PCCN CARDIAC EXAM QUESTIONS
AND ANSWERS
Which of the following is one danger of open abdominal aortic aneurysm repair?
A. Obstruction of renal blood flow
B. Interference with coronary diastolic filling
C. Creation of pulmonary emboli
D. Pericardial tamponade - Answer- A. Obstruction of renal blood flow
Since the aneurysm is abdominal, pericardial tamponade and coronary artery blood flow
are unlikely. Pulmonary emboli arise from venous sources, not arterial. This eliminates
option C. Decreased renal perfusion due to surgical cross-clamping and perioperative
low flow may be issues with any open aortic procedure, making option A the best
answer.
Which of the following is NOT an indication for a CABG?
A. 75% narrowing of the left main coronary artery
B. 90% narrowing of the left anterior descending (LAD) coronary artery not amenable to
stenting
C. 80% narrowing of the right coronary artery amenable to stenting
D. Multiple-vessel disease - Answer- C. 80% narrowing of the right coronary artery
amenable to stenting
Single-vessel disease that is able to be stented is not an indication for CABG. Single-
vessel disease that cannot be stented, significant left main disease, and multiple-vessel
disease are indications for CABG.
Which blood vessel is commonly used as the graft vessel in a CABG?
A. Femoral vein
B. Axillary artery
C. A coronary artery that is unobstructed
D. Internal mammary artery - Answer- D. Internal mammary artery
The internal mammary artery (IMA) is a vessel of choice for CABG and is a gold
standard for bypass grafting. It is typically used to bypass the left main, left anterior
descending, or diagonal branches. The greater saphenous vein is also commonly used.
Some surgeons will use the radial artery or right internal mammary artery depending on
patient characteristics and surgeon preference.
Which of the following is the most common complication following open surgery to
repair a ruptured abdominal aortic aneurysm (AAA)?
A. Acute renal failure
,B. Mesenteric ischemia
C. Paralysis
D. Compartment syndrome - Answer- A. Acute renal failure
Approximately 50% of patients undergoing ruptured AAA repair will develop renal failure
and 20% will develop as MI. Mesenteric ischemia and paralysis are relatively
uncommon after this procedure, eliminating options B and C. Option D is somewhat
obscure and not enough information is given regarding it.
What is the most common type of aortic aneurysm?
A. Ascending thoracic
B. Descending thoracic
C. Abdominal
D. Aortic arch - Answer- C. Abdominal
Approximately 65% of aortic aneurysms are located in the abdomen. Options A, B, and
D may be more associated with aortic dissection rather than aortic aneurysms
Dissecting aneurysms present with several symptoms. Which of the following is NOT a
symptom of a dissecting abdominal aortic aneurysm?
A. Gastrointestinal bleeding
B. Severe abdominal pain
C. Pain radiating to the back
D. Palpable abdominal mass - Answer- A. Gastrointestinal bleeding
Abdominal aortic aneurysms may be palpable and cause severe abdominal pain that
radiates to the back. Dissecting aortic aneurysms are a surgical emergency and carry a
significant risk of mortality. Aortic aneurysms are not associated with GI bleeding.
Dissection of an artery occurs because of which type of injury to the blood vessel?
A. Intimal tear
B. Weakness of the entire vessel wall
C. Transects the arterial wall
D. Bleeding into an already formed aneurysm - Answer- A. Intimal tear
Dissections begin when there is damage to the intimal lining of the aorta. This intimal
"tear" allows for blood to create a false lumen between the aortic intima and the media,
which allows the dissection to develop. Option D is attractive since many patients with
dissections can also have aneurysms, but that is not the correct pathophysiology of
aortic dissection and not all dissections begin from aneurysms. Options B and C are not
correct because the entire vessel wall may not be weakened, and transection occurs in
blunt aortic injury.
Which of the following is the outermost lining of the heart?
A. Endocardium
B. Myocardium
C. Transcardium
D. Pericardium - Answer- D. Pericardium
"Endo" meaning "within" is associated with the innermost lining of the heart, so eliminate
A. The myocardium is associated with the heart's middle layer, so eliminate option B.
,The "transcardium" is somewhat of a contrived term, so eliminate C as well. The prefix
in pericardium, "peri" means "outside". Option D is the best answer.
Which of the following statements regarding the coronary sinus is correct?
A. It provides arterial blood flow to the lateral LV wall
B. It provides arterial blood flow to the sinus node
C. It is the main venous drainage vessel of the heart
D. It stimulates secretion of the atrial natriuretic factor - Answer- C. It is the main venous
drainage vessel of the heart
The lateral LV wall is supplied by the circumflex and the sinus node is supplied by the
RCA, so eliminate options A and B. It is atrial distension that stimulates the secretion of
atrial natriuretic factor, so eliminate D as well. The coronary sinus is best known as the
main venous drainage vessel of the heart. C is the best answer.
Of the following four factors, three determine stroke volume. Identify the factor that does
NOT affect stroke volume.
A. Preload
B. Afterload
C. Contractility
D. Capillary permeability - Answer- D. Capillary permeability
Options A, B. and C all influence stroke volume (i.e. the mLs of blood the LV ejects with
each beat). Preload reflects the filling of the LV, afterload is associated with the
resistance of LV ejection, and contractility impacts the strength of which that volume is
ejected. Secondarily, capillary permeability may ultimately affect the mLs pumped by
the LV with each beat, but the impact will be indirect. Choose D.
Which of the following are atrioventricular (AV) valves?
A. Mitral and tricuspid
B. Pulmonic and aortic
C. Mitral and aortic
D. Tricuspid and pulmonic - Answer- A. Mitral and tricuspid
This is a straight knowledge question. The mitral and tricuspid valves (Choice A) are
called the AV valves because they separate the atriums and the ventricles. An easy way
to remember these is to remember that L (left) and M (mitral) are close to one another in
the alphabet and are on the left side of the heart. R (right) and T (tricuspid) are also
close in the alphabet and are on the right side of the heart. The aortic and pulmonic
valves (all mentioned in B, C, and D) are called the semilunar valves. Choose A.
Two circumstances may produce a systolic murmur. One exists when backward flow of
blood (regurgitant flow) occurs through a valve that is normal closed during systole. The
second exists when blood has difficulty getting past a valve (stenosis) that is normally
easily opened. Which two situations may produce a systolic murmur?
A. Aortic stenosis and mitral regurgitation
B. Pulmonic regurgitation and tricuspid stenosis
C. Aortic and tricuspid stenosis
D. Pulmonic and mitral regurgitation - Answer- A. Aortic stenosis and mitral regurgitation
, During ventricular systole, the semilunar valves (aortic and pulmonic) should be open
and the AV (mitral and tricuspid) valves should be closed. Option A provides the only
scenario where this should be occurring. A quick test-taking strategy would be to
identify that both options C and D identify situations where both types of valves are in
stenosis or regurgitation at the same time, allowing you to rule out C and D options
quickly.
All of the following but one are considered key treatments in the management of HF.
Which one is NOT a key treatment in HF?
A. Angiotensin-converting enzyme (ACE) inhibitors
B. Beta blockers
C. Diuretics
D. Nitroprusside - Answer- D. Nitroprusside
Remember, in these negatively stated questions, the question is essentially asking,
"These are all key treatments EXCEPT ..." ACE inhibitors and beta blockers (such as
carvedilol) are standards of care in HF, so options A and B can be eliminated quickly.
Although diuretics are not associated with mortality benefit in HF, they are frequently
administered in HF and key to preload reduction and symptom relief in acute HF, so
eliminate C. Although afterload reducers are often adjunctive treatment in HF,
nitroprusside is less commonly administered compared to the other options and not
considered a standard of care in HF. Choose D.
Pericardial tamponade presents with all but one of the following symptoms. Identify the
symptom NOT associated with pericardial tamponade.
A. Equalization of left and right atrial pressures (CVP and PAOP)
B. LV failure without RV involvement
C. Hypotension
D. Distended neck veins - Answer- B. LV failure without RV involvement
In this negatively stated question, it suggests that all options are characteristics of
pericardial tamponade EXCEPT one option. An equalization of all cardiac filling
pressures, option A, is a classic finding due to circumferential external pressure on the
myocardium. Due to the fact that the pressure distribution is circumferential, both
ventricles WOULD BE involved, making option B the best answer. Hypotension (option
C) is a classic finding due to decreased LV filling, and distended neck veins (option D) is
a classic finding due to a compressed RA. Choose B.
Phase 0 of cellular impulse transmission refers to which phase of electrical action?
A. Depolarization
B. Early repolarization
C. End repolarization
D. Myocardial relaxation - Answer- A. Depolarization
Even if you were unsure of the correct choice initially, notice that options B, C, and D all
relate to repolarization and rest. Option A is the only option that refers to depolarization
as suggested by phase 0. Choose A.
AND ANSWERS
Which of the following is one danger of open abdominal aortic aneurysm repair?
A. Obstruction of renal blood flow
B. Interference with coronary diastolic filling
C. Creation of pulmonary emboli
D. Pericardial tamponade - Answer- A. Obstruction of renal blood flow
Since the aneurysm is abdominal, pericardial tamponade and coronary artery blood flow
are unlikely. Pulmonary emboli arise from venous sources, not arterial. This eliminates
option C. Decreased renal perfusion due to surgical cross-clamping and perioperative
low flow may be issues with any open aortic procedure, making option A the best
answer.
Which of the following is NOT an indication for a CABG?
A. 75% narrowing of the left main coronary artery
B. 90% narrowing of the left anterior descending (LAD) coronary artery not amenable to
stenting
C. 80% narrowing of the right coronary artery amenable to stenting
D. Multiple-vessel disease - Answer- C. 80% narrowing of the right coronary artery
amenable to stenting
Single-vessel disease that is able to be stented is not an indication for CABG. Single-
vessel disease that cannot be stented, significant left main disease, and multiple-vessel
disease are indications for CABG.
Which blood vessel is commonly used as the graft vessel in a CABG?
A. Femoral vein
B. Axillary artery
C. A coronary artery that is unobstructed
D. Internal mammary artery - Answer- D. Internal mammary artery
The internal mammary artery (IMA) is a vessel of choice for CABG and is a gold
standard for bypass grafting. It is typically used to bypass the left main, left anterior
descending, or diagonal branches. The greater saphenous vein is also commonly used.
Some surgeons will use the radial artery or right internal mammary artery depending on
patient characteristics and surgeon preference.
Which of the following is the most common complication following open surgery to
repair a ruptured abdominal aortic aneurysm (AAA)?
A. Acute renal failure
,B. Mesenteric ischemia
C. Paralysis
D. Compartment syndrome - Answer- A. Acute renal failure
Approximately 50% of patients undergoing ruptured AAA repair will develop renal failure
and 20% will develop as MI. Mesenteric ischemia and paralysis are relatively
uncommon after this procedure, eliminating options B and C. Option D is somewhat
obscure and not enough information is given regarding it.
What is the most common type of aortic aneurysm?
A. Ascending thoracic
B. Descending thoracic
C. Abdominal
D. Aortic arch - Answer- C. Abdominal
Approximately 65% of aortic aneurysms are located in the abdomen. Options A, B, and
D may be more associated with aortic dissection rather than aortic aneurysms
Dissecting aneurysms present with several symptoms. Which of the following is NOT a
symptom of a dissecting abdominal aortic aneurysm?
A. Gastrointestinal bleeding
B. Severe abdominal pain
C. Pain radiating to the back
D. Palpable abdominal mass - Answer- A. Gastrointestinal bleeding
Abdominal aortic aneurysms may be palpable and cause severe abdominal pain that
radiates to the back. Dissecting aortic aneurysms are a surgical emergency and carry a
significant risk of mortality. Aortic aneurysms are not associated with GI bleeding.
Dissection of an artery occurs because of which type of injury to the blood vessel?
A. Intimal tear
B. Weakness of the entire vessel wall
C. Transects the arterial wall
D. Bleeding into an already formed aneurysm - Answer- A. Intimal tear
Dissections begin when there is damage to the intimal lining of the aorta. This intimal
"tear" allows for blood to create a false lumen between the aortic intima and the media,
which allows the dissection to develop. Option D is attractive since many patients with
dissections can also have aneurysms, but that is not the correct pathophysiology of
aortic dissection and not all dissections begin from aneurysms. Options B and C are not
correct because the entire vessel wall may not be weakened, and transection occurs in
blunt aortic injury.
Which of the following is the outermost lining of the heart?
A. Endocardium
B. Myocardium
C. Transcardium
D. Pericardium - Answer- D. Pericardium
"Endo" meaning "within" is associated with the innermost lining of the heart, so eliminate
A. The myocardium is associated with the heart's middle layer, so eliminate option B.
,The "transcardium" is somewhat of a contrived term, so eliminate C as well. The prefix
in pericardium, "peri" means "outside". Option D is the best answer.
Which of the following statements regarding the coronary sinus is correct?
A. It provides arterial blood flow to the lateral LV wall
B. It provides arterial blood flow to the sinus node
C. It is the main venous drainage vessel of the heart
D. It stimulates secretion of the atrial natriuretic factor - Answer- C. It is the main venous
drainage vessel of the heart
The lateral LV wall is supplied by the circumflex and the sinus node is supplied by the
RCA, so eliminate options A and B. It is atrial distension that stimulates the secretion of
atrial natriuretic factor, so eliminate D as well. The coronary sinus is best known as the
main venous drainage vessel of the heart. C is the best answer.
Of the following four factors, three determine stroke volume. Identify the factor that does
NOT affect stroke volume.
A. Preload
B. Afterload
C. Contractility
D. Capillary permeability - Answer- D. Capillary permeability
Options A, B. and C all influence stroke volume (i.e. the mLs of blood the LV ejects with
each beat). Preload reflects the filling of the LV, afterload is associated with the
resistance of LV ejection, and contractility impacts the strength of which that volume is
ejected. Secondarily, capillary permeability may ultimately affect the mLs pumped by
the LV with each beat, but the impact will be indirect. Choose D.
Which of the following are atrioventricular (AV) valves?
A. Mitral and tricuspid
B. Pulmonic and aortic
C. Mitral and aortic
D. Tricuspid and pulmonic - Answer- A. Mitral and tricuspid
This is a straight knowledge question. The mitral and tricuspid valves (Choice A) are
called the AV valves because they separate the atriums and the ventricles. An easy way
to remember these is to remember that L (left) and M (mitral) are close to one another in
the alphabet and are on the left side of the heart. R (right) and T (tricuspid) are also
close in the alphabet and are on the right side of the heart. The aortic and pulmonic
valves (all mentioned in B, C, and D) are called the semilunar valves. Choose A.
Two circumstances may produce a systolic murmur. One exists when backward flow of
blood (regurgitant flow) occurs through a valve that is normal closed during systole. The
second exists when blood has difficulty getting past a valve (stenosis) that is normally
easily opened. Which two situations may produce a systolic murmur?
A. Aortic stenosis and mitral regurgitation
B. Pulmonic regurgitation and tricuspid stenosis
C. Aortic and tricuspid stenosis
D. Pulmonic and mitral regurgitation - Answer- A. Aortic stenosis and mitral regurgitation
, During ventricular systole, the semilunar valves (aortic and pulmonic) should be open
and the AV (mitral and tricuspid) valves should be closed. Option A provides the only
scenario where this should be occurring. A quick test-taking strategy would be to
identify that both options C and D identify situations where both types of valves are in
stenosis or regurgitation at the same time, allowing you to rule out C and D options
quickly.
All of the following but one are considered key treatments in the management of HF.
Which one is NOT a key treatment in HF?
A. Angiotensin-converting enzyme (ACE) inhibitors
B. Beta blockers
C. Diuretics
D. Nitroprusside - Answer- D. Nitroprusside
Remember, in these negatively stated questions, the question is essentially asking,
"These are all key treatments EXCEPT ..." ACE inhibitors and beta blockers (such as
carvedilol) are standards of care in HF, so options A and B can be eliminated quickly.
Although diuretics are not associated with mortality benefit in HF, they are frequently
administered in HF and key to preload reduction and symptom relief in acute HF, so
eliminate C. Although afterload reducers are often adjunctive treatment in HF,
nitroprusside is less commonly administered compared to the other options and not
considered a standard of care in HF. Choose D.
Pericardial tamponade presents with all but one of the following symptoms. Identify the
symptom NOT associated with pericardial tamponade.
A. Equalization of left and right atrial pressures (CVP and PAOP)
B. LV failure without RV involvement
C. Hypotension
D. Distended neck veins - Answer- B. LV failure without RV involvement
In this negatively stated question, it suggests that all options are characteristics of
pericardial tamponade EXCEPT one option. An equalization of all cardiac filling
pressures, option A, is a classic finding due to circumferential external pressure on the
myocardium. Due to the fact that the pressure distribution is circumferential, both
ventricles WOULD BE involved, making option B the best answer. Hypotension (option
C) is a classic finding due to decreased LV filling, and distended neck veins (option D) is
a classic finding due to a compressed RA. Choose B.
Phase 0 of cellular impulse transmission refers to which phase of electrical action?
A. Depolarization
B. Early repolarization
C. End repolarization
D. Myocardial relaxation - Answer- A. Depolarization
Even if you were unsure of the correct choice initially, notice that options B, C, and D all
relate to repolarization and rest. Option A is the only option that refers to depolarization
as suggested by phase 0. Choose A.
