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Pathophysiology of the systemic blood circulation



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Pathophysiology of the systemic blood circulation

#The patient had myocardial infarction. In 1,5 months the Dressler’s syndrome with characteristic triad (pericarditis, pleurisy, pneumonia) was diagnosed. What is the main mechanism of this complication?

-Decreased resistance of the organism to infection

+Autoimmune lesion

-Activation of saprophytic microflora

-Intoxication with products of necrosis

-Miocardial enzymes influx into the blood

#The ECG findings of the patient with idiopathic hypertension: the sinus rhythm, pulsa rate- 92, interval PQ – 0.19 sec, complex QRS is not changed. Disorder of what function of the miocardium takes its place?

-Refracternity

-Conductivity

-Excitability

+Automatism

-Contractivity

#The patient had ischemia of the heart caused by coronary arteries atherosclerosis. Thrombosis of the frontal interventricular artery developed after coronarography. What is the initial mechanism of this complication development?

-Increased level of coagulants

-Retardation of blood flow

+Damage of endothelium of vascular wall

-Decreased content of anticoagulants in blood -Decreased activity of fibrinolytic system

#The patient, 45 years old, complains of a dispnoe during a slight exercise, edema of the legs. She has been ill for 2 years. In anamnesis: frequent anginas. Circulatory insufficiency is diagnosed. What hemodynamic parameter of the heart decompensation is seen in this case?

-Decrease of venous pressure

-Decrease of the total amount of blood

+Decrease of minute volume of the heart

-Rising arterial pressure

-Tachycardia

#In the man, 25 years old, failure of the mitral valve without disturbance of circulation is revealed. What type of immediate adaptive reaction takes its place?

-Homeometric

+Heterometric

-Myogenetic dilatation

-Hypertrophy of the heart

-Boudich’s mechanism

#The patient, 65 years old, complains of pain in the heart followed psychoemotional stress. An ambulance doctor diagnosed ischemic disease of the heart (stenocardia). What mechanism of ischemia is the most probable?

+Angiospastic

-Obliterating

-Compressing

-Obturational

-Hypovolemic

#The changes of ECG findings in a patient are as follows: at first, the prolongation of the P-Q interval; then, single QRS complexes dropout; later, increased quantity of QRS complexes; at least contraction of auricles and ventricles became different – frequency of auricles – 70, of ventricles – 35 per minute. What form of arrhythmia occurred?

-Extrasystole -Intraatrial blockade

-Intraventricular blockade

+Atrioventricular blockade

-Bradycardia

#The patient, 44 years old, complains of dispnoe, palpitation, pain in the right hypochondrium, edema on the legs. ECG findings are as follows - hypertrophy of the both ventricles and the right dextral atrium. Failure of the tricuspid valve is diagnosed. What pathogenetic variant of the heart failure is it?

-Arrhythmic

-Cardiac overload due to resistance

-Initial myocardial failure

+Cardiac overload due to increased volume -Extramiocardial

#An examination of a young man, 16 years old, revealed acceleration of the heart beats during inspiration, retardation - during expiration. Findings of ECG are as follows: diminished of the R-R interval during inspiration and its proelongation during expiration. What kind of arrhythmia does the patient demonstrate?

-Idioventricular rhythm

-Atrial fibrillation -Sinus tachycardia

+Respiratory arrhythmia -Sinus bradycardia

#The patient, 45 years old, has such changes in the ECG findings as: prolonged interval P-Q, each second or third complex QRST is missed. What type of arrhythmia is observed?

-Complete atrioventricular blockade

+Incomplete atrioventricular blockade, ІІІ degree

-Sinoauricular blockade

-Intraventricular blockade

-Incomplete atrioventricular blockade, І degree

#In one hour after application of the ring narrowing the aorta of a dog, force and frequency of systoles increased, but the volume of circulating blood and thickness of the left ventricle did not differ from the initial parameters. What stage of hypertrophy of the myocardium is observed? -The completed hypertrophy -Decompensation

-Progressive cardiosclerosis

-Relatively stable hyperfunction

+Emergency

#A patient has arterial hypertension. As the consequence of hypertonic crisis, an acute heart failure developed. What is the main mechanism of heart failure onset in this case?

-Absolute coronary failure

-Cardiac overload due to increased volume

-Damage of the myocardium

+Cardiac overload due to resistance

-Relative coronary failure

#Reperfusion syndrome activates processes of free-radical oxidation which results in damage of cellular membranes and functions of the cells. An excessive accumulation of ions in the cytoplasm takes its place. What ions namely?

-Potassium

-Magnesium

-Chlor


-Iron

+Calcium

#In 1 month after reproducing of experimental arterial hypertension the thickness of the left ventricle of the dog’s heart 1.7 times increased. Further the mass of the heart was not enlarged, the minute volume normalized. What stage of myocardial hypertrophy is observed?

-Initial

-Emergency

+Complete hypertrophy

-Progressive cardiosclerosis -Decompensation

#The teenager, 15 years old, complains of sensation of air hunger, general sickness, palpitation. Pulse rate is 130, arterial pressure - 100/60 mm Hg. Data of ECG: complex QRS is of normal form and duration; the amount of Р waves and ventricular complexes is the same, Т wave is united with P wave. What arrhythmia is observed?

-Sinus extrasystole

+Sinus tachycardia

-Atrial fibrillation

-Atrial flutter

-Atrial paroxysmal tachycardia

#The patient demonstrates abrupt arterial pressure increase due to changes of vascular tonus. What compensatory mechanism provides an increased force of myocardial contraction in this case?

-Renin-angiothensin system activation

-Influence of sympathetic nervous system on the heart

+Homeometric

-Influence of parasympatical nervous system on the heart -Heterometric

#The woman, 22 years old, with the diagnosis of rheumatic myocarditis demonstrates symptoms of heart failure. What is the cause of a systemic circulation disturbance?

-Cardiac overload due to increased blood outflow resistance

-Decreased volume of circulating blood

-Cardiac overload due to enlarged volume of blood

+Damage of the myocardium

-Rising resistance in vessels of small circle

#In the patient, 39 years old, with the signs of pulmonary edema and left ventricular heart failure, a diagnosis of aortic stenosis. What is the cause of a heart failure development?

-Increased volume of vascular bed

-Damage of the myocardium

-Decreased volume of circulating blood

-Cardiac overload due to increased volume of blood

+Cardiac overload due to increased blood outflow resistance

#The man, 60 years old, has atherosclerosis of blood vessels. Excess of what substances plays the leading role in pathogenesis of this disease?

-Histic lypoproteidlipase

-High-density lipoproteins

-Chylomicrons

+Low-density lipoproteins

-Fatty acids

#Serious infectious disease resulted in myocarditis accompanied with damage of the conductive system of the heart, periodic syncopes due to development of Morgan-Adams-Stocks syndrome. What kind of pathology developed in the patient?

-Right bundle-branch block

-Left bundle-branch block

+Transferring incomplete atrioventricular blockade into complete

-Proxysmal tachycardia

-Premature exaltation of ventricles

#The patient with failure of mitral valve had hypertrophy of the left heart ventricle. What is the mechanism of development of hypertrophy?

-Increased passage of potassium into the cell

-Increased consumption of fatty acids by cardiomyocites

-Activation of genetical mechanism

-Activation of glycolysis

+Decreased intensity of structure functioning

#The patient with acute myocardial infarction has developed edema of the lungs. What is the cause of this complication?

-Allergic response

-Right ventricle failure

+Left ventricle failure

-Deficiency of surfactant

-Intoxication with products of necrosis

#The woman has suffered from arterial hypertension for 15 years. Now dispnoe and palpitation appeared; the systolic pressure decreased a little. What is the basic mechanism of heart failure in this case?

-Disturbance of conduction

-Cardiac overload with enlarged volume of blood

-Damage of the myocardium

+Cardiac overload due to increased blood outflow resistance

-Disturbance of regulation of cardiac activity

#I degree atrioventricular blockade with elongation of the P-Q interval up to 0,25 sec is revealed in the patient. What disturbance of the heart function caused this condition?

-Automatism

+Conduction

-Excitability

-Contraction

-Rhythm


#The patient with rheumatism developed myocarditis with circulatory inefficiency. What disturbance of hemodynamics is typical for this case?

-Decrease of diastolic arterial pressure

+Decrease of systolic arterial pressure

-Rising of systolic arterial pressure

-Decrease of rate of circulation

-Decrease of venous pressure

#After one branch of the coronary artery of a dog had been tied up, myocardial infarction with resorbtion-necrotic syndrome developed. What is the characteristic symptom of this syndrome? -Pain behind the breastbone

-Rising level of catecholamins in blood

+Increased level of creatinphosphokynase in blood

-Fibrillation of ventricles

-Diminished minute volume of the heart

#The patient has the transmural myocardial infarction complicated by acute left ventricle failure. What is the most typical sings in this condition?

-Ascites

-Edema of the extremities

-Acrocyanosis

+Edema of the lungs

-Arterial hypertension

#The patient with alcoholic cirrhosis of the liver complains of general sickness, dyspnoe. Decrease of arterial pressure, ascites, dilating of superficial veins of the abdomen, splenomegaly are revealed. What impairment of hemodynamics is observed?

-Failure of the left ventricle

+Syndrome of the portal hypertension

-Failure of the right ventricle

-Collapse

-Total heart failure

#The patient has arterial hypertension caused by a stenosis of the renal arteries. Activation of what system is the main mechanism of this form of hypertension?

-Sympatho-adrenal

+Renin-angiotensin

-Parasympathic

-Callicrein-kinin

-Hypotalamopituitary

#The patient has myocardial infarction. His arterial pressure has decreased up to 70/40 mm Hg. What is the initial mechanism of development of arterial hypotension in this case?

+Decrease of minute volume of blood

-Sodium loss in the organism

-Accumulation potassium in the organism

-Generalized vasodilatation

-Vasoconstriction of the peripheric vessels

#A rising of intracranial pressure in a patient with cerebral hematoma caused excessive activity of the vagus nerve (vagotonia) and changes of cardiac contractions frequency. What kind of arrhythmia occurs? +Sinus bradycardia

-Sinus tachycardia

-Ventricular extrasystole

-Paroxysmal tachycardia

-Atrioventricular blockade

#The teenager having an experienced infectious disease developed arrhythmia with diminished interval R-R during inspiration and its elongation during expiration. What is the cause of this kind of arrhythmia?

-Disturbance of excitability of the myocardium

+Fluctuation tonus of vagus nerve during the act of respiration

-Disturbance of contractive function of the heart

-Bainbridge reflex

-Disturbance of conduction of the heart

#Acute failure of the mitral valve was experimentally reproduced in an animal. The heart has adapted by the activation of the heterometrical mechanism. What is the essence of this mechanism?

-Compensatory hypertrophy of the myocardium

+The law of Franc - Starling

-Decrease of formation of calcium-troponine complexes

-Intensifying of biosynthesis of protein

-Boudich mechanism

#Restoration of coronary blood-flow in the patient with myocardial infarction was accompanied by diminution of contractive ability of the heart and aggravation of general condition of the patient. What is the cause of cardiomyocites damage in the conditions of reperfusion?

-Phosphorylation

-Dephosphorylation

-Glycoseliring

+Free-radical

-Transamination

#The patient suffers from hypertonic crisis. Increased level of angiotensin ІІ was revealed in a blood. What is the pressure effect of angiotensin associated with?

-Activation of synthesis of biogenic amines

+Contraction of muscles of the arterioles

-Hyperproduction of prostaglandines

-Stimulation of vasopressin formation

-Activation of callicrein-kinin system

#The patient with idiopathic hypertensia revealed increased concentration of Vasopressin in blood. Function of what organ does this hormone directly influence?

-Liver


+Kidneys

-Heart


-Lungs

-Epinephral glands

#Rabbits were fed with addition of cholesterol. In 5 months atherosclerotic changes in the aorta were found. What is the main cause of atherogenesis in this case?

-Endogenic hypercholesterinemia

-Overeating

-Inactivation of receptors to the low density lipoproteins

-Hypodynamia

+Exogenous hypercholesterinemia

#The animal with failure of the aortal valves has the hypertrophy of the left ventricle of the heart with local contractures found. Accumulation of what substance in cardiomyocites is the cause of contractures?

-Sodium


-Potassium -Lactic acid

-Carbon dioxide +Calcium

#The patient with heart failure developed arrhythmia in form of ventricular extrasystoles. Disturbance of what function of the cardiac muscle is observed in this case?

-Rhythm


-Automatism

-Conduction

+Excitability

-Contractive

#The patient developed extrasystole. ECG data wave: Р is absent; QRS complex is deformed, complete compensatory pause. What is the localization of ectopic locus of excitation in this case? -Sinus node

-Auricles +Ventricles

-Atrioventricular node -Giss bundle-branch.

#The patient, 43 years old, suffers from arterial hypertension caused by moderate increase of cardiac outflow and the general peripheric resistance. What hemodynamical variant of arterial hypertension has developed in this case?

+Eukinetic

-Hyperkinetic

-Hypokynetic

-Akinetic

-Combined

#The man, 65 years old, has been suffering from arterial hypertension during 15 years. Now the systolic pressure is decreasing but and diastolic remains increased. What hemodynamical type of arterial hypertension is it?

-Hyperkinetic

-Normokinetic

+Hypokinetic

-Eukinetic

-Dyskinetic

#Arterial hypertension was reproduced by narrowing of the renal arteries in a dog. Activity of renin-angiothensin-aldostheron system increased. What component of this system has the strongest pressor effect?

-Renin

+Angiotensin ІІ -Angiotensin I

-Angiotensin ІІІ

-Aldosteron

#ECG findings of a woman with ischemic disease of the heart: pulse 230, the Р wave is deformed, ventricular complexes are without changes. What type of cardiac arrhythmia is it? +Atrial paroxysmal tachycardia

-Atrial fibrillation

-Atrial flutter

-Fibrillation of the ventricles

-Ventricular extrasystole

#The man, 55 years old, suffering from failure of the mitral valve for many years developed acute cardiac decompensation. What pathophysiological variant of cardiac failure is observed in this case?

-Neurogenic damage of the heart

-Hypoxic damage of heart

-Coronary damage of heart

+Cardiac overload due to volume

-Cardiac overload due to resistance

#The animal after experimental adrenalectomy demonstrated significant retention of potassium in the organism caused by hyperkaliemia. What the type of heart arrhythmia is the most possible in this animal?

-Ventricular extrasystole

-Sinus tachycardia -Atrial extrasystole

+Sinus bradycardia

-Respiratory arrhythmia

#The patient has failure of the mitral valve. As a result, the cardiac overload due to the volume of blood takes its place. What is the main mechanism of immediate compensation?

-Inotropic action of catecholamines

-Homeometrical

-Chronoinotropic

+Heterometrical

-Hypertrophy of the myocardium

#In the patient with persistent arterial hypertension angiography revealed atherosclerotic lesion of the both renal arteries. What is the initial mechanism of development of arterial hypertension?

-Increased secretion of Vasopressinum

-Increased level of catecholamines

-Increased level of hydrocortisone

-Increased cardiac outflow

+Increased production of a renin

#ECG findings of the patient with cardiac arrhythmia: pulse - 50, irregular sinus rhythm, the interval P-Q is prolonged; periodical missing of the QRS complex (Samoilov - Venkenbach periods).

What type of arrhythmia is it?

+Incomplete atrioventricular blockade, ІІ degree

-Complete atrioventricular blockade

-Right bundle- branch block

-Incomplete atrioventricular blockade, І degree

-Syndrome of the cardiac pacemaker weakness

#Ischemia of the myocardium was reproduced in an experimental animal. The activation of peroxide oxidation of lipids is revealed. An increased concentration of what substances in the myocardium stimulates this process?

+Catecholamines

-Catalase

-Gluthationperoxydase

-Superoxide dismutase

-Tocopherol

#The woman, 32 years old, had myocarditis. ECG reveals cardiac arrhythmia (rhythm is not sinus). The function of what type of cardiomyocites is affected?

-Contractive

+Pacemaking cells

-Conductive

-Cells of Giss fascicule

-Cardiomyocites of branches of the Giss fascicule

#Septic endocarditis was diagnosed in a patient. For 5 days the body temperature ranged within borders: 39,5° – 40° - 40,2 °С. On the 6-th day abrupt decrease of body temperature led to collapse development. What is the main mechanism of development of collapse in this case? -Hyperventilation

+Vasodilatation

-Vasoconstriction

-Tachycardia

-Polyuria

#ECG findings of the patient, 55 years old, with myocardiosclerosis: the Р waves were absent, instead of them numerous waves f appeared, complexes QRST appeared in irregular intervals (R-R irregular), the R waves were of different voltage. What kind of arrhythmia is it?

-Paroxysmal tachycardia

-Sinus arrhythmia

+Atrial fibrillation

-Sinus tachycardia

-Idioventricular rhythm

#The patient with heart failure developed arrhythmia. ECG data: aurical contraction frequency - 70, ventricles - 35. What function of cardiac muscle is broken?

-Rhythm


-Excitability

-Automatism +Conductive

-Contractive



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