PCCN Cardiac Questions & answers 2023/2024

PCCN Cardiac Questions & answers 2023/2024Which of the following is the outermost lining of the heart? A. Endocardium B. Myocardium C. Transcardium D. Pericardium - correct 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 - correct 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 - correct 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 - correct 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 - correct 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 - correct 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 - correct 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