous plaque
B. Complicated plaque
C. Fatty streak
D. Aneurysm
```
B
221
The PR interval represents the time from:
A. The onset of atrial systole to the completion of atrial diastole
B. The onset of atrial systole to the onset of ventricular diastole
C. The onset of atrial systole to the onset of ventricular diastole
D. The onset of atrial systole to the onset of ventricular systole
D
222
```
The circumflex artery off of the left coronary artery
A. Left atrium and ventricle
B. The two atria
C. The two ventricles
D. The aorta and the pulmonary artery
```
A
223
```
A mitral valve prolapse would be heard during
A. Ventricular systole
B. Atrial systole
C. Isovolumetric relaxation phase
D. Ventricular diastole
```
A
224
Hypertensive crisis (malignant hypertension) is best defined as:
a. An advancing failure of systemic circulation as the heart weakens
b. Rapidly progressive hypertension with a diastolic pressure of 140 mmHg or more
c. A pulse pressure of greater than 60
d. Blood pressure readings consistently greater than 140/90 mmHg
B
225
```
Intermittent claudication is:
A. Caused by coronary artery disease
B. A sign of peripheral artery disease
C. An attack of vasospasm brought on by the cold
D. A result of peripheral neuropathy
```
B
226
```
A patient presents with fever, diffuse microemboli presenting as petechial lesions, painful lesions on the fingertips and what looks like non-tender bruising on both hands is most indicative of which disease process?
A. Infective endocarditis
B. Rheumatic fever
C. HIV infection
D. Tuberculosis
```
A
227
Stroke volume:
A. Does not affect the cardiac index
B. Is equal to ESV - EDV
C. Does not vary much
D. None of the above are true
D
228
```
A T wave relates to ______ and shortly precedes the closure of the______ valves.
A. Ventricular depolarization, AV
B. Ventricular depolarization, SL
C. Ventricular repolarization, AV
D. Ventricular repolarization, SL
E. None of the above
```
D
229
```
How much of the oxygen carried by hemoglobin in the blood is actually transferred to the myocardium?
A. 10-20%
B. 40-50%
C. 70-75%
D. 100%
```
C
230
```
The key regulator determining if a muscle, such as cardiac muscle, contracts or not is the presence of:
A. Ca++
B. ATP
C. K+
D. Epinephrine
```
A
231
Myocardial hibernation is best described as:
A. Myocardial cells that are persistently ischemic and undergo metabolic adaptation to prolong survival
B. Hypertrophy that occurs
with loss of contractile function
C. Temporary loss of contractile function that persists for hours to days after restoration of perfusion
D. Fibroblast proliferation and severe inflammatory response
A
232
```
A thrombus is a blood clot that remains attached to a vessel wall. Which of the following is NOT one of the main factors as proposed by Virchow?
A. Obesity
B.Venous Stasis
C. Venous Endothelial damage
D. Hypercoagulable states
```
A
233
A 12-year-old boy presenting with complaints of fever, pink macular rash on the trunk and finding of diastolic murmur on the exam should be investigated for possible:
A. Restrictive cardiomyopathy
B. Dilated(congestive) cardiomyopathy
C. Rheumatic fever
D.Tuberculosis
C
234
```
The decreased or inability to generate action potential due to hyperpolarization or continued closure of inactivation gates is termed:
A. Rhythmicity
B. Quiesence
C. Refractory period
D. Afterload
```
C
235
```
All of the following antihypertensive agents would be appropriate first line treatments EXCEPT:
A. Calcium channel blockers
B. Beta blockers
C. Ace inhibitors or ARB’s
D. Diuretics such as Thiazide
```
B
236
```
STEMI would most like present with:
A. Inverted T waves and Q waves
B. Peaked T waves
C. Marked ST segment elevation
D. Absence of troponin I or T
```
C
237
```
What area is of the myocardium is affected by STEMI?
A. Transmural (entire wall thickness)
B. Subendothelial area
C. Just the right side
D. Only the atria
```
A
238
```
The disorder of the myocardium that expands overall intracardiac volume and leads to heart failure is:
A. Dilated (congestive) cardiomyopathy
B. Hypertrophic cardiomyopathy
C. Hypertensive cardiomyopathy
D. Valvular hypertrophic cardiomyopathy
E. Restrictive cardiomyopathy
```
A
239
Which of the following is a correct statement regarding baroreceptor reflex activity on the heart?
A. A drop in blood pressure would result in release of natriuretic peptides
B. A drop in blood pressure would result in reflex to decrease heart rate, contractility, and peripheral resistance
C. A rise in blood pressure would result in reflex to increase heart rate, contractility , and peripheral resistance
D. A drop in blood pressure would result in reflex to increase heart rate, contractility, and peripheral resistance
D
240
Which of the following is NOT a primary factor in determining preload?
A. Venous return during diastole
B. End systolic volume
C. Total peripheral (systemic) resistance
D. All of the above are primary factors of preload
C
241
```
A mitral valve prolapse would be heard during:
A. Atrial systole
B. Isovolumetric relaxation phase
C. Ventricular systole
D. Ventricular diastole
```
C
242
Which of the following statements regarding compliance and elasticity is correct?
A. Compliance and elasticity are directly related (i.e. as one increases, so does the other)
B. Elasticity is the ease by which a wall, like a vessel wall, will stretch in response to increases in pressure
C. A decrease in compliance, such as the aorta, means that it is stiffer and less easy to expand
D. As elasticity increases, the ease by which a vessel can expand increases as well
C
243
The isovolumetric contraction phase of the cardia life cycle occurs:
A.During atrial systole
B.When the AV valves are closed
C.When the SL valves are open
D.During diastole
B
244
Choose the correct conduction pathway for a cardiac action potential:
A. SA node to AV node to bundle branches to the Bundle of HIS to purkinje fibers
B. SA node to AV node to Purkinje fibers to bundle of HIS to bundle branches
C. SA node to bundle of HIS to AV node to bundle branches to purkinje fibers
D. SA node to AV node to bundle of HIS to bundle branches to purkinje fibers
D
245
Which of the following vessels carries oxygenated blood?
A.Inferior vena cava
B. Superior vena cava
C. Pulmonary artery
D. Pulmonary Vein
E.Inferior vena cava and superior vena cava
D
246
```
Which of the following valve abnormalities is heard during diastole (diastolic murmur)? (Hint: Think when blood should and should not flow past these structures in terms of diastole/systole)
A. Aortic stenosis
B. Mitral Valve Prolapse
C. Tricuspid Regurgitation
D. Mitral Stenosis
```
C
247
Which of the following can form an embolus?
A. Fat
B. Amniotic Fluid
C. Air
D. Bacteria, especially within clots
E. All of the above can become an embolus
E
248
An increase in Ca++ influx, brought about by catecholamines binding to beta receptors on the myocardium will result in:
A. An increase in cardiac contractility
B. An increase in speed of heart rate and electrical conduction through the heart
C. An increase in preload
D. Both an increase in contractility and heart rate / conduction speed
D
249
Myocardial infarction that shows an inverted T wave and ST segment depression is most likely a result of:
A. Non-STEMI (Non-ST elevation myocardial infarction)
B. STEMI (ST segment elevation myocardial infarction)
C. Transmural myocardial infarction
D. Myocardial stunning
A
250
The term vegetation as discussed in the cardiovascular lecture refers to:
a. Infiltration of sterile thrombi by bacteria
b. Myocardial cells that are inactive due to chronic ischemia
c. Temporarily non-contractile myocardial cells following reperfusion
d. Hemorrhagic, non-tender lesions on the hands
A
251
The T wave is an electrical recording resulting from:
a. Ventricular depolarization
b. Ventricular repolarization
c. Atrial depolarization
d. Atrial repolarization
B
252
As a result of the Starling effect, stroke volume should increase following an increase in:
a. Mean arterial pressure (MAP)
b. Heart rate
c. Sympathetic activity
d. Afterload
e. Preload
E
253
The light band in cardiac and skeletal muscle that varies by degree of contraction is termed the:
a. I band
b. A band
c. M line
d. Z disc
A
254
Which characteristic changes should the nurse keep in mind while caring for a patient with left heart failure? As left heart failure progresses:
A. Left ventricular preload increases
B. Systemic vascular resistance decreases
C. Left end-diastolic volume decreases
D. The pulse pressure widens
A
255
Myocardial remodeling of the affected area is a process that results in:
A. Myocardial cells that are persistently ischemic and undergo metabolic adaptation to prolong survival
B. Hypertrophy that occurs with loss of contractile function
C. Temporary loss of contractile function that persists for hours to days after restoration of perfusion
D. Fibroblast proliferation and severe inflammatory response
B
256
```
The portion of troponin that binds the troponin complex to actin and is released into the plasma during cardiac cell damage (and is thus a useful indicator of an acute MI) is troponin:
A. I
B. M
C. C
D. T
```
D
257
Arterial chemoreceptors within the aortic arch and carotid arteries:
A. Increase heart rate, stroke volume, and blood pressure in response to decreased oxygen or increased CO2 levels
B. Will stimulate vascular smooth muscle constriction in response to low oxygen levels
C. Detects oxygen but not carbon dioxide or hydrogen ion levels in the plasma
D. Triggers the release of insulin when hyperglycemia is detected
A
258
```
The ____ is an opening for venous drainage to empty into the right atrium.
A. Aortic ostia
B. Circumflex vein
C. Great cardiac vein
D. Coronary sinus
```
D
259
A result of the action potential’s long duration in stimulating muscle is that:
A. Summation cannot occur regardless of how strong the stimulus
B. Cardiac muscle cannot go into tetanus and lock up in contracted position
C. Cardiac muscle has a long refractory period
D. All of the above are true
D
260
What is the effect of decreasing O2 and increasing CO2 levels (hypoxemia) on myocardial contractility?
A. Only decreases contractility
B. Only increases contractility
C. Decreases at less severe (O2 sat>50%) but increases at more severe hypoxemia
D. Increases at less severes (O2 sat>50%) but decreases at more severe hypoxemia
D
261
A common and overlooked cause of chronic orthostatic hypertension is:
A. Abdominal aneurysm
B. Cerebral aneurysm in the Circle of Willis
C. Increased peripheral resistance caused by peripheral vascular disease
D. Autonomic neuropathy in persons with diabetes.
D
262
Secondary hypertension is best described as:
A. Of unknown causes
B. As a result of an identifiable condition such as pheochromocytoma.
C. The most common cause of hypertension in the United States.
D. Not likely to affect the heart
B
262
Which of the following factors is NOT commonly associated with the development of hypertension?
A. Obesity
B. Insulin resistance
C. Altered Natriuretic peptide hormones and salt retention
D. High dietary levels of Ca++ K+ and Mg
D
262
Your patient with a history of coronary artery disease ad regular chest pain brought on by
exercise of certain duration now has significant and worsening chest pain, sweating, and mild dyspnea. Which of the following statements is true regarding this patient?
A. He has unstable angina
B. He is at significant risk of an infarction soon
C. The pain is a signal that an atherosclerotic plaque has just ruptured in a coronary vein
D. All of the above are true
D
263
The disorder of the myocardium that is characterized by normal systolic but increased
diastolic pressure due to abnormal filling of either or both ventricles and normal wall
thickness is:
A. Dilated (congestive) cardiomyopathy
B. Hypertrophic cardiomyopathy
C. Valvular hypertrophic cardiomyopathy
D. Restrictive cardiomyopathy
D
264
```
An aortic semilunar valve prolapse would best be heard during:
A. Ventricular systole
B. Ventricular diastole
C. The entire cardiac cycle
D. None of the above
```
B
265
In cardiac muscle, Na+ inactivation gates will open again following another depolarization to potentially occur when:
A. The membrane potential reaches 0mV.
B. When the membrane returns to resting potential
C. K+ channels are closed
D. Membrane potential reaches threshold
B
266
```
Which of the following valvular abnormalities does NOT result in a potential for dyspnea and pulmonary edema?
A. Mitral valve prolapse
B. Tricuspid valve regurgitation
C. Aortic Stenosis
D. Mitral Stenosis
```
B
267
```
Your patient describes chest pain that has been regularly showing up, generally following exercise of a specific duration/intensity. You know he was a smoker, is overweight with poor diet and was recently shown to have hyperlipidemia through recent blood tests, The chest pain is most likely:
A Intermittent claudication
B. Unstable angina
C. Stable Angina
D. Prinzmetal angina
```
C
268
Which of the following is not a systemic disease that is associated with Raynaud phenomenon?
A. Congestive heart failure
B. Collagen vascular disease such as scleroderma
C. Pulmonary hypertension
D. Myxedema or smoking
A
269
Which of the following is NOT a risk factor for varicose veins?
A. Age > 40 yrs
B. High estrogen levels (pregnancy or BCP)
C. Obesity
D. Prior injury in the vein/leg
E. All of the above are risk factors for varicose veins
E
270
```
The cells of the cardiac conduction system (SA node, AV node, Purkinje fibers) have a unique property that allows a steady leakage toward depolarization during the diastolic phase of the cardiac cycle. This property is called:
A. Automaticity
B. Excitability
C. Refractory periods
D. Preload
```
A
271
```
As a wave of action potentials travel from the atria to the ventricles, it is momentarily delayed by about 0.1 second as a result of slow conduction through the:
A. SA node
B. AV node
C. Atrioventricular bundle (of his)
D. Left and right bundle branches
E. Purkinje fibers
```
B
272
The area that connects cardiac fibers to one another as well as electrically connecting them is termed:
A. The z disc
B. The M line
C. The intercalated disk
D. The A band
C
273
Which of following effects does the renin angiotensin aldosterone system (RAAS) directly affect in the development of hypertension?
A. Salt, water and increased vascular resistance
B. Endothelial dysfunction, insulin resistance, and platelet aggregation
C. Arteriolar remodeling making the increase vascular resistance permanent
D. Increase in heart rate and stroke volume, thus increasing cardiac output
D
274
Myocardial stunning refers to the
A. Myocardial cells that are persistently ischemic and undergo metabolic adaptation to prolong survival
B. Hypertrophy that occurs with loss of contractile function
C. Temporary loss of contractile function that persists for hour to days after restoration of perfusion
D. Fibroblast proliferation and severe inflammatory response
C
275
Identify the correct path of blood through the heart and lungs
A. Vena cava → L Atrium → Tricuspid valve → L ventricle → Pulmonary artery→ Pulmonary vein → R atrium → Mitral valve → R Ventricle
B. Vena Cava → Right atrium → Tricuspid valve → Right ventricle → Pulmonary vein → Pulmonary artery → Left Atrium → Mitral valve → Left Ventricle → Aorta
C. Vena Cava → R Atrium → Tricuspid valve → Right ventricle → Pulmonary artery → L Atrium → Mitral valve → L Ventricle → Aorta
D. Vena Cava → R atrium → Mitral valve → R Ventricle → Pulmonary artery → Pulmonary vein → L atrium → Tricuspid valve → L Ventricle → Aorta
C
276
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The innermost layer of the heart wall (inner lining layer) is the:
A. Epicardium
B. Myocardium
C. Endocardium
D. Pericardium
```
C
277
Which of the following is most likely to increase ejection fraction?
A. Sympathetic nervous system activation
B. Parasympathetic nervous system activation
C. An acute MI affecting the left ventricle
D. Increased afterload
A
278
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The volume/pressure inside the ventricle at the end of diastole is termed the:
A. Ejection fraction
B. Cardiac output
C. Preload
D. Afterload
```
C
279
Which of the following in an INCORRECT statement related to Poiseuille’s law?
. A. The resistance to flow is directly proportional to the vessel length
. B. The resistance to flow is inversely proportional to blood viscosity.
. C. The resistance of flow is inversely related to the radius of tube to the 4th power.
. D. The flow of blood is directly to the flow of the lumen
B
280
Myocardial remodeling of the affected area is a process that results in:
A. Myocardial cells that are persistently ischemic and undergo metabolic adaptation to prolong survival
B. Hypertrophy that occurs with loss of contractile function
C. temporary loss of contractile function that persists for hours to days after restoration of perfusion
D. Fibroblast proliferation and severe inflammatory response
B
281
Which of the following statement is correct?
A. The resistance to blood flow increases as the cross sectional area increases
B. The speed of blood flow decreases as the cross sectional area increases
C. The resistance to flow is indirectly proportional to blood viscosity
D. The resistance to blood flow of many vessels increases if they are in parallel as compared to the area around
B
