1) A 70 year old woman has had difficulty in breathing, she has been diagnosed with acute pulmonary edema. Which of the following therapies is more beneficial?

A)     Place tourniquets on all four limbs

B)      Infuse red blood cells and fresh frozen plasma

C)      Infuse saline

D)     Infuse dobutamine

E)      Infuse norepinephrine

A)     Place tourniquets on all four limbs

A 6 month old male infant is referred by his pediatrician to ER because of persistent vomiting.  The mother appears inept, and upon questioning, the physician learns that salt was most likely substituted for sugar in the infant's formula.  Which of the following sets of changes best describes the infant's body fluid volumes and osmolarity compared with a healthy infant?

            ECF Vol

            ICF Vol

                          EC Osmolarity

                           IC Osmolarity

 ICF Vol decreases

            EC Osmolarity increases

            IC Osmolarity increases

A 55yr. old woman with a 5 yr. history of hypertension visits her physician for examination. Laboratory test results indicate that the patient has plasma renin activity three or four times higher than normal. The patient is given a prescription for Captopen, an angiotensin II converting enzyme (ACE) inhibitor. An increase in which of the following would you expect to occur in this patient after administration of the ACE inhibitor?

A.      Total Peripheral Resistance

B.      Arterial Pressure

C.      Angiotensin I

D.      Aldosterone

E.       Atrial natriuretic peptide

.  A 65-year-old woman with a 10-year history of essential hypertension visits her physician for an examination.  Laboratory test results indicate that the patient has plasma rennin activity two or three times higher than normal.  The patient is given a prescription for Captopen, an angiotensin II converting enzyme (ACE) inhibitor.  An increase in which one of the following would you expect to occur in this patient after administration of the ACE inhibitor?

A. Total Peripheral resistance

B. Arterial pressure

C. Angiotensin II

D. Aldosterone

E. Kidney’s ability to excrete sodium

Which one of the following sets of changes would be expected to increase sodium excretion by the kidney?

A 55 year-old woman is diagnosed with a secreting adrenal cortex tumor. Laboratory tests reveal a plasma concentration of aldosterone five times above normal. Which one of the following sets of findings would be expected in this woman?

blood pressure

blood volume

plasma rennin activity

increase blood pressure

increase blood volume

decrease plasma rennin activity

A 45 year-old man with ahistory of normal health visits his physician for a check-up.  During his physical examination, it was revealed that his blood pressure was 170/98  mmHg.  Additional tests indicated that he had renovascular hypertension as a result of a stenosis in the left kidney.  Which one of the following sets of findings would be most likely expected int his man with renovascular hypertension?

renal blood flow

plasma renin

aldosterone

G: renal blood flow (down), plasma renin (up), aldosterone (up)

A 50-year-old man has a 3-year-history of hypertension.  He has been on several medications without ever having good blood pressure control.  He has been off medications entirely for the past six months.  He complains of fatigue and occasional muscle cramps.  There is no family history for hypertension.  The patient has not had any significant medical problems in the past.  Examination reveals a blood pressure of 168/104 mmHg. Additional laboratory tests indicate that the patient has primary hyperaldosteronism.  Which one of the following sets of findings would be most likely expected in this man with primary hyperaldosteronism hypertension?

40 y.o woman with history of DM for 16 yrs visited the  ER, where it was discovered that she had a bp of 270/110. She had her bp measured many time in the past and has never been known to be hypertensive. She also complains of pedal edema, which has been gradually progressive. She denies polyuria, polydipsia, or symptoms of hypoglycemia Her insulin regimen is 20 units of Humilin in the morning and 10 units in the afternoon.

                Lab tests revealed the following vallues (with normal in parenthesis).
                                BUN--33 (9 to 20)
                                Creatinine--2.7 (0.7 to 1.4)
                                GLucose --296 (74 to 106)
                                Total Protein --6.2 (6.3 to 8.2)
                                Albumin--3.0 (3.5 to 5.1)
                                Cholesterol --320 (120 to 199)
                                Urinalysis 3+ proteinuria
 …  A decrease in which one of the following would best explain the increase in blood pressure in this patient?
                A. Angiotensin II
                B. Aldosterone
                C. Sympathetic Nerve Actvity
                D. Glomerular Filtration Rate
                E. Endothelin

A 45 yo woman was seen by her physician for an upper respiratory infection. Her bloo pressure on that visit was 158/94 mm Hg. She was asked to return on two other visits, separated by 1 week each, for measurement of blood pressure.  Repeat measures were similar. She has no hx of hypertension. She denies any previous significant medical problems. There is a positive family hx of HTN.  The rest of her hx is unremarkable.  Other than moderate obesity and the elevated BP, her physical examination was completely normal. All routine labs were normal. Which of the following diagnoses would you predict for this woman?

a. renovascular HTN                             

b. primary hyperaldosteronism

C. essential HTN

d. phenochromoctyoma

e. modereate aortic valve regurgitation

C. essential HTN

A 55 year old man with history of normal health visits his physician for a check-up. During his physical exam, his blood pressure was 170/98 mm Hg. Also had renovascualr HT as a result of a stenosis in the left kidney. Which one of the following set of findings is most likely in this man with renovascular HT?

TPR

PR

Aldosterone

TPR: increases

PR: increases

Aldosterone: increases

A decrease in which one of the following would most likely result in chronic hypertension?

A: renal sympathetic nerve activity

B: Aldosterone

C: Angiotensin II

D: Nitric oxide

D: Nitric oxide

An echocardium was performed on a 5-year-old boy. The results indicated thickened right and left ventricles. Arterial oxygen concentration is normal. What condition does the boy have?
                A. Tetralogy of Fallot
                B. Mild aortic insufficienc

                C. Patent ductus arteriosus

                D. Tricuspid stenosis
                E. Mild mitral stenosis

The second heart sounds is associated with which one of the following?

                a.) In-rushing of blood into the ventricles due to atrial contraction

                b.) closing of the atrioventricular (A-V) valves

                c.) closing of the pulmonary valve

                d.) opening of the A-V valves

                e.) In-rushing of blood into the ventricles in the early to middle part of diastole

c.) closing of the pulmonary valve

A 40 year-old female patient has been diagnosed with a heart murmur.  The radiograph shows an enlarged heart but no fluid on the lungs.  Pulmonary capillary pressure is normal.  What is the diagnosis?

A: Aortic stenosis

B: Aortic regurgitation

C: Pulmonary valve stenosis

D: Tricuspid stenosis

E: Mild mitral regurgitation

C: Pulmonary valve stenosis

The third heart sound is associated with which of the following?

A: In-rushing of blood into the ventricles due to atrial contraction

B: Closing of the A-V valves, C: Closing of the pulmonary valve

D: Opening of the A-V valves

E: In-rushing of blood into the ventricles in the early to middle part of diastole

E: In-rushing of blood into the ventricles in the early to middle part of diastole

Which one of the following heart murmurs is heard during systole?

A.      Interventricular Septal Defect

B.      Mitral Stenosis

C.      Aortic Regurgitation

D.      Tricuspid Stenosis

E.       Pulmonary Valve Regurgitation

An increase in left atrial pressure is most likely to occur in which of the following heart murmurs?

                A) Tricuspid stenosis

                B) Pulmonary valve regurgitation

                C) Tricuspid regurgitation

                D) Mitral Regurgitation

In which type of shock does cardiac output often increase?

                a. Hemorrhagic shock

                b. Anaphylactic Shock

                c. Septic shock

                d. Neurogenic shock

                e. Shock due to a large burn

In which one of the following conditions would you expect to find increased left atrial pressure?

                A. Tricuspid Stenosis

                B. Tricuspid Regurgitation

                C. Pulmonary Valve Senosis

                D. Pulmonary Valve Regurgitation

                E. Severe Aortic Stenosis

E. Severe Aortic Stenosis

 Release of which one of the following substances causes vasodilation during anaphylactic shock?
                a. histamine
                b. bradykinin
                c. nitric oxide

d. atrial natriuretic factor
                e. adenosine

Which of the following treatments would be normally beneficial for patients with cardiogenic shock?
                A. place tourniquets on all four limbs

A 50 year old woman received an overdose of furosemide, and her arterial pressure decreased to 70/40 mm Hg. Her heart rate is 120 beats/min, and the respiratory rate is 30 breaths/min. What therapy would you recommend?

A.      Whole blood infusion

B.      Plasma infusion

C.      Infusion of a balanced electrolyte solution

D.      Infusion of a sympathomimetic drug

E.       Administration of a glucocorticoid

C.      Infusion of a balanced electrolyte solution

Which of the following often occurs during progressive shock?

a. decreased capillary permeability

b. vasomotor center failure

c. increased mitochondrial activity

d. increased urine output

e. increased pH in the tissues throughout the body

b. vasomotor center failure

Net movement of fluid from the intravascular space to the interstitial space occurs with all of the following conditions except:

a.  constriction of postcapillary membranes

b.  decreased plasma albumin concentration
c.  lymphatic obstruction
d.  constriction of precapillary arterioles
e.  activation of bradykinin

Lymph capillaries differ from systemic blood capillaries in that they

                A. are less permeable

                B. are not lined by epithelium

                C. lack valves

                D. are absent in the central nervous system

Which of the following will not cause edema?

a.       Decreased plasma concentration of albumin

b.      Decreased venous pressure

c.       Damage to capillary endothelium

d.      Blockage of lymph duct

b. Decreased venous pressure

 A FALSE statement concerning fluid exchange across the microvascular bed is:

                A: fluid exchange follows the laws of pressure filtration across a semipermeable membrane

                B: fluid is filtered outward at the arterial end of the vascular bed

                C: edema occurs if plasma protein concentration is reduced drastically

                D: edema occurs if the arterial blood pressure decrease

D: edema occurs if the arterial blood pressure decrease

Select the Dannet-Yarrow diagram which best illustrates the before [dashed] and after [solid] status of a person who recd 1L of hypertonic saline soln intravenously.

                a. dec vol of I, inc osm of I; inc vol of I, inc vol of E

                b. inc vol of I, dec osm of I; dec osm and inc vol of E 

                c dec vol of I, inc osm of I; inc vole and inc osm of E

                d inc vol, dec osm of I; inc vol and dec osm of E

                e inc osm and inc vol of I; inc vol and inc osm of E

X      Y

**    ********

**    ********

**    ********

Which drawing represents the volumes of X and Y when the system reaches equlibrium?

ANSWER::

                X------X goes down

Identify the fluid compartment that contains approximately two-thirds of the total body water

                A. Transcellular

                B. Plasma

                C. interstitial

                D. Intracellular

                E. Extracellular

Which set of the following best illustrates the consequences of the infusion of plasma:

An excessive intake of tap water over a short period of time would be expected to produce       which of the following:

Exposure to the sun in a hot desert environment for a prolonged period of time without              adequate fluid intake would produce:

A young man was found after wandering the Arizona desert for several hours under a hot sun with no source of drinking water. Which of the following solutions given intravenously would best return the individual’s intracellular volume toward normal?

a.       Hypertonic saline

b.      Isotonic saline

c.       Whole blood

d.      Plasma

e.      Dextran in isotonic saline.

b.      Isotonic saline

a)      diarrhea