Cardiovascular

Section 1

1 Regarding ECG changes, which is CORRECT?

a) hypernatraemia is associated with low voltage complexes
b) the first change in hyperkalaemia is prolongation of QRS
c) with hypokalaemia, the resting membrane potential decreases
d) in hyperkalaemia, the heart stops in systole
e) in hypercalcaemia, myocardial contractility is enhanced

2 Regarding jugular pressure waves:

a) the ‘v’ wave denotes the increased atrial pressure due to the bulging of the
tricuspid valve during isovolumetric ventricular contraction
b) in tricuspid insufficiency, there is a giant ‘A’ wave with each ventricular systole
c) atrial premature beats produce an ‘A’ wave
d) the ‘v’ wave occurs during systole
e) a giant ‘C’ wave (‘cannon wave’) may be seen in complete heart block

3 What factor does not alter cardiac output?

a) standing up
b) sleeping
c) eating
d) exercising
e) pregnancy

4 What is the O2 consumption of a beating heart at rest?

a) 2ml/100g/min
b) 9ml/g/min
c) 2ml/g/min
d) 2L/100g/min
e) 9ml/100g/min

5 Regarding percentages of blood volume in the body:

a) the heart has 5%
b) the pulmonary circulation has the greatest percentage
c) the venous circulation has 35%
d) the aorta has 2%
e) capillaries have 20%
 6 What is a biological action of endothelin?
a) dilates vascular smooth muscle
b) produces bronchodilation
c) increase GFR and renal blood flow
d) evokes positive inotropic and chronotropic effects on myocardium
e) inhibits gluconeogenesis

7 What inhibits gene transcription for endothelin-1 secretion:

a) nitric oxide
b) angiotensin II
c) insulin
d) growth factors
e) catecholamines

8 Regarding NO synthase:
a) it synthesises nitrous oxide from arginine
b) there are 2 isoforms
c) it is inactivated by haemoglobin
d) NOS-1 is activated by cytokines
e) NOS-2 is in endothelial cells

9 What factor dilates the arterioles?

a) decreased local temperature
b) myogenic theory of autoregulation
c) angiotensin II
d) increased discharge of noradrenergic vasomotor nerve
e) histamine

10 Which is NOT a baroreceptor site?

a) right atria at the entrance of SVC and IVC
b) aortic arch
c) left atria at the entrance of the pulmonary veins
d) pulmonary circulation
e) carotid body

11 Regarding cerebrospinal fluid:

a) the total volume of CSF is 300mL
b) CSF is absorbed through the choroid plexus
c) the average CSF pressure is 220m-CSF
d) CSF has a higher pH than plasma
e) it contains very low levels of cholesterol relative to plasma
12 Which substance has equal concentrations in CSF and plasma?
a) Ca2+
b) K+
c) Na+
d) PCO2
e) glucose

13 Which vessel has the lowest PO2?

a) maternal artery
b) maternal vein
c) uterine vein
d) umbilical vein
e) umbilical artery

14 During exercise:
a) diastolic BP increases more than systolic BP
b) regional blood flow to the brain doubles
c) cardiac output may increase 15-fold
d) after exercise, BP takes longer to return to normal than heart rate
e) O2 consumption of skeletal muscle may increase 100-fold

15 Atrial systole:
a) causes a decrease in atrial pressure
b) causes the ‘A’ wave of the jugular pulse
c) causes the ‘C’ wave of the jugular pulse
d) causes the ‘V’ wave of the jugular pulse
e) causes the dicrotic notch of the aortic pulse

16 The depolarisation of cardiac muscle cells is characterised by:

a) a slow depolarisation, a plateau then a rapid repolarisation
b) initial depolarisation due to a slow Na+ influx
c) repolarisation due to K+ efflux through two types of K+ channels
d) a plateau phase due to slowly opening Na+ channels
e) calcium efflux during the plateau phase

17 Regarding cardiac electrical properties:

a) all cardiac cells have the same resting membrane potential
b) cholinergic fibres act predominantly by blocking tonic sympathetic input
c) discharge rates of pacemaker tissue does not change significantly with
temperature
d) the bundle of HIS is not the most rapidly conducting part of the conducting system
e) the last parts of myocardium to depolarise normally do not include the septum
18 Abnormalities causing ECG changes in myocardial infarction include:
a) delayed repolarisation early on
b) delayed depolarisation
c) increased resting membrane potential
d) TQ segment elevation
e) current flow away from the infarct

19 Features of the venous system include all of the following EXCEPT:

a) total volume is approximately 55% of the total vascular volume
b) compliance approximately 25 times the arterial side
c) total volume of venules is twice the total capillary volume
d) valves in the cerebral circulation
e) substantial venoconstriction in response to noradrenaline

20 Arteriolar constriction is caused by:

a) serotonin
b) ANP
c) NO
d) K+
e) histamine

21 Regarding the inputs into the vasomotor centre:

a) baroreceptors causes stimulation
b) chemoreceptors cause inhibition
c) baroreceptors provide significant input below 70mmhg mean arterial pressure
d) atrial stretch receptors inhibit the vasomotor centre
e) direct inputs include pO2

22 CSF:
a) volume is about 600ml
b) normal pressure is 5-10cm CSF
c) has a higher concentration of creatinine than plasma
d) has a higher concentration of urea than plasma
e) is formed solely in the choroid plexus
23 Regarding arrhythmias, which is TRUE?
a) the PR interval is shortened but the QRS normal in length in Lown Ganong Levine
syndrome
b) with respect to the long QT syndrome, the genetic defect can occur in both Ca2+
and Na+ channels
c) with respect to the long QT syndrome, the genetic defect can occur in both Ca2+
and K+ channels
d) in atrial fibrillation, the atria beat at 200-300bpm, with the ventricles varying from
80-160/minute (irregular) depending on variable AV conduction
e) ventricular premature beats are never benign

24 With regards to CSF and the blood brain barrier, which is NOT true?
a) the concentration of K+ in CSF is 2.9 ???? H2O
b) the concentration of creatinine is approximately equal to that of plasma
c) the kety method utilises inhaled N2O to determine cerebral blood flow
d) injection of hypotonic fluids can disrupt the blood brain barrier
e) the chemoreceptor trigger zone for vomiting is in the area postnema

25 Foetal circulation, which is TRUE?

a) HbF has a higher affinity for O2 than HbA as it binds 2,3DPG more effectively than
HbA
b) the sucking action of the first breath in the newborn, plus constriction of the
umbilical veins, squeezes as much as 250ml blood from placenta
c) bradykinin dilates umbilical veins and the ductus arteriosus, while constricting the
pulmonary bed
d) blood in the umbilical veins is believed to be about 80% saturated with O2
e) the placenta is a more efficient gas exchange organ than the adult lungs

26 Regarding the conduction system of the heart:

a) the right bundle branch (of HIS) divides into anterior and posterior fasicles
b) the AV node contains P cells
c) myocardial fibres have a resting membrane potential of -60mV
d) action potential in the SA and AV nodes are largely due to Na+ influx
e) there are two types of K+ channels in pacemaker tissue – transient and long
acting

27 During systole:
a) the peak left ventricular pressure is 160mmHg
b) contraction of the atria propels 70% of the ventricular filling
c) the period of isovolumetric ventricular contraction is 0.5sec????
d) the end systolic ventricular volume is about 50mL
e) coronary blood flow to subendocardial portions of the left ventricle occur only in
systole
28 Regarding cardiac output:
a) “energy of contraction is proportional to the initial length of the cardiac muscle
fibre” is Fick’s Law of the heart
b) cardiac index is the correlation between resting cardiac output and height
c) sleep decreases cardiac output
d) basal O2 consumption by the myocardium is 2ml/g/min
e) standing normally decreases the length of ventricular cardiac muscle fibres

29 Effects of electrolyte changes:

a) PR interval increases in hyperkalaemia
b) in hyperkalaemia, the heart stops in systole
c) hypercalcaemia causes prolongation of the ST segments
d) hypernatraemia is associated with low voltage electrocardiographic complexes
e) magnesium counteracts digitalis toxicity

30 Which statement is TRUE regarding cardiac muscle?

a) cardiac muscle fibres are multinucleated
b) they are smaller than skeletal muscle fibres
c) Ca2+ release is triggered by membrane repolarisation
d) the elastic ‘Titin” protein component is greater than in skeletal muscle, adding
stiffness
e) the amount of Ca2+ in the sarcoplasmic reticulum is decreased by catecholamine
stimulation

31 Which statement regarding cardiac “work” is FALSE?

a) the energy applied to the blood stream is defined as kinetic plus potential
b) potential energy involves consideration of energy stored in elastic arterial walls
and gravity
c) there is an exchange between kinetic and potential energy
d) the largest drop in energy occurs at the level of the precupillary sphincters
e) the higher resistance in smaller calibre vessels corresponds to greater energy
losses

32 Which statement about blood flow is FALSE?

a) cardiac output = stroke volume x heart rate
b) the volume of blood pumped through the lungs equals the volume entering the
heart
c) Poiseville’s Law predicts the effects of pressure and resistance on cardiac output
d) the resistance of the systemic circulation is 5 to 10 times the pulmonary vascular
resistance
e) with constant pressure, a vessel with radius ‘2X ‘ has 16 times the flow of vessel
with radius ‘X’
33 Regarding haemodynamic principles, which statement is FALSE?
a) viscosity of blood with haematocrit of 40 is three times that of water
b) ‘arterial’ blood volume is 10-15% total volume
c) ‘elastance’ measures a vessel’s stiffness or recoil
d) aging causes increased elastance and therefore decrease in resting (unstressed)
arterial volume
e) an increase in total peripheral resistance leads to increased arterial volume and
BP

34 Considering conduction rates in myocardial cells, which statement is TRUE?

a) Perkinje fibres are subepicardial and are the largest fibres, 4-7 times the width of
other fibres
b) Perkinje fibres are ‘fast fibres’, and can conduct a wave of depolarisation at a
speed of 4m/sec
c) the duration of the action potential and refractory period in fast fibres is shorter
than slow fibres
d) initial depolarisation occurs in fast fibres with a rapid influx of Ca2+ ions from the
sarcoplasmic reticulum
e) none of the above statements are true

35 With respect to splanchnic circulation:

a) the liver is approximately 50% blood by volume
b) zone 3 of the hepatic acinus is well oxygenated
c) abdominal viscera receive at 30% cardiac output
d) liver receives blood from hepatic artery (1000???ml/min) and hepatic ??? vein
(500ml/min)
e) muscular layer of intestinal wall has higher flow of mucosal layer

36 Blood pressure:
a) the sounds of Korotkoff when taking blood pressure are caused by laminar flow
b) the diastolic pressure in resting adults correlates to the muffling of Korotkoff
sound
c) pressures obtained by palpation of auscultation methods are usually 2-5mmHg
higher
d) if cuff is inflated for some time, it can give falsely low BP readings
e) sounds of Korotkoff occur when velocity of flow through constriction exceeds
critical velocity

37 Coronary circulation:
a) left coronary artery has greater flow in 50% of people
b) thebesian veins connect arterioles to the heart chambers
c) cusps of the aortic valve occlude orifices of coronary arteries during LV ejection
d) coronary flow at rest is 250ml/min
e) at rest, heart extracts 50% O2 / unit of blood delivered
38 Regarding blood vessels:
a) the large diameter arteries are the major site of resistance to blood flow
b) true capillaries are about 5μm in diameter at the arterial end and 9μm in diameter
at the venous end
c) the aorta wall is 1mm thick
d) lymphatic endothelium contains fenestrations
e) angiogenin inhibits angiogenesis

39 Regarding blood flow:

a) turbulence is always present when ??? is more than 2,000
b) flow is displacement per unit time (cm/s)
c) velocity is proportionate to flow multiplied by the area of the conduit
d) the Poiseville-Hagen formula gives the relation between the flow in a long narrow
tube, the viscosity of the fluid and the radius of the tube
e) whole blood is 7 times as viscous as water
f) turbulence is more frequent in polycythaemia because the viscosity of the blood is
higher

40 Regarding venous circulation:

a) pressure is higher in the veins compared with the venules
b) central venous pressure averages 6.4mmHg and fluctuates with respiration and
heart action
c) the drop in venous pressure during expiration aids venous return
d) peripheral venous pressure is not affected by gravity
e) venous flow may be pulsitile

41 Which does not cause vasodilation?

a) decreased O2 tension
b) increased temperature
c) decreased K+
d) increased osmolality
e) adenosine
f) decreased pH

42 Regarding vasoactive substances:

a) endothelial cells produce new cyclooxygen over four days
b) nitrous oxide synthase in immune cells is induced by increased intracellular
calcium concentration
c) no synthase inhibition leads to a prompt rise in blood pressure
d) endothelin-1 is a potent vasodilator
e) angiotensin II inhibits secretion of endothelin-1
43 Heart rate is slowed by:
a) decreased activity of baroreceptors
b) inspiration
c) Bainbridge reflex
d) stimulation of pain fibres in trigenial nerve
e) increased activity of atrial stretch receptors

44 In myocardial infarction:
a) rapid depolarisation by Ca2+ channels is shown by ST segment elevation
b) resting membrane potential is increased
c) arrhythmias in the first 30 minutes are due to re-entry whereas after 12 hours, the
arrhythmias are due to increased automaticity
d) after three days arrhythmias are usually due to increased automaticity
e) failure to progression of the R wave occurs in infarction of the posterior left
ventricle

45 Regarding the jugular pulse:

a) the ‘A’ wave occurs prior to atrial systole
b) the ‘C’ wave is the rise in atrial pressure produced by the bulging of the mitral
valve into the atria during isovolumetric ventricular contraction
c) the ‘V’ wave occurs during systole
d) venous pressure falls in expiration
e) cannon waves are giant ‘A’ waves seen in complete heart block

46 Which does NOT stimulate angiogenesis?

a) platelet factor IV
b) angiogenin
c) tissue factor
d) IL-8
e) tumour necrosis factor α
Cardiovascular

Section 1 – Answers

1 E 24 no answer
2 C 25 no answer
3 B 26 B
4 E 27 D
5 D 28 E
6 D 29 E
7 A 30 B
8 C 31 D
9 E 32 B
10 E 33 D
11 E 34 B
12 C 35 C
13 E 36 E
14 E 37 D
15 B 38 no answer
16 D 39 no answer
17 D 40 no answer
18 B 41 no answer
19 D 42 no answer
20 A 43 no answer
21 D 44 no answer
22 C 45 no answer
23 no answer 46 no answer
Section 2

1 Which statement is FALSE regarding CVS?

a) the primary function of the CVS uses convection
b) secondary function involves heat control
c) the heart is two pumps operating in parallel
d) the same volume of blood passes through each semilunar valve over time
e) the Frank Starling mechanism is used in balancing the output of both ventricles

2 Regarding the heart, which is TRUE?

a) the right and left ventricles perform the same amount of work, because the same
volume of blood is pumped by each
b) the cross sectional shape of both ventricles is approximately cylindrical
c) the right ventricle pumps by a bellows type mechanism
d) the left ventricle pump action is via reducing cross-sectional area, as a function of
radius cubed
e) in pulmonary disease the right ventricle hypertrophies and assumes a crescented
shape in cross section

3 Which is FALSE? Stroke Volume varies with changes in:

a) ventricular contractility
b) arterial pressure
c) end diastolic volume of ventricle
d) blood viscosity
e) right ventricle compared to left

4 Regarding pressure in circulation, which is FALSE?

a) kinetic energy = M.V2 (mass x velocity2)
2
b) hydrostatic (gravitational) pressure = potential energy
c) the pressure in a foot vein may be 150 cm??? greater than at aortic root (in
upright posture)
d) the same pressure differential applies in arterial system, (in upright posture)
e) the greatest pressure drop occurs in the capillaries

5 Regarding volumes in each compartment, which is FALSE?

a) 3% in LV and aorta
b) 15% in arterial system
c) 7% in capillaries
d) 50% in venous system (systemic)
e) 40% in pulmonary circulation
 6 Regarding pressures, which is FALSE?
a) lateral (static) pressure is reduced but prolonged by elastic arteries
b) static pressure increases with gravitation (hydrostatic) pressure increases
c) static pressure does not include kinetic energy
d) greater resistance to flow through a segment of circulation leads to greater loss of
energy through that segment
e) kinetic energy becomes more significant in a narrowed segment and converts
back to potential energy when the tube widens

7 Regarding flow, which is FALSE?

a) flow is proportional to pressure gradient
b) flow is inversely proportional to resistance
c) Poiseville’s Law relates flow to pressure gradient and factors that influence
resistance
d) Poiseville’ Law demonstrates that resistance to flow is largely determined by
viscosity and length of tube and radius x 4
e) if radius of a vessel is halved, the flow may be reduced to 1/16th of previous flow

8 Concerning flow, which is TRUE in the circulatory system?

a) the volume of flow is predicted by velocity ????
b) the widest cross sectional area in the circulation has a flow rate equal to the
narrowest
c) increased viscosity (haematocrit) of blood does not influence the workload of the
heart
d) the greatest cross-sectional area in the blood circulation is in the capillary beds
e) all of the above are true

9 Which statement about factors affecting blood pressure is FALSE? Factors that
increase blood pressure are:
a) increased heart rate
b) increased blood volume
c) pressure rises in increased cardiac output until the amount entering the arterial
system equals the amount leaving
d) increased total peripheral resistance
e) increased end systolic volume

10 Regarding blood pressure, which is TRUE?

a) M.A.P. = pulse pressure / 2 + diastolic pressure
b) elastance increases progressively with age
c) increase in arterial blood pressure causes a subsequent increase in stroke
volume
d) increased sympathetic stimulation may sometimes lead to decreased cardiac
output
e) pulse pressure increases with age because of decreased arterial elastance
11 Regarding red blood cells, all are true EXCEPT:
a) erythropoiesis is stimulated by anaemia and hypoxia
b) after splenectomy, malaria has a higher mortality
c) normal adult haemoglobin is designated α2 β2
d) about 5% of adult haemoglobin is haemoglobin A2 (α2 δ2)
e) G6PD deficiency increases red cell susceptibility to lysis by drugs and infection

12 Regarding the function of the heart:

a) at increased heart rates, diastole is shortened more than systole
b) the pericardial sac normally contains about 50ml of fluid
c) during the cardiac cycle, left ventricular ejection begins before right ventricular
ejection
d) during expiration, the aortic valve closes before the pulmonary valve
e) the end—diastolic ventricular volume is about 170ml

13 Regarding flow in vessels:

a) velocity is greatest closest to blood vessel walls
b) turbulence is almost always present at a Reynold’s number greater than 2,000
c) probability of turbulence in a vessel is directly related to twice the radius
d) flow in vessels is directly related to the fourth power of the ?????
e) turbulence is related to increasing radius

14 Which of the following does not increase the length of ventricular cardiac muscle
fibres?
a) increased total blood volume
b) increased venous tone
c) increased pumping action of skeletal muscle
d) increased negative intrathoracic pressure
e) increased intrapericardial pressure

15 Which of the following does not cause a systolic murmur?

a) aortic stenosis
b) anaemia
c) mitral insufficiency
d) tricuspid stenosis
e) normal flow in children

16 Timing of events in the cardiac cycle:

a) right atrial systole begins after left atrial systole
b) the pulmonary closes after the aortic in inspiration
c) right ventricular ejection starts after left ventricular ejection
d) right ventricular systole starts after left ventricular systole
e) right and left atrial systole are synchronous
17 Starling’s Law of the heart:
a) is an example of hetermeric regulation
b) is an example of homomeric regulation
c) is explained by troponin / tropomyosin overlap
d) relates stroke volume to cardiac output
e) bears little relation to in vivo regulation of the heart

18 The least frequent “ABO” gene is:

a) A
b) B
c) O
d) AB
e) ABO

19 Stimulation of the right vagus:

a) increases calcium inflow to the SA node
b) decreases calcium inflow to the AV node
c) increases potassium outflow in the SA node
d) increases potassium outflow in the AV node
e) decreases potassium outflow in the SA node

20 Starling’s Law:
a) defines a linear relationship between wall tension and force of contraction of
cardiac muscle
b) is approximated by representing wall tension as preload and force of contraction
as afterload
c) predicts greater force of contraction when filling pressure is decreased (eg during
shock)
d) is explained by an increased availability of intracellular Ca2+
e) describes heterometric autoregulation

21 Pacemaker cells of the SA nodes:

a) have an unstable membrane potential due to lack of sodium channels
b) display a ‘prepotential’ prior to depolarisation due to opening of slow calcium
channels
c) do not ‘overshoot’ to the same degree as ordinary cardiac myocytes during
depolarisation
d) control heart rate by virtue of the relatively large numbers of contractile fibres they
contain
e) are primarily innervated by the left vagus nerve
22 Capillaries:
a) contain approximately 20% of the blood volume at rest
b) are often collapsed
c) exchange fluids between the vascular compartment and ISF primarily by filtration
d) are well innervated
e) respond to metabolites such as K+, H+ and heat by (vaso)dilating
Section 2 – Answers

1 C
2 C
3 E
4 E
5 E
6 B
7 D
8 B, D
9 E
10 B
11 D
12 A
13 C
14 E
15 D
16 B
17 A
18 B
19 C
20 E
21 no answer
22 no answer
Viva questions on vascular distensibility and function of
the arterial and venous system

1 Draw and describe the volume-pressure curve in the left ventricle

2 Describe the effects of systolic and diastolic dysfunction on the curve

3 Name the aides to venous flow

4 Describe the three venous waves

5 What are pulse pressure and mean pressure

6 Explain oedema and give causes for it

7 Explain La Places Law and give examples of its clinical relevance

8 Explain Starling forces and fluid ?????? and the capillary