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  • Question 1 - Where on the surface of the chest is the normal site of auscultation...

    Incorrect

    • Where on the surface of the chest is the normal site of auscultation for the mitral area?

      Your Answer: 5th left intercostal space mid-axillary line

      Correct 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      25.8
      Seconds

  • Question 2 - The function of ATP in cardiac muscle contraction includes: ...

    Correct

    • The function of ATP in cardiac muscle contraction includes:

      Your 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
      26.5
      Seconds

  • Question 3 - The right border of the heart corresponds to which line on the surface...

    Incorrect

    • The right border of the heart corresponds to which line on the surface of the chest?

      Your Answer: Line drawn from the 3rd left costal cartilage to the 6th left costal cartilage

      Correct Answer: Line drawn from the 3rd right costal cartilage to the 6th right costal cartilage

      Explanation:

      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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      102.8
      Seconds

  • Question 4 - Xanthines such as caffeine and theophylline are positively inotropic due to: ...

    Correct

    • Xanthines such as caffeine and theophylline are positively inotropic due to:

      Your Answer: Inhibition of cAMP breakdown

      Explanation:

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

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      5.7
      Seconds

  • Question 5 - Regarding blood supply to the heart; ...

    Correct

    • Regarding blood supply to the heart;

      Your 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      13.1
      Seconds

  • Question 6 - Describe the location of the SA node: ...

    Correct

    • Describe the location of the SA node:

      Your Answer: Junction of the SVC and right atrium

      Explanation:

      Anatomically the SA node is located at the junction of the superior vena cava and the right atrium.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      9.3
      Seconds

  • Question 7 - Cholinergic nerves from the vagus innervate the SA and AV nodes via which...

    Correct

    • Cholinergic nerves from the vagus innervate the SA and AV nodes via which receptor in the heart?

      Your Answer: M2 receptor

      Explanation:

      M2 receptor is found in the heart. M3 and M4 are associated with smooth muscle.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      7.8
      Seconds

  • Question 8 - The isoforms of nitric oxide synthase which are found in the nervous system...

    Correct

    • The isoforms of nitric oxide synthase which are found in the nervous system (NOS1) and endothelial cells (NOS3) are activated by agents that increase which of the following intracellular electrolytes?

      Your Answer: Ca

      Explanation:

      Synthesis of nitric oxide is stimulated by activation of the NMDA receptors by certain agents. This leads to opening of the Calcium channels and an influx of calcium into the cell. This will activate the nitric oxide synthase. Nitric oxide is produced on demand.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      13.3
      Seconds

  • Question 9 - Why does arterial blood pressure drop during pregnancy? ...

    Incorrect

    • Why does arterial blood pressure drop during pregnancy?

      Your Answer: Oestrogen relaxes vascular smooth muscle

      Correct Answer: Progesterone relaxes vascular smooth muscle

      Explanation:

      Progesterone relaxes vascular smooth muscle thus resulting In a decrease in total peripheral resistance. This accounts for the increase in the cardiac output.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      21
      Seconds

  • Question 10 - Regarding the surface anatomy of the orifices of the heart, where is the...

    Incorrect

    • Regarding the surface anatomy of the orifices of the heart, where is the aortic valve located?

      Your Answer: Opposite the 3rd left intercostal space bind the left margin of the sternum

      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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      66.8
      Seconds

  • Question 11 - The positive inotropic effect of digoxin is due to? ...

    Incorrect

    • The positive inotropic effect of digoxin is due to?

      Your Answer: Inhibition of breakdown of cAMP

      Correct Answer: Inhibition of the sodium potassium ATPase in the myocardium

      Explanation:

      Digitalis compounds are potent inhibitors of cellular Na+/K+-ATPase. This ion transport system moves sodium ions out of the cell and brings potassium ions into the cell. By inhibiting the Na+/K+-ATPase, cardiac glycosides cause the intracellular sodium concentration to increase. This then leads to an accumulation of intracellular calcium via the Na+/Ca++ exchange system. In the heart, increased intracellular calcium causes more calcium to be released by the sarcoplasmic reticulum, thereby making more calcium available to bind to troponin-C, which increases contractility (inotropy).

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      19.4
      Seconds

  • Question 12 - Which statement about the 2nd heart sound is true? ...

    Incorrect

    • Which statement about the 2nd heart sound is true?

      Your Answer: It occurs at the end of ventricular systole.

      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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      43.7
      Seconds

  • Question 13 - The Plateau phase in myocyte action potentials does all of the following except:...

    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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      19.5
      Seconds

  • Question 14 - Activation of nitric oxide synthesis by endothelial cells is triggered by: ...

    Correct

    • Activation of nitric oxide synthesis by endothelial cells is triggered by:

      Your Answer: All of the above

      Explanation:

      Acetylcholine, histamine, bradykinin, vasoactive intestinal peptide (VIP) and shear stress on the endothelial cells causing the release of NO. NO is formed from arginine and causes vasodilatation of the blood vessels.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      9.8
      Seconds

  • Question 15 - Myocardial fibers have a resting membrane potential of approximately: ...

    Correct

    • Myocardial fibers have a resting membrane potential of approximately:

      Your Answer: -90mv

      Explanation:

      The resting membrane potential of the mammalian heart is about -90 mv.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      5.9
      Seconds

  • Question 16 - Which of the following is first to rise following myocardial infarction? ...

    Correct

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

      Your 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
      6.8
      Seconds

  • Question 17 - According to Starling's law of the heart: ...

    Correct

    • According to Starling's law of the heart:

      Your Answer: The extent of the preload is proportional to the end-diastolic volume

      Explanation:

      Frank starlings law 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 increased 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 the development of tension in the muscle fiber. The greater the venous return the greater the cardiac output. This relationship is directly proportional.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      38.8
      Seconds

  • Question 18 - 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
      10.8
      Seconds

  • Question 19 - Which of the following affects the magnitude of the action potential? ...

    Incorrect

    • Which of the following affects the magnitude of the action potential?

      Your Answer: The amount of intracellular Ca2+

      Correct 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      64.5
      Seconds

  • Question 20 - A 55 year old cardiac patient is comfortable at rest but heavy housework...

    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 0

      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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      38.5
      Seconds

  • Question 21 - Which of the following factors serve to decrease cardiac output? ...

    Correct

    • Which of the following factors serve to decrease cardiac output?

      Your 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      34.5
      Seconds

  • Question 22 - Which of the following phases in depolarization and repolarization of cardiac muscle cells...

    Correct

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

      Your 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
      19.3
      Seconds

  • Question 23 - Which of the following is NOT an effect of a positive inotropic agent...

    Correct

    • Which of the following is NOT an effect of a positive inotropic agent on the heart?

      Your Answer: It decreases the rate of rise in ventricular blood pressure during systole

      Explanation:

      Inotropic agents increase the contractility of the heart as well as the rate of rise in ventricular blood pressure during systole, generating a greater pressure and increasing the stroke volume e.g. like catecholamines do.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      96.6
      Seconds

  • Question 24 - In the cardiac cycle, all of the following are true except: ...

    Correct

    • In the cardiac cycle, all of the following are true except:

      Your Answer: Mitral valve is closed by contraction of papillary muscles

      Explanation:

      Mitral valve is closed by contraction of papillary muscles: This statement is incorrect. The mitral valve closes due to the pressure difference between the left ventricle and the left atrium at the onset of ventricular systole. The papillary muscles contract to prevent prolapse of the valve into the atrium but do not cause the valve to close.

      The left ventricular volume is maximal at the end of atrial systole: This statement is true. At the end of atrial systole, the atria have pushed the remaining blood into the ventricles, making the ventricular volume maximal (end-diastolic volume).

      The left ventricular pressure is maximal just before the aortic valve opens: This statement is true. Left ventricular pressure peaks just before the aortic valve opens, as the ventricle contracts to overcome the pressure in the aorta.

      The ejection fraction is about 55%: This statement is true. The ejection fraction, which is the percentage of blood ejected from the ventricles with each contraction, is typically around 55%.

      The ‘a’ wave is due to atrial systole: This statement is true. The ‘a’ wave on the venous pressure curve corresponds to atrial systole, reflecting the increased pressure from atrial contraction.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      76.6
      Seconds

  • Question 25 - Which of the following is NOT true of the parasympathetic control of the...

    Correct

    • Which of the following is NOT true of the parasympathetic control of the heart?

      Your Answer: It can be blocked by beta blockers

      Explanation:

      Parasympathetic fibers do not innervate the Beta receptors on the heart. They are innervated by the sympathetic nerve fibers. Then a beta blocker such as propranolol will block the sympathetic outflow and increase the parasympathetic tone of the heart.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      20.4
      Seconds

  • Question 26 - 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
      8.6
      Seconds

  • Question 27 - Factors influencing cardiac output include which of the following? ...

    Correct

    • Factors influencing cardiac output include which of the following?

      Your 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      5.7
      Seconds

  • Question 28 - Isovolumetric ventricular contraction lasts for? ...

    Correct

    • Isovolumetric ventricular contraction lasts for?

      Your Answer: 0,05 s

      Explanation:

      Isovolumetric contraction lasts for about 0.05 seconds.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      15.6
      Seconds

  • Question 29 - The AV Node: ...

    Incorrect

    • The AV Node:

      Your Answer: It is a complex spindle shaped structure located in the interventricular septum

      Correct Answer: It decelerates impulses passing to the ventricles

      Explanation:

      The action potentials in the sinoatrial (SA) and atrioventricular (AV) nodes are largely due to Ca2+, with no contribution by Na+ influx. The depolarization continues to conduct slowly through the atrioventricular (AV) node. The AV node is located in the right posterior portion of the interatrial septum. This is small and bean-shaped. The atrial conductive system is organized so that the cardiac impulse does not travel from the atria into the ventricles too rapidly; this delay allows the atria to empty before ventricular contraction begins. It is the AV node and its adjacent conductive fibers that delay this transmission into the ventricles. Conduction through the AV Node is represented on the ECG by the PR interval.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      5.2
      Seconds

  • Question 30 - Vasodilatation of coronary arteries is caused by: ...

    Correct

    • Vasodilatation of coronary arteries is caused by:

      Your 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Medicine
      11.9
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular (20/30) 67%
Medicine (20/30) 67%
Passmed
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