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  • Question 1 - What are the diagnostic criteria for an ST segment elevation type of acute...

    Correct

    • What are the diagnostic criteria for an ST segment elevation type of acute myocardial infarction?

      Your 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.)

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      13.5
      Seconds

  • Question 2 - Where does the SA node develop? ...

    Correct

    • Where does the SA node develop?

      Your 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      12.1
      Seconds

  • Question 3 - The principle by which the energy of contraction is proportional to the initial...

    Correct

    • The principle by which the energy of contraction is proportional to the initial length of cardiac muscle fiber is known as:

      Your Answer: Starling’s law

      Explanation:

      The Frank starling relationship describes that an increase in the venous return or the end diastolic volume will cause an increase in the stroke volume/ preload and also cardiac output. It stems from the fact that increase venous return will increase the stretch on the ventricular muscle fibers. The sarcomere will stretch a considerable length that is needed for maximum contraction and increased development of tension in the muscle fiber. The greater the venous return the greater the cardiac output. This relation is directly proportional.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      14.9
      Seconds

  • Question 4 - Which one of the following have not been shown to improve mortality in...

    Correct

    • Which one of the following have not been shown to improve mortality in patients with chronic heart failure?

      Your 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)

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      12
      Seconds

  • Question 5 - Which of the following is first to rise following myocardial infarction? ...

    Incorrect

    • Which of the following is first to rise following myocardial infarction?

      Your Answer: Troponin I

      Correct Answer: Myoglobin

      Explanation:

      Myoglobin, is a sensitive indicator of muscle injury and is first to rise following MI within two hours but is nonspecific.Troponin and CK-MB both begin to rise approximately three hours after MI. The cardiac troponins T and I which are released within 4–6 hours of an attack of MI and remain elevated for up to 2 weeks, have nearly complete tissue specificity and are now the preferred markers for assessing myocardial damage.Lactate dehydrogenase (LDH) begins to rise approximately 12 hours after MI.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      11.3
      Seconds

  • Question 6 - In a normal heart rate at rest, the left ventricular end-diastolic volume is...

    Incorrect

    • In a normal heart rate at rest, the left ventricular end-diastolic volume is ….

      Your Answer: 30-50 ml

      Correct Answer: 100-130 ml

      Explanation:

      In cardiovascular physiology, end-diastolic volume (EDV) is the volume of blood in the right and/or left ventricle at end load or filling in (diastole) or the amount of blood in the ventricles just before systole. Because greater EDVs cause greater distention of the ventricle, EDV is often used synonymously with preload, which refers to the length of the sarcomeres in cardiac muscle prior to contraction (systole). End-diastolic volume: Right = 144 mL(± 23mL) & Left = 142 mL (± 21 mL).

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      12.3
      Seconds

  • Question 7 - Which of the following statements is true regarding pulsus alternans? ...

    Incorrect

    • Which of the following statements is true regarding pulsus alternans?

      Your Answer: It is diagnosed electrocardiographically

      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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      42.2
      Seconds

  • Question 8 - Endothelial cells produce the following substance(s): ...

    Correct

    • Endothelial cells produce the following substance(s):

      Your Answer: All of the above

      Explanation:

      Endothelial cells produce thromboxane, prostacyclins, nitric oxides, endothelins, IL-1 and TNF.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      15
      Seconds

  • Question 9 - All of the following are consistent with the indicator dilution method except--- ...

    Correct

    • All of the following are consistent with the indicator dilution method except---

      Your Answer: In thermodilution, the indicator used is warm saline

      Explanation:

      In thermodilution, the indicator used is cold saline.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      17.6
      Seconds

  • Question 10 - Coronary arteries arise from? ...

    Incorrect

    • Coronary arteries arise from?

      Your Answer: Ascending aorta

      Correct Answer: None of the above

      Explanation:

      Coronary arteries arise from the sinuses behind 2 of the cusps of the aortic valve at the root of aorta.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      36.1
      Seconds

  • Question 11 - In Starling’s law of the heart, the decrease in tension developed by muscle...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      32
      Seconds

  • Question 12 - Which is the most common site for primary cardiac tumours to occur in...

    Incorrect

    • Which is the most common site for primary cardiac tumours to occur in adults?

      Your Answer: Right atrium

      Correct Answer: Left atrium

      Explanation:

      Myxomas are the most common type of primary heart tumour. The tumour is derived from multipotential mesenchymal cells and may cause a ball valve-type obstruction. About 75% of myxomas occur in the left atrium of the heart, usually beginning in the wall that divides the two upper chambers of the heart.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      8.2
      Seconds

  • Question 13 - Which of the following is true of the Natriuretic hormones? ...

    Correct

    • Which of the following is true of the Natriuretic hormones?

      Your Answer: They are released in response to hypervolemia

      Explanation:

      Natriuretic hormones are vasodilators released in response to hypervolemia.

      Natriuretic hormones (NH) include three groups of compounds: the natriuretic peptides NPs (ANP, BNP and CNP), the gastrointestinal peptides (guanylin and uroguanylin), and endogenous cardiac steroids. These substances induce the kidney to excrete sodium and therefore participate in the regulation of sodium and water homeostasis, blood volume, and blood pressure (BP). In addition to their peripheral functions, these hormones act as neurotransmitters or neuromodulators in the brain.

      Atrial natriuretic peptide (ANP) plays a crucial role in blood pressure regulation by inducing natriuresis and diuresis in the kidney, inhibiting renin secretion, aldosterone production, and promoting vasorelaxation.  Two paracrine factors derived from endothelial cells play important roles in modulating ANP secretion. Endothelin, a potent vasoconstrictor, stimulates ANP secretion and augments stretch induced ANP secretion. The dramatic increase in ANP release produced by cardiac ischemia appears to be mediated in part by endothelin. Nitric oxide (NO), an important vasodilator, is also produced by endothelial cells and inhibits ANP secretion.

      Brain natriuretic peptide (BNP) shares ANP’s receptor but is primarily associated with antifibrotic effects in ventricular remodeling, serving as a biomarker for heart failure and myocardial infarction.

      C-type natriuretic peptide (CNP) acts locally in an autocrine/paracrine manner, exerting potent cardiovascular effects, including vasorelaxation and vascular remodeling post-injury. NPs also demonstrate diverse effects beyond cardiovascular and renal systems, such as bronchodilation, anti-inflammatory actions, and metabolic effects on adipose tissue and long bones.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      20.4
      Seconds

  • Question 14 - The triangle with the heart at its centre, using limb leads is called:...

    Incorrect

    • The triangle with the heart at its centre, using limb leads is called:

      Your Answer: Beethoven

      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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      11.8
      Seconds

  • Question 15 - Xanthines (for example Caffeine), exhibit their positive inotropic effect by: ...

    Correct

    • Xanthines (for example Caffeine), exhibit their positive inotropic effect by:

      Your Answer: Inhibiting the breakdown cAMP

      Explanation:

      Xanthines exert their positive inotropic effect by inhibiting the breakdown of the cAMP resulting in stronger and sustained contraction.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      10
      Seconds

  • Question 16 - The coronary arteries fill during? ...

    Correct

    • The coronary arteries fill during?

      Your 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      5
      Seconds

  • Question 17 - During which phase of the cardiac cycle does most of the ventricular filling...

    Incorrect

    • During which phase of the cardiac cycle does most of the ventricular filling occur?

      Your Answer: Atrial systole

      Correct Answer: Ventricular diastole

      Explanation:

      During the phase of ventricular diastole when the heart muscle relaxes and all the valves are open, blood flows easily into the heart. This is the phase of rapid ventricular filling. During isovolumetric contraction and relaxation the volume of blood in the heart does not change. During ventricular ejection blood enters into the aorta and pulmonary vessels.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      47
      Seconds

  • Question 18 - All valves are closed in which phase of the cardiac cycle? ...

    Correct

    • All valves are closed in which phase of the cardiac cycle?

      Your Answer: Isovolumetric relaxation

      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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      10.4
      Seconds

  • Question 19 - Which of the following phases in depolarization and repolarization of cardiac muscle cells...

    Incorrect

    • Which of the following phases in depolarization and repolarization of cardiac muscle cells are caused by the inactivation of Na+ channels?

      Your Answer: Phase 2 : plateau

      Correct Answer: Phase 1 : rapid repolarization

      Explanation:

      Phase 0 is caused by the sodium current. Voltage gated sodium channels open leading to the influx of sodium into the cardiac muscle cell. Phase 1 is the rapid transient repolarization phase which is caused by the inactivation of the voltage gated sodium channels and opening of the voltage gated potassium channels along with opening of the slow calcium channels. Phase 2 which is the plateau is caused by opening of the slow calcium channels. Phase 4 is caused by closing of the slow calcium channels and opening of the potassium channels leading to efflux of potassium leading to the establishment of the resting membrane potential.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      24.7
      Seconds

  • Question 20 - Tunica intima is made up of? ...

    Correct

    • Tunica intima is made up of?

      Your 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      11.9
      Seconds

  • Question 21 - Pacemaker cells in the SA node and the AV node are connected by?...

    Correct

    • Pacemaker cells in the SA node and the AV node are connected by?

      Your 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      11.7
      Seconds

  • Question 22 - With regards to the cardiac cycle which of the following is true ...

    Incorrect

    • With regards to the cardiac cycle which of the following is true

      Your Answer: Left ventricular ejection begins before right ventricular ejection

      Correct Answer: Right atrial systole occurs before left atrial systole: as below

      Explanation:

      Cardiac cycle: The first event in the cycle is atrial depolarization (a P wave on the surface ECG) follows by RIGHT ATRIAL and then LEFT ATRIAL contraction. Ventricular activation (QRS) follows after a short interval (the PR interval). LEFT VENTRICULAR contraction starts shortly thereafter RIGHT VENTRICULAR contraction begins. At the end, the aortic valve closure is followed by pulmonary valve closure.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      43.5
      Seconds

  • Question 23 - The initial rapid depolarization in the action potential of cardiac muscle cells is...

    Correct

    • The initial rapid depolarization in the action potential of cardiac muscle cells is due to:

      Your 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      13.5
      Seconds

  • Question 24 - Which membrane bound protein in the sarcoplasmic reticulum regulates calcium return from the...

    Correct

    • Which membrane bound protein in the sarcoplasmic reticulum regulates calcium return from the cytosol to the sarcoplasmic reticulum?

      Your 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).

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      4.9
      Seconds

  • Question 25 - Which of the following regulates the calcium release channels? ...

    Incorrect

    • Which of the following regulates the calcium release channels?

      Your Answer: Both a and d

      Correct Answer: Calstabin 2

      Explanation:

      Ca2+ is released from the SR through a Ca2+ release channel, a cardiac isoform of the ryanodine receptor (RyR2), which controls intracytoplasmic [Ca2+] and, as in vascular smooth-muscle cells, leads to the local changes in intracellular [Ca2+] called calcium sparks. A number of regulatory proteins, including calstabin 2, inhibit RyR2 and, thereby, the release of Ca2+ from the SR.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      21.9
      Seconds

  • Question 26 - The function of ATP in cardiac muscle contraction includes: ...

    Incorrect

    • The function of ATP in cardiac muscle contraction includes:

      Your Answer: Transmission of contractile force from one cell to the next

      Correct Answer: Binding to myosin after the power stroke to allow uncoupling of actin and myosin

      Explanation:

      After calcium binds to the troponin C, there is a conformational change in the structure of troponin I and tropomyosin, which moves out of the way and frees the site where myosin can bind to actin. This results in the formation of the cross linkage of the actin and myosin giving rise to the power stroke in the contraction phase. This occurs with the release of ADP. When ATP combines to this complex it breaks and the cycle repeats itself.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      18.1
      Seconds

  • Question 27 - The following determines the strength of contraction ...

    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

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      28.3
      Seconds

  • Question 28 - AV valves open during? ...

    Correct

    • AV valves open during?

      Your 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      50.1
      Seconds

  • Question 29 - Although variable, branches of which artery most often supply the SA and AV...

    Correct

    • Although variable, branches of which artery most often supply the SA and AV nodes?

      Your 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      11.3
      Seconds

  • Question 30 - Which of the atrial pressure changes represents the a-wave of the JVP ...

    Correct

    • Which of the atrial pressure changes represents the a-wave of the JVP

      Your 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      15
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular (17/30) 57%
Medicine (17/30) 57%
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