Cardiovascular MCQs for pharmacology review. USMLE style questions on antiarrhythmics

Here are a couple of questions related to the pharmacology cardiac rhythm.  These questions from the UMKC School of Medicine have a different degree of difficulty, but are useful to review the topic.

Item Number: 11423   correct answer: 1  category: Antiarrhythmics
1.  Properties of the class IA antiarrhythmics include
A.  reduce automaticity of his-Purkinje fibers
B.  decrease the rate of rise and amplitude of phase 0 depolarization
C.  prolong P-R and Q-T intervals
D.  facilitate inward sodium conductance during rapid depolarization
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

Item Number: 11432   correct answer: 4  category: Antiarrhythmics
2.  Which of the following antiarrhythmics may worsen angina symptoms by
increasing myocardial oxygen requirements?
A.  lidocaine
B.  verapamil
C.  propranolol
D.  disopyramide
1. A,B,C
2. A,C
3. B,D
4. D only .
5. All are correct

Item Number: 11433   correct answer: 4  category: Antiarrhythmics
3.  Cinchonism is a dose-related adverse reaction associated with which of the
following antiarrhythmics?
A.  tocainide
B.  procainamide
C.  disopyramide
D.  quinidine
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

Item Number: 11447   correct answer: 4  category: Antiarrhythmics
4.  Addition of propranolol to the drug regimen of a patient receiving lidocaine
for premature ventricular contractions after a myocardial infarction results
in:
A.  increased likelihood of breakthrough PVCs
B.  displacement of protein-bound lidocaine
C.  reduced renal clearance of lidocaine
D.  increased likelihood of lidocaine toxicity
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

Item Number: 11448   correct answer: 1  category: Antiarrhythmics
5.  Electrophysiologic properties possessed by lidocaine include:
A.   reduction of effective refractory period in normal his-Purkinje
fibers
B.   prolonged effective refractory period in ischemic his-Purkinje
fibers
C.   shortened Q-T interval
D.   prolonged P-R interval
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

Item Number: 11464   correct answer: 5  category: Antiarrhythmics
6.  Which of the following are classified as IB antiarrhythmics?
A.  lidocaine
B.  phenytoin
C.  tocainide
D.  mexiletine
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

Item Number: 11466   correct answer: 1  category: Antiarrhythmics
7.  In treating supraventricular arrhythmias, which of the following reduces
ventricular response primarily by increasing the effective refractory period
of the A-V node?
A.  propranolol
B.  digoxin
C.  verapamil
D.  tocainide
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

Item Number: 11474   correct answer: 1  category: Antiarrhythmics
8.  Potential side effects associated with amiodarone therapy include:
A.  pneumonitis
B.  pseudocyanosis
C.  photosensitivity
D.  parotiditis
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

Item Number: 11475   correct answer: 3  category: Antiarrhythmics
9.  Class IC antiarrhythmics possess which of the following electrophysiologic
properties?
A.  markedly prolong repolarization
B.  markedly depress phase 0 depolarization
C.  inhibit calcium entry during plateau portion of action potential
D.  inhibit sodium entry during phase 0 depolarization
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

Item Number: 11476   correct answer: 1  category: Antiarrhythmics
10.  Adverse effects associated with disopyramide therapy include:
A.  urinary retention
B.  constipation
C.  blurred vision
D.  lupus syndrome
1. A,B,C
2. A,C
3. B,D
4. D only
5. All are correct

Item Number: 289   correct answer: 5  category: Antiarrhythmics
11.  Antiarrhythmic drugs can be separated into four groups, types I to IV. All of
the following are type I antiarrhythmic drugs EXCEPT:
1. quinidine
2. lidocaine
3. procainamide
4. phenytoin
5. propranolol

Item Number: 291   correct answer: 5  category: Antiarrhythmics
12.  Individual antiarrhythmic agents can alter the surface electrocardiogram.
Characteristics of quinidine include:
1. decreased PR interval
2. increased QRS duration
3. increased QT interval
4. All of the above
5. 2,3

Item Number: 292   correct answer: 5  category: Antiarrhythmics
13.  Quinidine toxicity includes all of the following EXCEPT:
1. thrombocytopenia
2. diarrhea
3. cinchonism
4. ventricular fibrillation
5. hypertension

Item Number: 293   correct answer: 1  category: Antiarrhythmics
14.  Of the following antiarrhythmic agents, the one which most closely resembles
procainamide with respect to electrophysiologic effects and mechanism of
action is:
1. quinidine
2. lidocaine
3. phenytoin
4. propranolol
5. bretylium

Item Number: 1360   correct answer: 5  category: Antiarrhythmics
15.  Bronchiolar constriction is a rare but potentially dangerous side effect of:
1. quinidine
2. lidocaine
3. procainamide
4. phenytoin
5. propranolol

Item Number: 1578   correct answer: 4  category: Antiarrhythmics
16.  The effect of different antiarrhythmic agents is best understood by knowing
their predominant actions on cardiac fibers.  All of the following general
statements are true EXCEPT:
1.   quinidine slows the rate of depolarization of cardiac action potentials
and increases the refractory period
2.   lidocaine and phenytoin are class 1 B antiarrhythmic
3.   beta-receptor blocking drugs act by reducing the slope of the pacemaker
potential
4.   procainamide acts as a specific calcium antagonist
5.   bretylium prolongs the action potential and so prolongs the absolute
refractory period

Item Number: 9518   correct answer: 4  category: Antiarrhythmics
17.  In the pharmacologic treatment of cardiovascular disorders, quinidine has all
of the following effects EXCEPT:
1. prolongation of the effective refractory period
2. slows conduction velocity
3. reduces spontaneous frequency of discharge of ectopic pacemaker
4. has a positive chronotropic effect
5. produces peripheral vasodilation in large doses

Item Number: 9893   correct answer: 3  category: Antiarrhythmics
18.  Which of the following medications is contraindicated in a patient with
untreated complete heart block?
1. atropine
2. prednisone
3. quinidine
4. isoproterenol
5. hydrochlorothiazide

Item Number: 11386   correct answer: 1  category: Antiarrhythmics
19.  The therapeutic rationale for the use of quinidine or procainamide includes
their ability to:
1. depress ectopic myocardial automaticity
2. enhance myocardial membrane responsiveness
3. decrease the effective refractory period
4. 1,2
5. 2,3

Item Number: 12788   correct answer: 3  category: Antiarrhythmics
20.  All of the following are common side effects of quinidine administration
EXCEPT:
1. diarrhea
2. nausea and vomiting
3. dry mouth
4. tinnitus
5. headache

Item Number: 14457   correct answer: 4  category: Antiarrhythmics
21.  24 hours after an acute myocardial infarction, a 46-year-old male is being
treated with a continuous intravenous drip of an antiarrhythmic drug to
suppress frequent multifocal premature ventricular contractions. He develops
generalized seizure activity.  The seizure activity can be most readily
explained by:
1. ventricular tachycardia
2. systemic embolization
3. systemic hypotension
4. lidocaine toxicity
5. ventricular asystole

Item Number:     correct answer: 1  category: Antiarrhythmics
22.  TRUE statements concerning Vaughan-Williams’s Class III antiarrhythmic
drugs include all EXCEPT:
1.   encainide, flecainide, and propafenone are in this class
2.   bretylium, amiodarone, and sotalol are in this class
3.   possess diverse pharmacologic effects but share the capacity to prolong
action potential duration and refractoriness in Purkinje fibers
4.   block outflow of potassium during cell repolarization
5.   do not alter phase 0 depolarization or resting membrane potential

Questions 23 – 29
Choose the correct answer for the following questions from the list below.
Each answer can be used once, more than once, or not at all.

1.   bretylium
2.   amiodarone
3.   adenosine
4.   flecainide
5.   lidocaine

Item Number:     correct answer: 5  category: Antiarrhythmics
23.  In ACLS algorithm, first antiarrhythmic to be administered in the treatment of
ventricular fibrillation refractory to defibrillation and epinephrine.

Item Number:     correct answer: 3  category: Antiarrhythmics
24.  Drug of choice for paroxysmal supraventricular tachycardia unresponsive to
vagal maneuvers.

Item Number:     correct answer: 1  category: Antiarrhythmics
25.  Produces transient increase in blood pressure followed by hypotension due to
an initial release of norepinephrine from neurons followed by blockade of
norepinephrine re-uptake.

Item Number:     correct answer: 2  category: Antiarrhythmics
26.  Contains iodine in molecular structure, is similar to thyroxine, and use is
associated with hyper- or hypothyroidism in 2% – 5% of patients.

Item Number:     correct answer: 2  category: Antiarrhythmics
27.  Pharmacokinetic properties characterized by very high protein-binding (99.9%),
very large volume of distribution (66 L/kg), and average elimination half-life
of 25 days.

Item Number:     correct answer: 4  category: Antiarrhythmics
28.  A class IC antiarrhythmic, characterized by high affinity for and slow
dissociation from fast sodium channels

Item Number:     correct answer: 5  category: Antiarrhythmics
29.  A class IB antiarrhythmic, characterized by rapid association – dissociation
from sodium channels

Item Number:     correct answer: 4  category: Antiarrhythmics
30.  Correct statements concerning propafenone include all EXCEPT:
1.   class IC antiarrhythmic
2.   slows actions potential conduction by blocking sodium channels
3.   possesses weak beta blocking activity
4.   class III antiarrhythmic
5.   increases duration of QRS complex

Item Number:     correct answer: 1  category: Antiarrhythmics
31.  Correct statements concerning sotalol include all EXCEPT:
1.   prolongs action potential duration and effective refractory period by
blocking sodium channels.
2.   prolongs cell repolarization by blocking potassium channels.
3.   produces bradycardia
4.   prolongs Q-T interval
5.   increases effective refractory period

Questions 32 – 35
Choose the correct answer for the following questions from the list below.
Each answer can be used once, more than once, or not at all.
1.   propranolol
2.   acebutolol
3.   sotalol
4.   esmolol
5.   butorphanol

Item Number:     correct answer: 4  category: Antiarrhythmics
32.  Cardioselective beta blocker with a short elimination half-life administered
intravenously only.

Item Number:     correct answer: 3  category: Antiarrhythmics
33.  Nonselective beta blocker which slows heart rate and also prolongs action
potential duration by blocking transmembrane potassium currents.

Item Number:     correct answer: 2  category: Antiarrhythmics
34.  Cardioselective beta blocker possessing intrinsic sympathetic activity and
given by oral administration only.

Item Number:     correct answer: 1  category: Antiarrhythmics
35.  Nonselective beta blocker possessing quinidine-like membrane stabilizing
effects.

Item Number:     correct answer: 5  category: Antiarrhythmics
36.  FALSE statement concerning use of calcium channel blockers as antiarrhythmics:
1.   slows inward calcium current thereby decreasing the rate of spontaneous
phase 4 depolarization in Purkinje fibers
2.   slows conduction velocity through the atrio-ventricular node and
increases functional refractory period
3.   useful for slowing ventricular rate in atrial fibrillation
4.   hypotension may be a limiting side effect
5.   verapamil, diltiazem, and nifedipine all exert equally effective
antiarrhythmic actions

Item Number:     correct answer: 3  category: Antiarrhythmics
37.  CORRECT statement concerning the antiarrhythmic drug adenosine:
1.   undergoes extensive hepatic metabolism
2.   produces coronary vasoconstriction
3.   causes frequent but transient post-conversion arrhythmias
4.   increases sinus node rate
5.   increases atrio-ventricular conduction

Item Number:     correct answer: 1  category: Antiarrhythmics
38.  True statement concerning adenosine include all EXCEPT:
1.   administered sublingually
2.   negative chronotrope
3.   negative dromotrope
4.   negative inotrope
5.   may precipitate bronchospasm

Item Number:     correct answer: 5  category: Antiarrhythmics
39.  FALSE statement concerning adenosine:
1.   half-life of 1 – 10 seconds
2.   higher doses necessary in patients taking theophylline
3.   chest pain and shortness of breath are common but short-lived side
effects
4.   indicated for treating paroxysmal supraventricular tachycardia
5.   less effective than verapamil for treating paroxysmal supraventricular
tachycardia

Item Number:     correct answer: 2  category: Antiarrhythmics
40.  Correct statements about epinephrine administration for ventricular
fibrillation include all EXCEPT:
1.   1 mg IV push every 3 – 5 minutes
2.   0.1 mg IV push every 3 – 5 minutes
3.   0.1 mg/kg IV push every 3 – 5 minutes
4.   1 mg IV push followed by 3 mg IV push followed by 5 mg IV push 3 minutes
apart
5.   2.5 mg diluted to a total volume of 10 ml in saline solution via an
endotracheal tube when no IV access is available

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