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Question 1
Incorrect
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Digoxin causes:
Your Answer: Negative inotropy
Correct Answer: Increase in cytosolic calcium concentration
Explanation:Digoxin is a positive inotrope which inhibits NA/K ATPase, increases cardiac contractility and can cause hypokalaemia.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 2
Correct
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Angina pectoris develops when blood through the coronary artery becomes:
Your Answer: Restricted, limiting blood blow
Explanation:Angina pectoris develops when stenosis ( >70%) of the artery occurs as a result of formation of an atherosclerotic plaque. This leads to a decrease in the O2 carried to the thickened heart muscle by the blood, leading to the characteristic chest pain associated with angina pectoris.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 3
Correct
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Which of the following affects the magnitude of the action potential?
Your Answer: Changes in the external Na+ concentration
Explanation:The magnitude of the action potential is determined by the sodium current. Increase in external sodium will result in increased influx of sodium and hence generation of a stronger action potential.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 4
Incorrect
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Which of the following causes the closure of the ductus arteriosus during birth?
Your Answer: Reduced right atrium pressure
Correct Answer: Reduced levels of prostaglandins
Explanation:Ductus arteriosus is kept open by the prostaglandin E2 which is a vasodilator. At birth the high levels of cyclooxygenase blocks the production of prostaglandins which results in the closure of the ductus arteriosus.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 5
Incorrect
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During exercise, a man consumes 2L O2/min, his arterial 02 content is 190 ml/l and the 02 content of his mixed venous blood is 130ml/l. His cardiac output is approximately:
Your Answer: 15 l/min
Correct Answer: 33l/min
Explanation:In Fick’s original method, the following variables are measured:VO2, oxygen consumption in ml of pure gaseous oxygen per minute. This may be measured using a spirometer within a closed rebreathing circuit incorporating a CO2 absorberCa, the oxygen concentration of blood taken from the pulmonary vein (representing oxygenated blood)Cv, the oxygen concentration of blood from an intravenous cannula (representing deoxygenated blood)From these values, we know that:VO2 = (CO x Ca) – (CO x Cv)where CO = Cardiac Output, Ca = Oxygen concentration of arterial blood and Cv = Oxygen concentration of mixed venous blood.This allows us to sayCO = VO2/{Ca – Cv}and hence calculate cardiac output.Therefore CO = 2/(0.190-0.130) = 33l/minNote that (Ca – Cv) is also known as the arteriovenous oxygen difference.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 6
Correct
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The Sinoatrial node in the majority of people is supplied by the?
Your Answer: Right coronary artery
Explanation:In 60% of people, the SA node is supplied by the right coronary artery branch and in 40% of the people by the left coronary artery.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 7
Correct
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Which of the following are responsible for the 4th heart sound?
Your Answer: Ventricular hypertrophy
Explanation:The fourth heart sound is not normally audible in a normal adult. It occurs as a consequence of ventricular hypertrophy. It is caused by filling of the ventricle in atrial systole.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 8
Correct
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Which factor produced by the endothelium is responsible for the regulation of vascular cell growth?
Your Answer: Vascular endothelial growth factor (VEGF)
Explanation:VEGF is produced by the endothelial cells and is the major growth factor responsible for causing vasculogenesis. Some isoforms of this growth factor also have a prominent role in formation of lymphatic vessels.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 9
Incorrect
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Adrenergic stimulation will lead to myocyte relaxation via the following mechanisms
Your Answer: Down regulation of phospholambin
Correct Answer: Increased phosphorylation of phosholamban
Explanation:Phosphorylation of phospholamban, which increases calcium ATPase activity and sequestration of calcium in the sarcoplasmic reticulum. An increased rate of relaxation is explained because cAMP also activates the protein phospholamban, situated on the membrane of the SR, that controls the rate of uptake of calcium into the SR. The latter effect explains enhanced relaxation (lusitropic effect).
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 10
Correct
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The approximate incidence of deep venous thrombosis (DVT) in the general population each year is:
Your Answer: 1 per 1000
Explanation:About 1 in 1000 adults per year has DVT, but as of 2011, available data is dominated by North American and European populations. DVT is rare in children, with an incidence of about 1 in 100,000 a year. From childhood to old age, incidence increases by a factor of about 1000, with almost 1% of the elderly experiencing DVTs yearly.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 11
Correct
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The branche(s) of the left coronary artery include:
Your Answer: Left circumflex artery & anterior interventricular artery
Explanation:The left main coronary divides into branches:
1. The left anterior descending artery branches off the left coronary artery and supplies blood to the front of the left side of the heart.
2. The circumflex artery branches off the left coronary artery and encircles the heart muscle.
The anterior interventricular artery is otherwise known as the anterior descending branch. The posterior descending artery comes from Right coronary artery.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 12
Correct
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Coronary arteries fill up during
Your Answer: Diastole
Explanation:During contraction of the ventricular myocardium (systole), the subendocardial coronary vessels (the vessels that enter the myocardium) are compressed due to the high ventricular pressures. This compression results in momentary retrograde blood flow (i.e., blood flows backward toward the aorta) which further inhibits perfusion of myocardium during systole. However, the epicardial coronary vessels (the vessels that run along the outer surface of the heart) remain open. Because of this, blood flow in the sub endocardium stops during ventricular contraction. As a result, most myocardial perfusion occurs during heart relaxation (diastole) when the subendocardial coronary vessels are open and under lower pressure.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 13
Correct
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Question 14
Correct
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The interventricular septum is supplied anteriorly by the?
Your Answer: Left anterior descending artery
Explanation:The anterior interventricular artery or left anterior descending artery supplies the anterior 2/3rds of the interventricular septum.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 15
Correct
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When is the blood pressure at its lowest during pregnancy?
Your Answer: Second trimester
Explanation:It is lowest during the second trimester.
Previous studies have reported changes in blood pressure (BP) throughout pregnancy, and it was generally accepted that in clinically healthy pregnant women, BP falls gradually at first trimester, reaching the lowest around 22–24 weeks, rising again from 28 weeks, and reaching preconception levels by 36 weeks of gestation
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 16
Correct
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Which heart sounds are matched correctly?
Your Answer: All of the above
Explanation:In healthy adults, there are two normal heart sounds often described as a lub and a dub (or dup), that occur in sequence with each heartbeat. These are the first heart sound (S1) and second heart sound (S2), produced by the closing of the atrioventricular valves and semilunar valves, respectively. In addition to these normal sounds, a variety of other sounds may be present including heart murmurs, adventitious sounds, and gallop rhythms S3 and S4. S3 is thought to be caused by the oscillation of blood back and forth between the walls of the ventricles initiated by blood rushing in from the atria. The reason the third heart sound does not occur until the middle third of diastole is probably that during the early part of diastole, the ventricles are not filled sufficiently to create enough tension for reverberation. S4 when audible in an adult is called a presystolic gallop or atrial gallop. This gallop is produced by the sound of blood being forced into a stiff or hypertrophic ventricle.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 17
Correct
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Which of the following does not contribute to increased stroke volume during exercise?
Your Answer: Increased length of filling time during diastole
Explanation:Prolonged aerobic exercise training may also increase stroke volume, which frequently results in a lower (resting) heart rate. Reduced heart rate prolongs ventricular diastole (filling), increasing end-diastolic volume, and ultimately allowing more blood to be ejected.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 18
Correct
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The ‘c’ wave in JVP corresponds more closely with:
Your Answer: Isovolumetric contraction
Explanation:The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease. Classically three upward deflections (peaks) and two downward deflections (troughs) have been described:The upward deflections are the a (atrial contraction), c (ventricular contraction and resulting bulging of tricuspid into the right atrium during isovolumetric systole) and v = venous filling.The downward deflections of the wave are the x (the atrium relaxes and the tricuspid valve moves downward) and the y descent (filling of ventricle after tricuspid opening).
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 19
Incorrect
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In the blood supply of the heart, ‘dominance’ refers to the coronary artery which supplies the?
Your Answer: Sinoatrial node
Correct Answer: Posterior interventricular artery
Explanation:Dominance of the coronary artery system is defined by the artery that gives rise to the posterior interventricular artery. Dominance of the right coronary artery is more common (68%). It gives rise to the large posterior interventricular branch which goes down to the apex of the heart.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 20
Correct
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Question 21
Incorrect
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Following an action potential, cytosolic Ca2+ is increased. The binding of free Ca2+ to troponin C results in all of the following except:
Your Answer: Formation of myosin/troponin i cross-bridges
Correct Answer: Weakening of the troponin i interaction with actin
Explanation:At rest, troponin i is bound to actin and tropomyosin and covers the site where the myosin head interacts with actin. When Calcium enters into the muscle, it binds with troponin C and cause a structural change in troponin i which moves out of the myosin binding site and causes the cross bridges between the actin and myosin filaments to occur.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 22
Incorrect
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Where are the baroreceptors of the great arteries located?
Your Answer: In the endothelium
Correct Answer: In the adventitia
Explanation:Arterial baroreceptors are located in the aortic arch and carotid sinuses, and are formed by small nerve endings present in the adventitia of these vessels.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 23
Correct
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Coronary flow is reduced during
Your Answer: Tachycardia
Explanation:Maximum amount of blood flow in the coronary arteries occur during diastole. When the heart rate increases which is also called tachycardia the duration of diastole decreases. Hence the amount of blood flow to the cardiac muscle also decreases.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 24
Incorrect
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The following is true of the sinus node:
Your Answer: It has the same action potentials as myocytes
Correct Answer: It generates impulses automatically & at a quicker rate than other cardiac cells
Explanation:The SA node exhibits automaticity. It generates the impulses to which the heart beats. It fires at a faster speed than the rest of the nervous components of the heart i.e. the AV nodes, purkinje fibers. This is the reason when the SA node fails the heart beats to the rhythm of the AV node.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 25
Incorrect
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The initial rapid depolarization in the action potential of cardiac muscle cells is due to:
Your Answer: Closure of Ca2+ channels
Correct Answer: Opening of voltage-gated Na+ channels
Explanation:The initial depolarization of the action potential in a cardiac muscle cell is due to the sodium current generated by opening of the voltage gated sodium channels leading to an influx of sodium ions into the cell and raising the membrane potential towards threshold.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 26
Incorrect
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Closure of the tricuspid valve is marked by which of the following features of the jugular venous waveform?
Your Answer: v wave
Correct Answer: c wave
Explanation:The jugular venous pressure (JVP) classically has three upward deflections and two downward deflections. The upward deflections are the a (atrial contraction), c (ventricular contraction and resulting bulging of tricuspid into the right atrium during isovolumetric systole) and v = venous filling. The downward deflections of the wave are the x (the atrium relaxes and the tricuspid valve moves downward) and the y descent (filling of ventricle after tricuspid opening).
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 27
Incorrect
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In Starling’s law of the heart, the decrease in tension developed by muscle contraction at high degrees of stretch is due to:
Your Answer: A conformational change in the myosin head at high degrees of stretch.
Correct Answer: Disruption of myocardial fibers
Explanation:Starling law states that the force of contraction is directly proportional to the preload. When the heart muscle is stretched beyond its limit the tension that is developed decreases, this is not due to loss of formation of effective myosin and actin cross bridges. The heart muscles despite being fully stretched is never stretched to this point. The reason for this decreased tension is physical disruption of the myocardial fibers.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 28
Correct
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In cardiac muscle, which of the following is directly responsible for the release of Ca2+ stored in the sarcoplasmic reticulum (calcium-induced calcium release)?
Your Answer: Ryanodine receptor (RyR)
Explanation:Ryanodine receptor (RyR) is a ligand-gated Ca2+ channel with Ca2+ as its natural ligand. In skeletal muscle, Ca2+ entry from ECF by this route is not required for Ca2+ release. Instead, the DHPR that serves as the voltage sensor unlocks release of Ca2+ from the nearby SR via physical interaction with the RyR. The release is amplified through ca-induced ca release. However, in cardiac muscle, it is the influx of extracellular Ca2+ through the voltage-sensitive DHPR in the T system that triggers ca-induced ca release trough the RyR at the SR.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 29
Correct
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Concerning surface anatomy, where is the aortic valve found?
Your Answer: Situated in the left third intercostal space underneath the sternum
Explanation:The aortic valve is situated in the left 3rd intercostal space just beneath the sternum.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 30
Incorrect
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The rate of depolarisation of the sinus node membrane potential is modulated by all the following except:
Your Answer: Acidosis
Correct Answer: Cardiac output
Explanation:Cardiac output has no effect on the depolarization of the pacemaker potential of the heart.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 31
Incorrect
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Concerning surface anatomy, where is the base of the heart
Your Answer: 4th intercostal space anterior axillary line
Correct Answer: 2nd left costal to 3rd right costal cartilage
Explanation:The base of the heart, also known as the superior border of the heart corresponds to a line connecting the inferior border of the 2nd left costal cartilage to the superior border of the 3rd right costal cartilage.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 32
Correct
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Where on the surface of the chest is the normal site of auscultation for the mitral area?
Your Answer: 4th left intercostal space in the mid-clavicular line
Explanation:The mitral valve is situated in the left 4th intercostal space just beneath the sternum, in the mid clavicular line.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 33
Incorrect
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In Jugular vein pressure the “a” wave represents?
Your Answer: Bulging of mitral valve
Correct Answer: Atrial systole
Explanation:The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease. Classically three upward deflections and two downward deflections have been described: The upward deflections are the a (atrial contraction), c (ventricular contraction and resulting bulging of tricuspid into the right atrium during isovolumetric systole) and v = venous filling.The downward deflections of the wave are the x (the atrium relaxes and the tricuspid valve moves downward) and the y descent (filling of ventricle after tricuspid opening).
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 34
Incorrect
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Where does the SA node develop?
Your Answer: From the endocardium
Correct Answer: From structures on the right side of the embryo.
Explanation:The SA node develops from the right side of the embryo and the AV node from the left. This is the reason why in adults the right vagus supplies the SA node and the left vagus supplies the AV node.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 35
Incorrect
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AV valves open during?
Your Answer: Isovolumetric contraction of ventricles
Correct Answer: Early diastole
Explanation:The cardiac cycle refers to a complete heartbeat from its generation to the beginning of the next beat, and so includes the diastole, the systole, and the intervening pause.The first stage, diastole, is when the semilunar valves (the pulmonary valve and the aortic valve) close, the atrioventricular (AV) valves (the mitral valve and the tricuspid valve) open, and the whole heart is relaxed. The second stage, atrial systole, is when the atrium contracts, and blood flows from atrium to the ventricle.The third stage, isovolumic contraction is when the ventricles begin to contract, the AV and semilunar valves close, and there is no change in volume. The fourth stage, ventricular ejection, is when the ventricles are contracting and emptying, and the semilunar valves are open. During the fifth stage, isovolumic relaxation time, pressure decreases, no blood enters the ventricles, the ventricles stop contracting and begin to relax, and the semilunar valves close due to the pressure of blood in the aorta.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 36
Incorrect
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When the heart rate is increased (to pathological levels) which of the following is correct when comparing the duration of diastole to systole?
Your Answer: It is lengthened to a greater degree
Correct Answer: It is shortened to a greater degree
Explanation:The duration of systole is more fixed than the duration of diastole. When the heart rate increases the timing of the systole remains more or less the same however diastole decreases.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 37
Incorrect
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Question 38
Incorrect
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Direct conduction from the atrium to the ventricles is prevented by:
Your Answer: Purkinje system
Correct Answer: Annulus fibrosus
Explanation:The annulus fibrosus disconnects the syncytium complex. The atria are rapidly activated however the activation peters out when the insulating layer-the annulus fibrosus-is reached.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 39
Incorrect
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Tunica intima is made up of?
Your Answer: Endothelial cells and smooth muscle cells
Correct Answer: Endothelial cells
Explanation:Tunica intima is a single cell thick lining of endothelial cells that lines the inside of the blood vessels. It is the inner most layer of the blood vessel.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 40
Incorrect
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Absolute refractory period in a cardiac action potential graph occurs during.
Your Answer: Initial rapid repolarization
Correct Answer: All of the above
Explanation:Absolute refractory period (ARP): the cell is completely unexcitable to a new stimulus and occurs from phase 0 – 2 i.e. depolarisation, early repolarisation and plateau phase.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 41
Incorrect
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Catecholamines…
Your Answer: None of the above
Correct Answer: Activate adenylyl cyclase
Explanation:Norepinephrine and epinephrine activate or deactivate adenylyl cyclase resulting in a decrease or an increase in the production of cAMP.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 42
Correct
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Afferent fibers from the baroreceptors of the great arteries form branches of which cranial nerves?
Your Answer: Glossopharyngeal and vagus nerves
Explanation:The receptors of the carotid sinus are innervated by the carotid sinus nerve, a branch of the glossopharyngeal nerve. The aortic arch receptors located in the arch of the aorta are innervated by the aortic depressor nerve, a branch of the vagus nerve.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 43
Incorrect
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Which one of the following have not been shown to improve mortality in patients with chronic heart failure?
Your Answer: Nitrates and hydralazine
Correct Answer: Furosemide
Explanation:A number of drugs have been shown to improve mortality in patients with chronic heart failure:
- ACE inhibitors (SAVE, SOLVD, CONSENSUS)
- spironolactone (RALES)
- beta-blockers (CIBIS)
- hydralazine with nitrates (VHEFT-1)
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 44
Incorrect
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Which is the commonest cardiovascular abnormality seen in an adult patient with Marfan’s syndrome?
Your Answer: Mitral regurgitation
Correct Answer: Aortic aneurysm
Explanation:Marfan syndrome (MFS) is a genetic disorder of connective tissue. The degree to which people are affected varies. People with Marfan’s tend to be tall, and thin, with long arms, legs, fingers and toes. They also typically have flexible joints and scoliosis. The most serious complications involve the heart and aorta with an increased risk of mitral valve prolapse and aortic aneurysm.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 45
Incorrect
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Regarding the surface anatomy of the orifices of the heart, where is the aortic valve located?
Your Answer: Opposite the right upper sternal border in the 2nd intercostal space
Correct Answer: Opposite the left 3rd intercostal space to the left of the sternum
Explanation:The aortic valve is situated in the left 3rd intercostal space just beneath the sternum.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 46
Incorrect
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Where would one find pericytes around endothelial cells?
Your Answer: Smaller venules
Correct Answer: Post-capillary venules
Explanation:Pericytes release a wide variety of vasoactive agents which regulate the flow through the junction between endothelial cells.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 47
Incorrect
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In the Fick‘s method of measuring cardiac output, the arterial oxygen content can be measured in a sample obtained from
Your Answer: The left ventricle
Correct Answer: The pulmonary vein
Explanation:In Fick’s original method, the following variables are measured:VO2, oxygen consumption in ml of pure gaseous oxygen per minute. This may be measured using a spirometer within a closed rebreathing circuit incorporating a CO2 absorberCa, the oxygen concentration of blood taken from the pulmonary vein (representing oxygenated blood)Cv, the oxygen concentration of blood from an intravenous cannula (representing deoxygenated blood)From these values, we know that:VO2 = (CO x Ca) – (CO x Cv)where CO = Cardiac Output, Ca = Oxygen concentration of arterial blood and Cv = Oxygen concentration of mixed venous blood.This allows us to sayCO = VO2/{Ca – Cv}and hence calculate cardiac output.Note that (Ca – Cv) is also known as the arteriovenous oxygen difference.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 48
Correct
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Coronary vasoconstriction can be caused by:
Your Answer: Beta blockage
Explanation:Coronary arteries contain alpha and beta receptors. The alpha receptor stimulates vasoconstriction and beta receptors stimulate vasodilation. When the chronotropic and inotropic effects of noradrenergic receptors are blocked by a B blocking drug, stimulation of the noradrenergic nerves will cause coronary vasoconstriction.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 49
Incorrect
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Which of the following factors serve to decrease cardiac output?
Your Answer: Pregnancy
Correct Answer: Standing from a lying position
Explanation:Sleep has no effect on the cardiac output. Anxiety, excitement, increased body temperature and pregnancy will increase the cardiac output. Standing from a lying position will decrease the cardiac output transiently.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 50
Incorrect
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The bradycardia that occurs in patients with raised intracranial pressure is a result of the?
Your Answer: Bezold jarisch reflex
Correct Answer: Cushing reflex
Explanation:When intracranial pressure is increased, the blood supply to RVLM neurons is compromised. This results in an increase in their discharge as a result of hypoxia and hypercapnia. The resultant rise in systemic arterial pressure (Cushing reflex) tends to restore the blood flow to the medulla.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 51
Incorrect
-
The celiac trunk consists of which arteries?
Your Answer: Right gastric, common hepatic, superior mesenteric
Correct Answer: Left gastric, common hepatic, splenic
Explanation:The celiac trunk is the first major branch of the abdominal aorta. It is 1.25 cm in length. Branching from the aorta at thoracic vertebra 12 (T12). There are three main divisions of the celiac artery:- left gastric artery- common hepatic artery- splenic artery
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 52
Incorrect
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Depolarization of the T tubule membrane activates the sarcoplasmic reticulum via which receptors?
Your Answer: Ryanodine receptors
Correct Answer: Dihydropyridine receptors
Explanation:Action potentials are transmitted to the fibrils of a fiber through the T tubule system. It triggers the release of Ca 2+ form the terminal cisterns. Depolarization of the T tubules activates the sarcoplasmic reticulum through the dihydropyridine receptors.
Dihydropyridine receptors (DHPRs), are voltage-gated Ca2+ channels, and ryanodine receptors (RyRs), which are intracellular Ca2+ release channels, are expressed in diverse cell types, including skeletal and cardiac muscle.
Ryanodine receptors (RyRs) are located in the sarcoplasmic/endoplasmic reticulum membrane and are responsible for the release of Ca2+ from intracellular stores during excitation-contraction coupling in both cardiac and skeletal muscle.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 53
Incorrect
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Which of the atrial pressure changes represents the a-wave of the JVP
Your Answer: Bulging of the tricuspid valve into the atrium during isovolumetric ventricular contraction
Correct Answer: Atrial systole
Explanation:The a-wave created on the venous pulse curve occurs as a result of atrial systole. Due to the pressure build-up in the atria, it causes a back pressure in the vena cava. This pressure is exerted on the valve and this back pressure is what causes a slight increase in the venous pressure.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 54
Incorrect
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In which area is depolarization initiated?
Your Answer: Purkinje fibers
Correct Answer: SA node
Explanation:SA node is the pacemaker of the heart. It determines the rate of contractions. It is the place where depolarization is initiated. It exhibits phase 4 depolarization or automaticity. Electrical impulses then spread to the AV node, purkinje fibers, bundle of his and the ventricular muscles.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 55
Incorrect
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The steps of cardiac cycle in sequence are:
Your Answer: Isovolumetric relaxation, isovolumetric contraction, ejection, passive ventricular filling, active ventricular filling
Correct Answer: Isovolumic contraction, ejection, isovolumic relaxation, passive ventricular filling, active ventricular filling.
Explanation:The cardiac cycle refers to a complete heartbeat from its generation to the beginning of the next beat, and so includes the diastole, the systole, and the intervening pause.1st stage: diastole, or passive filling is when the semilunar valves (the pulmonary valve and the aortic valve) close, the atrioventricular (AV) valves (the mitral valve and the tricuspid valve) open, and the whole heart is relaxed. 2nd stage: atrial systole, is when the atrium contracts, and blood flows from atrium to the ventricle (active filling).3rd stage: isovolumic contraction is when the ventricles begin to contract, the AV and semilunar valves close, and there is no change in volume. 4th stage: ventricular ejection, is when the ventricles are contracting and emptying, and the semilunar valves are open. 5th stage: isovolumic relaxation time, pressure decreases, no blood enters the ventricles, the ventricles stop contracting and begin to relax, and the semilunar valves close due to the pressure of blood in the aorta.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 56
Incorrect
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Myocyte action potentials – Choose the false statement:
Your Answer: Myocardial fibers have a resting membrane potential of about -90mv
Correct Answer: Repolarisation is due to net k+ influx
Explanation:Final repolarization (phase 3) to the resting membrane potential (phase 4) is due to closure of the Ca2+ channels and a slow, delayed increase of K+ efflux through various types of K+ channels.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 57
Correct
-
Calcium needed for cardiac muscle contraction is made available during which phase of the action potential?
Your Answer: 2
Explanation:It is made available during the plateau phase of the action potential i.e. phase 2. During the plateau phase of the action potential, Calcium from the extracellular fluid enters through the L type of calcium channels. This entry triggers the release of more calcium from the sarcoplasmic reticulum via the ryanodine receptors.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 58
Incorrect
-
The Plateau phase in myocyte action potentials does all of the following except:
Your Answer: It directly determines the strength of cardiac contraction
Correct Answer: It allows early reactivation of the myocytes
Explanation:The presence of the plateau in the action potential causes ventricular contraction to last as much as 15 times longer in cardiac muscle as in skeletal muscle. The plateau phase which follows is unique to myocytes and results from a small, but sustained inward calcium current through L-type calcium channels lasting 200-400 ms. This calcium influx is caused by a combined increase in permeability of the cell and especially the sarcolemmal membranes to calcium. This plateau (refractory) phase prevents early reactivation of the myocytes and directly determines the strength of contraction.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 59
Incorrect
-
Question 60
Incorrect
-
The coronary arteries fill during?
Your Answer: Isometric ventricular contraction
Correct Answer: Diastole
Explanation:During systole the coronary arteries collapse as a result of the pressure due to contraction that is exerted on them. During diastole the heart muscle relaxes and the pressure on the coronary vessels is relieved allowing blood to flow through them to the subendocardium.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 61
Incorrect
-
Vasodilatation of coronary arteries is caused by:
Your Answer: Carbon-monoxide
Correct Answer: Hypoxia
Explanation:The heart is highly metabolically active and boasts the highest oxygen consumption by mass of any organ. This demand for oxygen is met by the coronary circulation, which is responsible for delivering blood to the myocardium and represents approximately 5% of cardiac output. Vasodilation may be due to the local effect of hypoxia on coronary vessels, or local metabolic vasodilation, or the activation of β-adrenoceptors or some combination of these mechanisms.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 62
Incorrect
-
Pacemaker cells in the SA node and the AV node are connected by?
Your Answer: Organelle
Correct Answer: Gap junctions
Explanation:Gap junctions allows for rapid propagation of the action potential from one cell to the other. The cells of the heart are connected by gap junctions.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 63
Correct
-
Question 64
Correct
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Question 65
Incorrect
-
Which of the following is NOT associated with the development of aortic regurgitation?
Your Answer: Marfan's syndrome
Correct Answer: Dilated cardiomyopathy
Explanation:Aortic insufficiency, is often due to the aortic root dilation, which is idiopathic in over 80% of cases, but otherwise may result from aging, syphilitic aortitis, osteogenesis imperfecta, aortic dissection, Bechet’s disease, reactive arthritis and systemic hypertension. Additionally, aortic insufficiency has been linked to the use of some medications and other potential causes that affect the valve directly including Marfan’s syndrome, Ehlers–Danlos syndrome, ankylosing spondylitis, and systemic lupus erythematosus. In acute cases of aortic insufficiency, the main causes are infective endocarditis, aortic dissection or trauma. Dilated cardiomyopathy is associated with the development of mitral regurgitation, not aortic regurgitation
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 66
Incorrect
-
Which coronary artery supplies the right atria?
Your Answer: Left posterior descending
Correct Answer: Right coronary
Explanation:The left coronary artery distributes blood to the left side of the heart, the left atrium and ventricle, and the interventricular septum. The circumflex artery arises from the left coronary artery and follows the coronary sulcus to the left. Eventually, it will fuse with the small branches of the right coronary artery. The right coronary artery proceeds along the coronary sulcus and distributes blood to the right atrium, portions of both ventricles, and the heart conduction system.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 67
Incorrect
-
Currents caused by opening of which of the following channels contribute to the repolarization phase of the action potential of the ventricular muscle fibers?
Your Answer: Chloride channels
Correct Answer: Potassium channels
Explanation:Depolarization occurs due to opening of the voltage gated sodium channels. Repolarization occurs due to opening of the voltage gates potassium channels causing an out flux of potassium ions, decreasing the membrane potential towards resting potential.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 68
Correct
-
The effects of β1 stimulation include the following
Your Answer: Increased strength of contraction
Explanation:β1 stimulation include the phosphorylation of L type Ca++ channels and phospholamban and increased Ca++ influx from myocytes.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 69
Incorrect
-
Which of the following antiarrhythmic drugs may be used in the treatment of long QT syndrome?
Your Answer: Flecainide
Correct Answer: Atenolol
Explanation:Beta-blockers are the mainstay of treatment in long QT syndrome. Implantable cardioverter-defibrillators are the most effective treatment in genotypes with a high risk of recurrence.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 70
Incorrect
-
Impulse conduction through the AV node is slow and depends on the action potential produced by which of the following.
Your Answer: Sodium diffusion
Correct Answer: Calcium flux
Explanation:The action potentials in the SA and AV nodes are largely due to Ca2+, with no contribution by Na+ influx.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 71
Incorrect
-
Question 72
Correct
-
In ventricular fibrillation (VF), the first defibrillation attempt (with a biphasic defibrillator) should be made at:
Your Answer: 200 J
Explanation:Defibrillation is a common treatment for life-threatening cardiac dysrhythmias and ventricular fibrillation. If the patient is in Ventricular tachycardia (VT) or ventricular fibrillation (VF) on the monitor, immediately apply the pads and shock the patient with 120-200 Joules on a biphasic defibrillator or 360 Joules on a monophasic defibrillator.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 73
Incorrect
-
Question 74
Incorrect
-
Relaxation of the cardiac muscle at the actin-myosin cross bridges is initiated by binding of which molecule to the exposed site on the myosin.
Your Answer: ADP
Correct Answer: ATP
Explanation:A crossbridge is a myosin projection, consisting of two myosin heads, that extends from the thick filaments. Each myosin head has two binding sites: one for ATP and another for actin. The binding of ATP to a myosin head detaches myosin from actin, thereby allowing myosin to bind to another actin molecule. Once attached, the ATP is hydrolysed by myosin, which uses the released energy to move into the cocked position whereby it binds weakly to a part of the actin binding site.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 75
Incorrect
-
Question 76
Incorrect
-
Blood flow to the subendocardial portions of the left ventricular muscle occurs mainly during:
Your Answer: Isovolumetric ventricular relaxation
Correct Answer: Diastole
Explanation:The sub endocardium receives the least amount of blood from the coronary arteries. During systole the coronary arteries collapse as a result of the pressure from contraction that is exerted on them. During diastole the heart muscle relaxes and the pressure on the coronary vessels is relieved allowing blood to flow through them to the sub endocardium.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 77
Incorrect
-
Concerning S3, which of the following statements is INCORRECT?
Your Answer: Normal in children
Correct Answer: Coincide with atrial contraction
Explanation:A third heart sound also called a ventricular gallop occurs at the beginning of diastole after S2 and is lower in pitch than S1 or S2 as it is not of valvular origin. The third heart sound is benign in youth, some trained athletes, and sometimes in pregnancy but if it re-emerges later in life it may signal cardiac problems, such as a failing left ventricle as in dilated congestive heart failure (CHF). S3 is thought to be caused by the oscillation of blood back and forth between the walls of the ventricles initiated by blood rushing in from the atria. The reason the third heart sound does not occur until the middle third of diastole is probably that during the early part of diastole, the ventricles are not filled sufficiently to create enough tension for reverberation. It may also be a result of tensing of the chordae tendineae during rapid filling and expansion of the ventricle. In other words, an S3 heart sound indicates increased volume of blood within the ventricle. An S3 heart sound is best heard with the bell-side of the stethoscope (used for lower frequency sounds). A left-sided S3 is best heard in the left lateral decubitus position and at the apex of the heart, which is normally located in the 5th left intercostal space at the midclavicular line. A right-sided S3 is best heard at the lower-left sternal border. The way to distinguish between a left and right-sided S3 is to observe whether it increases in intensity with inhalation or exhalation. A right-sided S3 will increase on inhalation, while a left-sided S3 will increase on exhalation.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 78
Correct
-
The ability of the SA node cells to allow ionic flow through channels activated in a hyperpolarized state is known as:
Your Answer: Pace maker potential
Explanation:Rhythmically discharging cells have a membrane potential that, after each impulse, declines to the firing level. Thus this prepotential or Pacemaker potential triggers the next impulse. The inherent leakiness of the sinus nodal fibers to Na+ and Ca2+ causes their self excitation.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 79
Incorrect
-
Which ion channel does not contribute to the myocardial action potential?
Your Answer: Inward sodium channel
Correct Answer: Chloride channel
Explanation:The upstroke in the cardiac action potential is due to opening of the sodium channels and an influx of sodium into the cell. The initial repolarization phase is due to transient opening of the potassium channels along with calcium channels. Influx of calcium causes the prolonged plateau phase of the action potential. Delayed opening of the rectifier potassium channel and delayed closure of the calcium channel leads to the repolarization phase of cardiac action potential.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 80
Incorrect
-
Myocardium requires more oxygen to expel blood in:
Your Answer: A stenotic pulmonary valve
Correct Answer: A stenotic aortic valve
Explanation:In aortic valve stenosis, increased ventricular pressure Is needed to expel the blood into the aorta. Increased pressure means increased contractility hence increase O2 consumption by the heart muscles.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 81
Incorrect
-
Which of the following corresponds to an oblique line drawn from the sternal end of the left 3rd costal cartilage to the sternal end of the right 6th costal cartilage?
Your Answer: Ascending aorta
Correct Answer: Atrio-ventricular (coronary) groove
Explanation:The AV groove corresponds to the right border of the heart. The right border corresponds to a line drawn from the 3rd right costal cartilage to the 6th right costal cartilage; this border is slightly convex to the right.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 82
Incorrect
-
In the jugular venous pressure wave…
Your Answer: Giant v wave occurs in tricuspid stenosis
Correct Answer: Consists of 3 peaks and 2 troughs
Explanation:The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease. Classically three upward deflections (peaks) and two downward deflections (troughs) have been described:The upward deflections are the a (atrial contraction), c (ventricular contraction and resulting bulging of tricuspid into the right atrium during isovolumetric systole) and v = venous filling.The downward deflections of the wave are the x (the atrium relaxes and the tricuspid valve moves downward) and the y descent (filling of ventricle after tricuspid opening).
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 83
Incorrect
-
Stroke volume in a average sized man lying in supine position is about?
Your Answer: 5l/min
Correct Answer: 70 ml
Explanation:The stroke volume of an average sized man who is lying is the supine position is about 70 ml.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 84
Incorrect
-
Concerning coronary arteries, what is the net effect of B2 stimulation on the heart (e.g. Running athlete)?
Your Answer: No change in coronary artery diameter
Correct Answer: Vasodilation via production of metabolites
Explanation:The coronary arterioles contain α-adrenergic receptors, which cause vasoconstriction, and β-adrenergic receptors, which cause vasodilation. Activity in the noradrenergic nerves to the heart and injections of norepinephrine cause coronary vasodilation. However, norepinephrine also increases the heart rate and the force of cardiac contraction, and the vasodilation is due to production of vasodilator metabolites in the myocardium secondary to the increase in its activity. As exercise has the same effect as sympathetic stimulation, it will result in vasodilation.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
-
Question 85
Incorrect
-
Most of the venous blood returns to the heart through the:
Your Answer: Left ventricle
Correct Answer: Coronary sinus and anterior cardiac veins
Explanation:Most of the venous blood returns to the heart via the coronary sinus and the anterior cardiac veins which drain into the right atrium.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 86
Incorrect
-
Hyperkalaemia [K+ =7meq/l] can lead to the following ECG changes [Ca++ normal]
Your Answer: Lengthened PR interval
Correct Answer: Peaked T waves
Explanation:Hyperkalaemia causes the formation of tall tented T waves due to altered repolarization.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 87
Incorrect
-
Which of the following pairs are correct concerning arteriolar tone?
Your Answer: None of the above
Correct Answer: Hormonal control: catecholamines affect the adrenergic receptors of the vascular smooth muscle
Explanation:Catecholamines released from the adrenal medulla act on the noradrenergic receptors of the vascular smooth muscles. In the skeletal muscles and liver it causes vasodilation whilst it causes vasoconstriction in the rest of the blood vessels of the body.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 88
Incorrect
-
Which one of the following ECG findings is least associated with digoxin use?
Your Answer: AV block
Correct Answer: Prolonged QT interval
Explanation:Digoxin ECG features:• ST depression (‘reverse tick’)• flattened/inverted T waves• Prolonged PR interval• short QT interval• arrhythmias e.g. AV block, bradycardia, ventricular tachycardia or fibrillation (for example paroxysmal atrial tachycardia with A-V block – so-called PAT with block) is said to be pathognomonic (i.e. diagnostic) of digoxin toxicity.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 89
Incorrect
-
Which membrane bound protein in the sarcoplasmic reticulum regulates calcium return from the cytosol to the sarcoplasmic reticulum?
Your Answer: Calmodulin
Correct Answer: Phospholamban
Explanation:Phosphorylation of phospholamban increases calcium ATPase activity and sequestration of calcium in the sarcoplasmic reticulum. An increased rate of relaxation is explained because cAMP also activates the protein phospholamban, situated on the membrane of the sarcoplasmic reticulum (SR), that controls the rate of uptake of calcium into the SR. The latter effect explains enhanced relaxation (lusitropic effect).
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 90
Incorrect
-
The following determines the strength of contraction
Your Answer: None of the above
Correct Answer: Plateau phase
Explanation:The plateau phase which follows is unique to myocytes and results from a small, but sustained inward calcium current through L-type calcium channels lasting 200-400 ms. This calcium influx is caused by a combined increase in permeability of the cell and especially the sarcolemmal membranes to calcium. This plateau (or refractory) phase in myocyte action potential prevents early reactivation of the myocytes and directly determines the strength of contraction
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
-
Question 91
Incorrect
-
The most resistant area in the brain to hypoxia is:
Your Answer: Cerebral cortex
Correct Answer: Brain stem
Explanation:The structures in the brainstem are more resistant to hypoxia than the cerebral cortex and the rest of the brain structures.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 92
Incorrect
-
What is the isolated effect of B2 stimulation on the coronaries?
Your Answer: The coronary arteries have no B2 receptors
Correct Answer: Vasodilatation
Explanation:Norepinephrine and epinephrine are agonists for all adrenergic receptor subtypes, although with varying affinities. Based on their physiology and pharmacology, adrenergic receptors have been divided into two principal types: alpha and beta. These types have been further differentiated into alpha-1, alpha-2, b1, and b2 receptors.
Alpha-1 Receptors are located on postsynaptic cells in smooth muscle and elicit vasoconstriction.
Alpha-2 receptors are localized on presynaptic membranes of postganglionic nerve terminals that synthesize norepinephrine. When activated by catecholamines, alpha-2 receptors act as negative feedback controllers, inhibiting further norepinephrine release.
Activation of myocardial b1 receptors stimulates the rate and strength of cardiac contraction, and consequently increases cardiac output. b1 Receptor activation also stimulates renin release from the kidney. Another class of antihypertensive agents acts by inhibiting b1 receptors.
Activation of b2 receptors by epinephrine relaxes vascular smooth muscle and results in vasodilation.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 93
Correct
-
In which organ will you find extremely porous sinusoidal capillaries, with discontinuous endothelium?
Your Answer: Liver
Explanation:The liver is the organ which contains sinusoidal capillaries with discontinuous endothelium. The brain, lungs and the intestine all contain continuous capillaries, however the kidney contains fenestrated capillaries to aid in filtration.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 94
Incorrect
-
The following are examples of the functions of the vascular endothelium except:
Your Answer: Prothrombotic
Correct Answer: Tumour suppression
Explanation:Vascular endothelium has many important functions including regulation of vascular tone, molecular exchange between blood and tissue compartments, hemostasis and signaling for the immune regulation and inflammation. Depending on specific tissue needs and local stresses, endothelial cells are capable of evoking either antithrombotic or prothrombotic events. Tumor suppression is related to genes, or anti-oncogenes, that regulate a cell during cell division and replication.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 95
Incorrect
-
Which statement about the 2nd heart sound is true?
Your Answer: A split 2nd heart sound is always pathological.
Correct Answer: It is caused by closure of the aortic and pulmonary valves.
Explanation:The second heart sound is produced due to closure of the aortic and pulmonary valves. It is a high pitched dub sound.
Normally the aortic closure sound (A2) occurs prior to the pulmonic closure sound (P2), and the interval between the two (splitting) widens on inspiration and narrows on expiration. With quiet respiration, A2 will normally precede P2 by 0.02 to 0.08 second (mean, 0.03 to 0.04 sec) with inspiration. In younger subjects inspiratory splitting averages 0.04 to 0.05 second during quiet respiration. With expiration, A2 and P2 may be superimposed and are rarely split as much as 0.04 second. If the second sound is split by greater than 0.04 second on expiration, it is usually abnormal. Therefore, the presence of audible splitting during expiration (i.e., the ability to hear two distinct sounds during expiration) is of greater significance at the bedside in identifying underlying cardiac pathology than is the absolute inspiratory increase in the A2–P2 interval.
The respiratory variation of the second heart sound can be categorized as follows: (1) normal (physiologic) splitting; (2) persistent (audible expiratory) splitting, with normal respiratory variation; (3) persistent splitting without respiratory variation (fixed splitting); and (4) reversed (paradoxical) splitting.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 96
Incorrect
-
The T-tubular system in cardiac muscle is:
Your Answer: Has dihydropyridine receptors which act as calcium activated Ca2+ release channels.
Correct Answer: Transmits action potential from sarcolemma to the SR to allow for Ca2+ release into the cytoplasm
Explanation:Action potentials are transmitted to the fibrils of a fiber through the T tubule system. It triggers the release of Ca 2+ from the terminal cisterns. Depolarization of the T tubules activates the sarcoplasmic reticulum through the dihydropyridine receptors, which are voltage gated calcium channels.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 97
Correct
-
Activation of baroreceptor reflex involves:
Your Answer: Short term regulation of systemic blood pressure
Explanation:Baroreceptors are found in the heart and the blood vessels. They are the carotid sinus and the aortic arch receptors and respond to the minute to minute change in the blood pressure i.e. a change in the pulsatile pressure and not to a change in the mean arterial pressure. If the pulse pressure decreases, the rate of firing of the receptors decreases, stimulating an increase in the heart rate and blood pressure. Mechanisms that regulate the long term blood pressure control include the renin-angiotensin-aldosterone mechanism.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 98
Incorrect
-
Stimulation of the carotid sinus results in:
Your Answer: Sweating
Correct Answer: Drop in blood pressure
Explanation:Stimulation of the carotid sinus will result in an increase in the baroreceptor discharge. This will travel via the afferent nerves to the medulla. Signals will pass through the vagus nerve to decrease the sympathetic outflow to the heart and the blood vessels. This inhibition will result in vasodilation of the blood vessels, venodilation and bradycardia hence decreasing the total peripheral resistance and lowering the blood pressure.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 99
Incorrect
-
Which of the following components regulate cardiac output?
Your Answer: Chronotropic and inotropic action
Correct Answer: All of the above
Explanation:Cardiac output is regulated by the autonomic nervous system with sympathetic nerves having a positive chronotropic and inotropic effect and parasympathetic nerves having the opposite effect. An increase in preload will increase cardiac output likewise an afterload increase will also increase cardiac output.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 100
Incorrect
-
The process by which depolarization of the muscle fiber initiates contraction is called?
Your Answer: Activation of contraction
Correct Answer: Action potential
Explanation:This process is known as an action potential. Upon generation of an action potential when depolarization reaches threshold, it spreads throughout the muscle fiber, resulting in generation of an excitation-contraction coupling leading to contraction of the muscle.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 101
Incorrect
-
In a 30 year old male with hypertrophic obstructive cardiomyopathy (HOCM), which of the following is not associated with increased risk of sudden death?
Your Answer: Family history of sudden death
Correct Answer: Age
Explanation:Hypertrophic cardiomyopathy (HCM) is a disease in which a portion of the myocardium (heart muscle) is enlarged without any obvious cause, creating functional impairment of the heart. It is the leading cause of sudden death in young athletes. The major risk factors for sudden death (SD) are recent unexplained syncope unlikely to be neurocardiogenic; HCM-related SD in first-degree or other close relatives; repetitive and/or prolonged nonsustained ventricular tachycardia (NSVT) episodes on Holter or extended ambulatory monitoring; massive left ventricular hypertrophy (LVH) (wall thickness ≥30 mm); extensive/diffuse late gadolinium enhancement (LGE); end-stage heart failure usually with systolic dysfunction; and thin-walled akinetic LV apical aneurysm with regional scarring.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 102
Incorrect
-
What is the effect of catecholamines (i.e. increased heart rate) on the pressure volume loop?
Your Answer: No effect
Correct Answer: Shifts the diastolic pressure curve upward and leftward
Explanation:Catecholamines have a positive ionotropic and chronotropic effect on the heart. The ventricles develop greater tension during systole resulting in an increase in the stroke volume. The increase in stroke volume results in a decrease in the end diastolic volume. This pushes the loop towards the left and upwards.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 103
Incorrect
-
Regarding the myofilament molecules, which of the following contains binding sites for calcium that helps to initiate contraction?
Your Answer: Actinin
Correct Answer: Troponin c
Explanation:Troponin T binds the troponin components to tropomyosin. Troponin I inhibits the interaction of myosin with actin and troponin C contains the binding sites for the Ca2+ that helps initiate contraction.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 104
Incorrect
-
The postextrasystolic potentiation of myocardial contractility is due to:
Your Answer: Increased ventricular filling
Correct Answer: Increase in intracellular Ca2+
Explanation:The postextrasystolic potentiation of myocardial contractility Is not due to ventricular filling. It occurs in isolated locations in the heart and is due to increase availability of intracellular calcium.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 105
Incorrect
-
The coronary arteries supply which part of the heart’s subendocardial region exclusively in diastole?
Your Answer: Right ventricle
Correct Answer: Left ventricle
Explanation:It is only during diastole that the blood flows to the subendocardial portion of the left ventricle, as the heart muscle relaxes and the coronary arteries regain their patency.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 106
Incorrect
-
A 55 year old cardiac patient is comfortable at rest but heavy housework results in fatigue, palpitations or dyspnoea. What New York Heart Association class best describes the severity of their disease?
Your Answer: NYHA Class I
Correct Answer: NYHA Class II
Explanation:New York Heart Association functional classification:
Class I: no limitation is experienced in any activities; there are no symptoms from ordinary activities.
Class II: slight, mild limitation of activity; the patient is comfortable at rest or with mild exertion.
Class III: marked limitation of any activity; the patient is comfortable only at rest.
Class IV: any physical activity brings on discomfort and symptoms occur at rest.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 107
Incorrect
-
What are the diagnostic criteria for an ST segment elevation type of acute myocardial infarction?
Your Answer: Q waves in any two leads
Correct Answer: 1 mm ST elevation in 2 limb leads
Explanation:The current guidelines for the ECG diagnosis of the ST segment elevation type of acute myocardial infarction require at least 1 mm (0.1 mV) of ST segment elevation in the limb leads, and at least 2 mm elevation in the precordial leads. These elevations must be present in anatomically contiguous leads. (I, aVL, V5, V6 correspond to the lateral wall; V3-V4 correspond to the anterior wall ; V1-V2 correspond to the septal wall; II, III, aVF correspond to the inferior wall.)
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 108
Incorrect
-
Although variable, branches of which artery most often supply the SA and AV nodes?
Your Answer: Left anterior descending artery
Correct Answer: Right coronary artery
Explanation:The RCA (right coronary artery) supplies the SA and the AV nodes along with the postero-basal wall of the left ventricle, posterior one third of the inferior vena cava, right ventricle and the posteromedial papillary muscle in the left ventricle.
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This question is part of the following fields:
- Cardiovascular
- Medicine
-
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Question 109
Incorrect
-
Which of the following statements is true regarding pulsus alternans?
Your Answer: It is found in patients with a small pericardial effusion
Correct Answer: It is found in association with a third heart sound
Explanation:Pulsus alternans is a physical finding with arterial pulse waveform showing alternating strong and weak beats. It is almost always indicative of left ventricular systolic impairment, and carries a poor prognosis. A pathological third heart sound is usually associated.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 110
Incorrect
-
Transport of Ca2+ into the reticulum to initiate cardiac muscle relaxation in via:
Your Answer: Closure of the ryanodine receptor
Correct Answer: Serca (sarcoplasmic or endoplasmic reticulum Ca2+ ATPase)
Explanation:Phosphorylation of phospholamban, which increases calcium ATPase activity and sequestration of calcium in the sarcoplasmic reticulum. An increased rate of relaxation is explained because cAMP also activates the protein phospholamban, situated on the membrane of the SR, that controls the rate of uptake of calcium into the SR. The latter effect explains enhanced relaxation (lusitropic effect).
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 111
Correct
-
Calcium is mobilized from the sarcoplasmic reticulum through:
Your Answer: Ryanodine receptor (RyR2) calcium release channels
Explanation:During the plateau phase of the action potential, calcium from the extracellular fluid enters through the L type of calcium channels. This entry triggers the release of more calcium from the sarcoplasmic reticulum via the ryanodine receptors. As a result intracellular calcium increases binding to troponin C resulting in contraction.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 112
Incorrect
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The rate of depolarization of the SA node membrane potential is modulated by the following:
Your Answer: Autonomic tone
Correct Answer: All of the above
Explanation:Rate of depolarization of the SA node is modulated by all of these.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 113
Incorrect
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The triangle with the heart at its centre, using limb leads is called:
Your Answer: Jones
Correct Answer: Einthoven
Explanation:The Einthoven triangle is formed by placing the limb leads on both the arms and on the left leg with the heart in the centre.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 114
Incorrect
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Which of the following is true with AV nodal delay?
Your Answer: The delay is about 0.01s
Correct Answer: Shortened by sympathetic stimulation
Explanation:AV nodal delay Is about 0.1s before the action potential spreads to the ventricles. It is shortened by stimulation of the sympathetic nervous system and lengthened by stimulation of the parasympathetic system.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 115
Incorrect
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The internodal tract of Bachman:
Your Answer: Its main function is to reduce the amount of conduction to the AV node
Correct Answer: Connects the SA node to the AV node
Explanation:Internodal tract of Bachman connects the SA node to the AV node conducting the electrical impulses generated from the SA node to the AV node and from the AV node to the rest of the electrical complex of the heart.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 116
Incorrect
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Regarding cardiac muscle contractility, the afterload refers to:
Your Answer: Cardiac acceleration action of catecholamines
Correct Answer: The resistance against which blood is expected
Explanation:The afterload for the left ventricle is the aortic pressure. Hence it is this pressure that offers resistance against which the blood is to be expelled from the heart.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 117
Incorrect
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Regarding blood supply to the heart;
Your Answer: Coronary arteries arise from the ventricular septum
Correct Answer: Coronary arteries fill as the heart relaxes
Explanation:The heart muscles acts like the skeletal muscle in the fact that it also compress the vessels during contraction. As the pressure in the ventricle is slightly greater than in the aorta the coronary vessels collapse during systole. Blood flows through them during the diastole phase of contraction.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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Question 118
Incorrect
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Question 119
Incorrect
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Question 120
Incorrect
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Factors influencing cardiac output include which of the following?
Your Answer: Postural positioning
Correct Answer: All of the above
Explanation:There is a correlation between resting CO and body surface area. The output per min per square meter of body surface (the cardiac index) averages 3.2l.
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This question is part of the following fields:
- Cardiovascular
- Medicine
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