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MULTIPLE CHOICE QUESTIONS (Select the single best answer) 1.

Which of the following normally has the most prominent prepotential? A. Sinoatrial node* B. Atrial muscle cells C. Bundle of His D. Purkinje fibers E. Ventricular muscle cells 2. Currents caused by opening of which of the following channels contribute to the repolarization phase of the action potential of ventricular muscle fibers? A. Na+ channels B. Cl- channels C. Ca2+ channels D. K+ channels* E. HCO3- channels 3. In the sinoatrial (SA) node, phase 4 depolarization (pacemaker potential) is attributable to A. An increase in K+ conductance B. An increase in Na+ conductance* C. A decrease in C1- conductance D. A decrease in Ca2+ conductance E. Simultaneous increases in K+ and C1- conductances 4. During which phase of the ventricular action potential is the membrane potential closest to the K+ equilibrium potential? A. Phase 0 B. Phase 1 C. Phase 2 D. Phase 3 E. Phase 4* 5. During which phase of the ventricular action potential is the conductance to Ca2+ highest? A. Phase 0 B. Phase 1 C. Phase 2* D. Phase 3 E. Phase 4 6. Which phase of the ventricular action potential coincides with diastole? A. Phase 0 B. Phase 1 C. Phase 2 D. Phase 3 E. Phase 4* 7. During which phase of the cardiac cycle does the mitral valve open? A. Atrial systole B. Isovolumetric ventricular contraction C. Rapid ventricular ejection D. Reduced ventricular ejection E. Isovolumetric ventricular relaxation*

8. The ventricles are completely depolarized during which isoelectric portion of the electrocardiogram (ECG)? A. PR interval B. QRS complex C. QT interval D. ST segment* E. T wave 9. Cardiac output of the right side of the heart is what percentage of the cardiac output of the left side of the heart? A. 25% B. 50% C. 75% D. 100%* E. 125% 10. If the ejection fraction increases, there will be a decrease in A. Cardiac output B. End-diastolic volume C. End-systolic volume* D. Heart rate E. Pulse pressure 11. If the heart rate is 70 beats/min, then the cardiac output of this ventricle is closest to A. 3.45 L/min B. 4.55 L/min C. 5.25 L/min* D. 8.00 L/min E. 9.85 L/min

12. The second heart sound is caused by A. Closure of the aortic and pulmonary valves* B. Vibrations in the ventricular wall during systole C. Ventricular filling D. Closure of the mitral and tricuspid valves E. Retrograde flow in the vena cava 13. The fourth heart sound is caused by A. Closure of the aortic and pulmonary valves B. Vibrations in the ventricular wall during systole* C. Ventricular filling D. Closure of the mitral and tricuspid valves E. Retrograde flow in the vena cava 14. Inspiration "splits" the second heart sound because A. The aortic valve closes before the pulmonic valve* B. The pulmonic valve closes before the aortic valve C. The mitral valve closes before the tricuspid valve D. The tricuspid valve closes before the mitral valve E. Filling of the ventricles has fast and slow components 15. During exercise, a man consumes l.8 L of oxygen per minute. His arterial O2 content is 190 ml/L, and the O2 content of his mixed venous blood is l34 ml/L. His cardiac output is approximately

A. 3.2 L/min B. l6 L/min C. 32 L/min* D. 54 L/min E. 160 ml/min 16. The work performed by the left ventricle is substantially greater than that performed by the right ventricle, because in the left ventricle A. The contraction is slower B. The wall is thicker C. The stroke volume is greater D. The preload is greater E. The afterload is greater* 17. When a person moves from a supine position to a standing position, which of the following compensatory changes occurs? A. Decreased heart rate B. Increased contractility* C. Decreased total peripheral resistance (TPR) D. Decreased cardiac output E. Increased PR intervals 18. During exercise, total peripheral resistance (TPR) decreases because of the effect of A. The sympathetic nervous system on splanchnic arterioles B. The parasympathetic nervous system on skeletal muscle arterioles C. Local metabolites on skeletal muscle arterioles* D. Local metabolites on cerebral arterioles E. Histamine on skeletal muscle arterioles 19. The greatest pressure decrease in the circulation occurs across the arterioles because A. They have the greatest surface area B. They have the greatest cross-sectional area C. The velocity of blood flow through them is the highest D. The velocity of blood flow through them is the lowest E. They have the greatest resistance* 20. Pulse pressure is A. The highest pressure measured in the arteries B. The lowest pressure measured in the arteries C. Measured only during diastole D. Determined by stroke volume* E. Decreased when the capacitance of the arteries decreases 21. At which site is systolic blood pressure the highest? A. Aorta B. Central vein C. Pulmonary artery D. Right atrium E. Renal artery* 22. During which phase of the cardiac cycle is ventricular volume lowest? A. Atrial systole B. Isovolumetric ventricular contraction

C. Rapid ventricular ejection D. Reduced ventricular ejection* E. Isovolumetric ventricular relaxation 23. The physiologic function of the relatively slow conduction through the atrioventricular node is to allow sufficient time for A. Runoff of blood from the aorta to the arteries B. Venous return to the atria C. Filling of the ventricles* D. Contraction of the ventricles E. Repolarization of the ventricles 24. Which of the following parameters is decreased during moderate exercise? A. Arteriovenous O2 difference B. Heart rate C. Cardiac output D. Pulse pressure E. Total peripheral resistance (TPR)* 25. Starlings law of the heart A. Does not operate in the failing heart B. Does not operate during exercise C. Explains the increase in heart rate produced by exercise D. Explains the increase in cardiac output that occurs when venous return is increased* E. Explains the increase in cardiac output when the sympathetic nerves supplying the heart are stimulated 26. Which of the following has the highest total cross-sectional area in the body? A. Arteries B. Arterioles C. Capillaries* D. Venules E. Veins 27. Which of the following does not occur as blood passes through the systemic capillaries? A. Its hematocrit increases B. Its hemoglobin dissociation curve shift to the left* C. Its protein content increases D. Its pH decreases E. Its red blood cells increase in size 28. The velocity of blood flow A. Is higher in the capillaries than the arterioles B. Is higher in the veins than in the venules* C. Is higher in the veins than the arteries D. Falls to zero in the descending aorta during diastole E. Is reduced in a constricted area of a blood vessel 29. When the radius of the resistance vessels is increased, which of the following is increased? A. Systolic blood pressure B. Diastolic blood pressure C. Viscosity of the blood D. Hematocrit E. Capillary blood flow*

30. When the viscosity of the blood is increased, which of the following is increased? A. Mean blood pressure* B. Radius of the resistance vessels C. Radius of the capacitance vessels D. Central venous pressure E. Capi1lary blood flow 31. Lymph flow from the foot is A. Increased when an individual rises from the supine to the standing position B. Increased by massaging the foot* C. Increased when capillary permeability is decreased D. Decreased when the valves of the leg veins are incompetent E. Decreased by exercise 32. Vasopressin secretion is increased by A. Increased pressure in the right ventricle B. Decreased pressure in the right ventricle C. Increased pressure in the right atrium D. Decreased pressure in the right atrium E. Increased pressure in the aorta* 33. Catecholamines acting on -adrenergic receptors A. Increase the contractility of cardiac muscle B. Increase the rate of discharge of the sinoatrial node C. Increase cardiac output D. Constrict coronary arteries by a direct action on these blood vessels* E. Dilate blood vessels in skeletal muscle 34. Which of the following would be expected to raise blood pressure? A. Prostacyclin B. A drug that inhibits an angiotensin II-converting enzyme C. A drug that inhibits NO synthase* D. A drug that inhibits V1 vasopressin receptors E. A drug that inhibits endothelin-converting enzyme 35. The pressure differential between the heart and the aorta is least in the A. left ventricle during systole* B. left ventricle during diastole C. right ventricle during systole D. right ventricle during diastole E. left atrium during systole 36. Which of the following organs has the greatest blood flow per l00 g of tissue? A. Brain B. Heart muscle C. Skin D. Liver E. Kidneys* 37. Which of the following organs has the most permeable capillaries? A. Brain B. Posterior pituitary gland

C. Liver* D. Small intestine E. Kidneys 38. Which of the following does not dilate arterioles in the skin? A. Increased body temperature B. Epinephrine C. Bradykinin D. Substance P E. Vasopressin* 39. Which of the following is not increased during isotonic exercise? A. Respiratory rate B. Stroke volume C. Heart rate D. Total peripheral resistance E. Systolic blood pressure* 40. Which of the following would you expect to decrease in a normal individual who stands quietly in the same position for l hour? A. Hematocrit B. Diameter of the thigh C. Plasma renin activity D. Plasma vasopressin concentration E. Central venous pressure* 41. An acute decrease in arterial blood pressure elicits which of the following compensatory changes? A. Decreased firing rate of the carotid sinus nerve* B. Increased parasympathetic outflow to the heart C. Decreased heart rate D. Decreased contractility E. Decreased mean systemic pressure 42. During which phase of the cardiac cycle is aortic pressure highest? A. Atrial systole B. Isovolumetric ventricular contraction C. Rapid ventricular ejection D. Reduced ventricular ejection* E. Isovolumetric ventricular relaxation 43. Myocardial contractility is best correlated with the intracellular concentration of A. Na+ B. K+ C. Ca2+* D. C1E. Mg2+ 44. Carbon dioxide (CO2) regulates blood flow to which one of the following organs? A. Heart B. Skin C. Brain* D. Skeletal muscle at rest E. Skeletal muscle during exercise

45. Which receptor is blocked when propranolol is administered to reduce cardiac output? A. 1 receptors B. 1 receptors* C. 2 receptors D. Muscarinic receptors E. Nicotinic receptors 46. Which of the following changes will cause an increase in myocardial O2 consumption? A. Decreased aortic pressure B. Decreased heart rate C. Decreased contractility D. Increased size of the heart* E. Increased influx of Na+ during the upstroke of the action potential 47. Propranolol has which of the following effects? A. Decreases heart rate* B. Increases left ventricular ejection fraction C. Increases stroke volume D. Decreases splanchnic vascular resistance E. Decreases cutaneous vascular resistance 48. Which of the following agents or changes has a negative inotropic effect on the heart? A. Increased heart rate B. Sympathetic stimulation C. Norepinephrine D. Acetylcholine (ACh)* E. Cardiac glycosides 49. The low-resistance pathways between myocardial cells that allow for the spread of action potentials are the A. Gap junctions* B. T tubules C. Sarcoplasmic reticulum (SR) D. Intercalated disks E. Mitochondria 50. Which agent is released or secreted after a hemorrhage and causes an increase in renal Na+ reabsorption? A. Aldosterone* B. Angiotensin I C. Angiotensin II D. Antidiuretic hormone (ADH) E. Atrial natriuretic peptide

TERMS 1 Premature systole 2. Atrioventricular delay 3. Electrocardiogram 4. Cardiac cycle 5. Stroke volume 6. cardiac output 7. Ejection fraction

8. Cardiac index 9. Cardiac reserve 10. Frank-Starling mechanism 11. Blood pressure 12. Central venous pressure 13. Renin-angiotensin system 14. Nitric oxide synthase 15. Vasomotor center 16. Baroreceptor reflex QUESTIONS 2. Describe the way the ECG is recorded and the waves of the ECG. 3. Describe in sequence the events that occur in the heart during cardiac cycle. 4. List the factors that affect heart pumping and the effect of each. 5. State the Poiseuille formula for flow in blood vessels, and explain on the basis of this formula why the radius of a vessel is such an important determination of flow. 6. List the factors affecting arterial blood pressure. 7. Describe the local control of blood flow. 8. List the factors affecting formation of interstitial fluid. 9. Outline the neural mechanisms that control arterial blood pressure and heart rate, including the receptors, afferent and efferent pathways, central integrating pathway, and effector mechanisms involved. 10. List the principal vasoregulatory factors secreted by endothelial cells, and describe the function of each. 11. Name the principal hormones that affect arterial blood pressure, and know the physiologic role of each. 12. Summarize the integrated, multifaceted system for arterial pressure regulation.

ANSWERS MULTIPLE-CHOICE QUESTIONS 1. A 2. D 3. B 4. E 5. C 6. E 7. E 8. D 9 . D 10. C 11. C 12. A 13. C 14. A 15. C 16. E 17. B 18. C 1 9. E 20. D 21. E 22. D 23. C 24. E 25. D 26. C 27. B 28. B 29. E 30. A 31. B 32. E 33. D 34. C 35. A 36. E 37. C 38. E 39. D 40. E 41. A 42. D 43. C 44. C 45. B 46. D 47. A 48. D 49. A 50. A TERMS 1. Premature systole A premature contraction of the heart, resulting in momentary cardiac arrhythmia, is called premature systole. 2. Atrioventricular delay The conductive system is organized so that the cardiac impulse does not travel from the atria into the ventricles too rapidly. It is primarily the A-V node and its adjacent conductive fibers that delay this transmission of the cardiac impulse from the atria into the ventricles. This delay allows time for the atria to empty their blood into the ventricles before ventricular contraction begins. 3. Electrocardiogram When the cardiac impulse passes through the heart, electrical current also spreads from the heart into the adjacent tissues surrounding the heart. A small proportion of the current spreads all the way to the surface of the body. If electrodes are placed on the body skin on opposite sides of the heart, electrical potentials generated by the current can be recorded; the recording is known as an electrocardiogram.

4. Cardiac cycle The cardiac events that occur from the beginning of one heartbeat to the beginning of the next are called the cardiac cycle. The cardiac cycle consists of a period of relaxation called diastole, during which the heart fills with blood, followed by a period of contraction called systole. 5. Stroke volume Stroke volume is the volume of blood ejected from the left ventricle each beat. In adults, the normal value of stroke volume output for the resting adult is 60~80ml. 6. Cardiac output Cardiac output is the total volume of blood pumped by the ventricle per minute, or simply the product of heart rate (HR) and stroke volume (SV). The average cardiac output for the resting adult is about 5 L/min. 7. Ejection fraction The percentage of blood that is pumped out of a filled ventricle as a result of a heartbeat is called ejection fraction. 8. Cardiac index Cardiac index is the cardiac output per square meter of body surface area. The normal human being weighing 70 kilograms has a body surface area of about 1.7 square meters, which means that the normal average cardiac index for adults is about 3 L/min/m2 of body surface area. 9. Cardiac reserve Cardiac reserve refers to the heart's ability to quickly adjust to immediate demands placed upon it. The maximum percentage that the cardiac output can increase above normal is called the cardiac reserve. In the normal young adult the cardiac reserve is 300 to 400 percent. 10. Frank-Starling mechanism The heart has the intrinsic capability of increasing its force of contraction and therefore stroke volume in response to an increase in venous return. This is called the Frank-Starling mechanism in honor of the scientific contributions of Otto Frank (late 19th century) and Ernest Starling (early 20th century). This phenomenon occurs in isolated hearts, and therefore is independent of neural and humoral influences.

11. Blood pressure The pressure exerted by the blood against the walls of the blood vessels, especially the arteries. It varies with the strength of the heartbeat, the elasticity of the arterial walls, the volume and viscosity of the blood, and a person's health, age, and physical condition. In the healthy young adult, the pressure at the height of each pulse, called the systolic pressure, is about 120 mmHg and at its lowest point, called the diastolic pressure, it is about 80 mmHg. The difference between these two pressures, about 40 mmHg, is called the pulse pressure. 12. Central venous pressure The pressure in the thoracic vena cava near the right atrium is called central venous pressure (CVP). CVP is influenced by a number of factors, including cardiac output, respiratory activity, contraction of skeletal muscles and hydrostatic forces (i.e., gravity). 13. Renin-angiotensin system The renin-angiotensin system plays an important role in regulating blood volume, arterial pressure, and cardiac and vascular function. While the pathways for the renin-angiotensin system have been found in a number of tissues, the most important site for renin release is the kidney. Sympathetic stimulation, renal artery hypotension, and decreased sodium delivery to the distal tubules stimulate the release of renin by the kidney. Renin is an enzyme that acts upon a circulating substrate (angiotensinogen) to release a 10-amino acid

peptide, angiotension . Vascular endothelium, particularly in the lungs, has an enzyme, angiotensin converting enzyme (ACE), that cleaves off two amino acids to form the octapeptide, angiotensin II (AII). 14. Nitric oxide synthase The enzyme that catalyzes the formation of NO from oxygen and arginine is nitric oxide synthase, a very complex enzyme containing five bound cofactors/prosthetic groups, FAD, FMN, haem, tetrahydrobiopterin (BH4) and Ca2+-calmodulin (CaM), and a heme group which is part of the catalytic site. In mammals, three distinct genes encode NOS isozymes: neuronal (nNOS or NOS1), cytokineinducible (iNOS or NOS2) and endothelial (eNOS or NOS3). 15. Vasomotor center The vasomotor center, located bilaterally mainly in the reticular substance of the medulla and of the lower third of the pons, is responsible for the overall control of blood distribution and pressure throughout the body. This center transmits parasympathetic impulses through the vagus nerves to the heart and transmits sympathetic impulses through the cord and peripheral sympathetic nerves to all or almost all the blood vessels of the body. 16. Baroreceptor reflex The baroreceptor reflex is the body's rapid response system for dealing with changes in blood pressure. This reflex is initiated by stretch receptors, called either baroreceptors or pressoreceptors, which are located in the walls of several of the large systemic arteries. If a rise in arterial pressure stretches the baroreceptors and causes them to transmit signals into the central nervous system. Feedback signals are then sent back through the autonomic nervous system to the circulation to reduce arterial pressure downward toward the normal level.

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