Question 1

The most common cause of angina is:

Accepted Answer

A)  Vasospasm of the coronary arteries 
B)  Atherosclerosis 
C)  Platelet aggregation 
D)  Low systemic oxygen 
A)  Vasospasm of the coronary arteries 
B)  Atherosclerosis 
C)  Platelet aggregation 
D)  Low systemic oxygen B

Question 2

The rationale for prescribing calcium blockers for angina can be based on the need for:

Accepted Answer

A)  Increased inotropic effect in the heart 
B)  Increasing peripheral perfusion 
C)  Keeping heart rates high enough to ensure perfusion of coronary arteries 
D)  Help with rate control 
A)  Increased inotropic effect in the heart 
B)  Increasing peripheral perfusion 
C)  Keeping heart rates high enough to ensure perfusion of coronary arteries 
D)  Help with rate control D

Question 3

Cost of antianginal drug therapy should be considered in drug selection because of all of the following EXCEPT:

Accepted Answer

A)  Patients often require multiple drugs 
B)  A large number of angina patients are older adults on fixed incomes 
C)  Generic formulations may be cheaper but are rarely bioequivalent 
D)  Lack of drug selectivity may result in increased adverse reactions 
A)  Patients often require multiple drugs 
B)  A large number of angina patients are older adults on fixed incomes 
C)  Generic formulations may be cheaper but are rarely bioequivalent 
D)  Lack of drug selectivity may result in increased adverse reactions C

Question 4

Isosorbide dinitrate is a long-acting nitrate given twice daily. The schedule for administration is 7 a.m. and 2 p.m. because:

Accepted Answer

A)  Long-acting forms have a higher risk for toxicity. 
B)  Orthostatic hypotension is a common adverse effect. 
C)  It must be taken with milk or food. 
D)  Nitrate tolerance can develop. 
A)  Long-acting forms have a higher risk for toxicity. 
B)  Orthostatic hypotension is a common adverse effect. 
C)  It must be taken with milk or food. 
D)  Nitrate tolerance can develop.

Question 5

Combinations of a long-acting nitrate and a beta blocker are especially effective in treating angina because:

Accepted Answer

A)  Nitrates increase MOS and beta blockers increase MOD. 
B)  Their additive effects permit lower doses of both drugs and their adverse reactions cancel each other out. 
C)  They address the pathology of patients with exertional angina who have fixed atherosclerotic coronary heart disease. 
D)  All of the above 
A)  Nitrates increase MOS and beta blockers increase MOD. 
B)  Their additive effects permit lower doses of both drugs and their adverse reactions cancel each other out. 
C)  They address the pathology of patients with exertional angina who have fixed atherosclerotic coronary heart disease. 
D)  All of the above

Question 6

When is aspirin (ASA) used in angina patients?

Accepted Answer

A)  All angina patients should be taking ASA unless it is contraindicated for allergy or other medical reasons. 
B)  ASA should only be used in men. 
C)  ASA has no role in angina, but is useful in MI prevention. 
D)  The impact of ASA is best at the time of an angina attack. 
A)  All angina patients should be taking ASA unless it is contraindicated for allergy or other medical reasons. 
B)  ASA should only be used in men. 
C)  ASA has no role in angina, but is useful in MI prevention. 
D)  The impact of ASA is best at the time of an angina attack.

Question 7

Beta blockers are especially helpful for patients with exertional angina who also have:

Accepted Answer

A)  Arrhythmias 
B)  Hypothyroidism 
C)  Hyperlipidemia 
D)  Atherosclerosis 
A)  Arrhythmias 
B)  Hypothyroidism 
C)  Hyperlipidemia 
D)  Atherosclerosis

Question 8

Nitrates are especially helpful for patients with angina who also have:

Accepted Answer

A)  Heart failure 
B)  Hypertension 
C)  Both 1 and 2 
D)  Neither 1 nor 2 
A)  Heart failure 
B)  Hypertension 
C)  Both 1 and 2 
D)  Neither 1 nor 2

Question 9

Which of the following drugs has been associated with increased risk for myocardial infarction in women?

Accepted Answer

A)  Aspirin 
B)  Beta blockers 
C)  Estrogen replacement 
D)  Lipid-lowering agents 
A)  Aspirin 
B)  Beta blockers 
C)  Estrogen replacement 
D)  Lipid-lowering agents

Question 10

Patients at high risk for developing significant coronary heart disease are those with:

Accepted Answer

A)  LDL values between 100 and 130 
B)  Systolic blood pressure between 120 and 130 
C)  Class III angina 
D)  Obesity 
A)  LDL values between 100 and 130 
B)  Systolic blood pressure between 120 and 130 
C)  Class III angina 
D)  Obesity

Question 11

To reduce mortality, all patients with angina, regardless of class, should be on:

Accepted Answer

A)  Aspirin 81 to 325 mg/d 
B)  Nitroglycerin sublingually for chest pain 
C)  ACE inhibitors or angiotensin receptor blockers 
D)  Digoxin 
A)  Aspirin 81 to 325 mg/d 
B)  Nitroglycerin sublingually for chest pain 
C)  ACE inhibitors or angiotensin receptor blockers 
D)  Digoxin

Question 12

Rapid-acting nitrates are important for all angina patients. Which of the following are true statements about their use?

Accepted Answer

A)  These drugs are useful for immediate symptom relief when the patient is certain it is angina. 
B)  The dose is one sublingual tablet or spray every 5 minutes until the chest pain goes away. 
C)  Take one nitroglycerine tablet or spray at the first sign of angina; repeat every 5 minutes for no more than two doses. If chest pain is still not relieved, call 911. 
D)  All of the above 
A)  These drugs are useful for immediate symptom relief when the patient is certain it is angina. 
B)  The dose is one sublingual tablet or spray every 5 minutes until the chest pain goes away. 
C)  Take one nitroglycerine tablet or spray at the first sign of angina; repeat every 5 minutes for no more than two doses. If chest pain is still not relieved, call 911. 
D)  All of the above

Question 13

Medications are typically started for angina patients when:

Accepted Answer

A)  The first permanent EKG changes occur 
B)  The start of class I or II symptoms 
C)  The events trigger a trip to the emergency department 
D)  When troponin levels become altered 
A)  The first permanent EKG changes occur 
B)  The start of class I or II symptoms 
C)  The events trigger a trip to the emergency department 
D)  When troponin levels become altered

Question 14

Management of all types and grades of angina includes the use of lifestyle modification to reduce risk factors. Which of these modifications are appropriate for which reason? Both the modification and the reason for it must be true for the answer to be correct.

Accepted Answer

A)  Lose at least 10 pounds of body weight. Excessive weight increases cardiac workload. 
B)  Reduce sodium intake to no more than 2,400 mg of sodium. Sodium increases blood volume and cardiac workload. 
C)  Increase potassium intake to at least 100 mEq/d. The heart needs higher levels of potassium to improve contractility and oxygen supply. 
D)  Intake a moderate amount of alcohol. Moderate intake has been shown by research to improve cardiac function. 
A)  Lose at least 10 pounds of body weight. Excessive weight increases cardiac workload. 
B)  Reduce sodium intake to no more than 2,400 mg of sodium. Sodium increases blood volume and cardiac workload. 
C)  Increase potassium intake to at least 100 mEq/d. The heart needs higher levels of potassium to improve contractility and oxygen supply. 
D)  Intake a moderate amount of alcohol. Moderate intake has been shown by research to improve cardiac function.

Question 15

Situations that suggest referral to a specialist is appropriate include:

Accepted Answer

A)  When chronic stable angina becomes unpredictable in its characteristics and precipitating factors 
B)  When a post-myocardial infarction patient develops new-onset angina 
C)  When standard therapy is not successful in improving exercise tolerance or reducing the incidence of angina 
D)  All of the above 
A)  When chronic stable angina becomes unpredictable in its characteristics and precipitating factors 
B)  When a post-myocardial infarction patient develops new-onset angina 
C)  When standard therapy is not successful in improving exercise tolerance or reducing the incidence of angina 
D)  All of the above

Question 16

Patients who have angina, regardless of class, who are also diabetic, should be on:

Accepted Answer

A)  Nitrates 
B)  Beta blockers 
C)  ACE inhibitors 
D)  Calcium channel blockers 
A)  Nitrates 
B)  Beta blockers 
C)  ACE inhibitors 
D)  Calcium channel blockers

Question 17

Angina is produced by an imbalance between myocardial oxygen supply (MOS) and demand (MOD) in the myocardium. Which of the following drugs help to correct this imbalance by increasing MOS?

Accepted Answer

A)  Calcium channel blockers 
B)  Beta blockers 
C)  Angiotensin-converting-enzyme (AC
E)  inhibitors 
D)  Aspirin 
A)  Calcium channel blockers 
B)  Beta blockers 
C)  Angiotensin-converting-enzyme (AC
E)  inhibitors 
D)  Aspirin

Question 18

The New York Heart Association and the Canadian Cardiovascular Society have described grading criteria for levels of angina. Angina that occurs with unusually strenuous activity or on walking or climbing stair after meals is class:

Accepted Answer

A)  I 
B)  II 
C)  III 
D)  IV 
A)  I 
B)  II 
C)  III 
D)  IV

Question 19

Not all chest pain is caused by myocardial ischemia. Noncardiac causes of chest pain include:

Accepted Answer

A)  Pulmonary embolism 
B)  Pneumonia 
C)  Gastroesophageal reflux 
D)  All of the above 
A)  Pulmonary embolism 
B)  Pneumonia 
C)  Gastroesophageal reflux 
D)  All of the above

Question 20

Drug choices to treat angina in older adults differ from those of younger adults only in:

Accepted Answer

A)  Consideration of risk factors for diseases associated with and increased in aging 
B)  The placement of drug therapy as a treatment choice before lifestyle changes are tried 
C)  The need for at least three drugs in the treatment regimen because of the complexity of angina in the older adult 
D)  Those with higher risk for silent myocardial infarction 
A)  Consideration of risk factors for diseases associated with and increased in aging 
B)  The placement of drug therapy as a treatment choice before lifestyle changes are tried 
C)  The need for at least three drugs in the treatment regimen because of the complexity of angina in the older adult 
D)  Those with higher risk for silent myocardial infarction

Exam 28: Chronic Stable Angina and Low-Risk Unstable Angina

The most common cause of angina is:

The rationale for prescribing calcium blockers for angina can be based on the need for:

Cost of antianginal drug therapy should be considered in drug selection because of all of the following EXCEPT:

Isosorbide dinitrate is a long-acting nitrate given twice daily. The schedule for administration is 7 a.m. and 2 p.m. because:

Combinations of a long-acting nitrate and a beta blocker are especially effective in treating angina because:

When is aspirin (ASA) used in angina patients?

Beta blockers are especially helpful for patients with exertional angina who also have:

Nitrates are especially helpful for patients with angina who also have:

Which of the following drugs has been associated with increased risk for myocardial infarction in women?

Patients at high risk for developing significant coronary heart disease are those with:

To reduce mortality, all patients with angina, regardless of class, should be on:

Rapid-acting nitrates are important for all angina patients. Which of the following are true statements about their use?

Medications are typically started for angina patients when:

Management of all types and grades of angina includes the use of lifestyle modification to reduce risk factors. Which of these modifications are appropriate for which reason? Both the modification and the reason for it must be true for the answer to be correct.

Situations that suggest referral to a specialist is appropriate include:

Patients who have angina, regardless of class, who are also diabetic, should be on:

Angina is produced by an imbalance between myocardial oxygen supply (MOS) and demand (MOD) in the myocardium. Which of the following drugs help to correct this imbalance by increasing MOS?

The New York Heart Association and the Canadian Cardiovascular Society have described grading criteria for levels of angina. Angina that occurs with unusually strenuous activity or on walking or climbing stair after meals is class:

Not all chest pain is caused by myocardial ischemia. Noncardiac causes of chest pain include:

Drug choices to treat angina in older adults differ from those of younger adults only in:

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