Cardiovascular physiology

MCQs

24th April 2012

You may do this paper as an open book exam but to get the
most learning, please attempt without the book. This will
show you where your knowledge gaps are.
Physiology – Circulation MCQs

1. Which of the following is incorrect about B cells?

a. Can bind directly to antigens
b. B cells contact to helper T cells is not always required to produce full
activation and antibody formation
c. Activated B cells can transform into memory B cells and plasma cells
d. Immunoglobulins are the secreted form of antigen-binding receptors on
the B cell membrane

2. Which of the following is incorrect about Platelets?

a. Thrombopoietin is involved in regulation of platelet production
b. Membranes contain receptors for ADP and fibrinogen
c. Aggregate at sites of vascular injury
d. alpha-granules contain non-protein substances like serotonin

3. With respect to ABO system, which is correct?

a. Inherited as mendelian recessive
b. A and B antigens are complex oligosaccharides that terminate in a
terminal fructose molecule
c. Antibodies against red cell agglutinogens are called agglutinins
d. Type AB individuals develop anti-A and anti-B antibodies

4. Which of the following is not a congenital condition?

a. Hageman trait
b. Haemophilia A
c. Hypoprothrombinemia
d. Parahemophilia

5. Which of the following has the slowest rate of conduction (m/s)?

a. SA node
b. Bundle of His
c. Purkinje System
d. Atrial pathways

6. With respect to the cardiac cycle, which of the following is false?

a. End-diastolic ventricular volume is about 130mls
b. Ejection fraction is a valuable index of ventricular function
c. 60% of ventricular filling occurs passively during diastole
d. Highest rate at which the ventricle can contract is theoretically 400/min

7. Which of the following will not increase cardiac output?

a. Eating
b. Moderate changes in environmental temperature
c. Pregnancy
d. exercise
8. Heterometric regulation of cardiac output relates to?
a. Changes in cardiac muscle length
b. Changes in contractility
c. Changes in muscle tension
d. Changes in systolic ventricular volume

9. The following all depress cardiac output except?

a. Hypocapnia
b. Hypoxia
c. Acidosis
d. Procainamide

10. When considering oxygen consumption by the heart, which of the following is
true?
a. Stroke work of the left ventricle is 9 times that of the right ventricle
b. O2 consumption by the beating heart is about 6ml/100g/min at rest
c. Cardiac venous O2 tension is low
d. Increased preload causes a greater increase in cardiac O2 consumption
than an increase in afterload

11. Regarding capillaries, which is false?

a. Total area of all capillary walls in the body exceeds 6300 m2 in the
adult
b. Walls are made up of a single layer of endothelial cells
c. Junctions between skeletal endothelial cells can allow passage of
molecules up to 100 nm in diameter
d. Pericytes warp around capillaries and can release vasoactive agents

12. The permeability of capillaries is expressed in terms of their hydraulic

conductivity. Which of the following type of capillaries have the highest
hydraulic conductivity?
a. Brain
b. Skin
c. Skeletal muscle
d. Lung

13. With respect to laminar flow in blood vessels, which is incorrect?

a. There is a layer of blood in contact with blood vessel wall that does
not move
b. Turbulence occurs less frequently in anaemia
c. Flow will not be turbulent if the Reynolds number (Re) is less than
2000
d. Blood flows through vessels in a parabolic distribution
14. When considering viscosity and resistance of blood, which is false?
a. haematocrit is the percentage of the volume of blood occupied by red
blood cells
b. whole blood is 1.8 times as viscous as water
c. vascular hindrance relates to the radius of the blood vessel
d. viscosity is affected by the composition of plasma and the resistance
of cells to deformation

15. Which of the following does not cause an increase in interstitial fluid volume
and oedema?
a. Substance P
b. Decrease in osmotically active substances in the interstitial space
c. Decreased plasma protein levels
d. Venous obstruction

16. The following are all vasodilators except

a. Potassium
b. Adenosine
c. Lactate
d. Decreased CO2 tension

17. Regarding Nitric Oxide (NO), which is true?

a. Nitric oxide synthase (NOS) 1 is found in macrophages and immune
cells
b. NOS 1 and NOS 3 are activated by intracellular calcium concentrations
c. NO is activated in the presence of haemoglobin
d. Platelet aggregation inhibits NO release

18. Which of the following is a stimulator of endothelin-1 secretion?

a. Angiotensin II
b. Nitric oxide
c. PGE2
d. Prostacyclin

19. All of the following will cause vasoconstriction of arterioles except:

a. Endothelin-1
b. Decreased local temperature
c. Circulating Na-K ATPase inhibitor
d. Decreased discharge of noradrenergic vasomotor nerves

20. Increased baroreceptor discharge produces all of the following except:

a. Vasodilation
b. Venodilation
c. Drop in blood pressure
d. Tachycardia
21. Heart Rate is not slowed by:
a. Fear
b. Increased intracranial pressure
c. hypoxia
d. expiration

22. Which of the following tissues has the highest oxygen consumption
(ml/100g/min)?
a. Brain
b. Skin
c. Skeletal muscle
d. kidney

23. Regarding Cerebrospinal fluid (CSF), which of the following is false?

a. Bulk Flow of CSF into venous blood is unidirectional
b. In adults, free communication appears to occur between brain
interstitial fluid and CSF
c. Osmolality of CSF is less than plasma
d. 50-70% of CSF is formed in the choroid plexuses

24. All of the following are referred to collectively as the circumventricular organs
except:
a. Neurohypophysis
b. Anterior pituitary
c. Area postrema
d. Subfornical organ

25. Concerning dynamics of blood flow, all are true except:

a. Arterioles are the major site of blood flow resistance
b. The probability of turbulence within a vessel can be expressed as the
Reynold’s number
c. Forward flow is continuous because of vessel wall recoil during systole
d. Veins are capacitance vessels and small arteries and arterioles are
resistance vessels

26. Considering vasodilator metabolites, which is correct?

a. Nitric oxide synthase (NOS) in immune cells is activated by cytokines
instead of calcium
b. Endothelin receptors are coupled via G protein to adenylyl cyclase
c. Vasopressin, angiotensin II and bradykinin are all vasodilators
d. Atrial natiuretic peptide (ANP) is released in response to hypovolaemia

27. Regarding the normal physiology of the heart, which is true?

a. The end diastolic ventricular volume is about 90 mls
b. The ejection fraction is approximately 85%
c. The end-systolic ventricular volume is approximately 50mls
d. Peak right ventricular pressure is about 120 mmHg
28. Regarding the normal ECG, which is false?
a. The PR interval is 0.18 seconds
b. QT interval is 0.8 seconds
c. Ventricular repolarisation occurs during the ST interval
d. Right axis deviation is when the electrical axis falls to the right of +110
degrees

29. All of the following are true with respect to human immunoglobulins functions
except for:
a. A function of IgG is complement activation
b. A function of IgD is localised protection in external secretions
c. Antigen recognition by B cells is not a function of IgA
d. Histamine release is a function of IgE

30. Regarding hypertension, which of the following is false?

a. Plasma renin levels can be low in up to 25% of patients with essential
hypertension
b. The incidence of atherosclerosis increases in hypertension
c. Coarctation of the thoracic aorta increases rennin secretion and
increases peripheral resistance
d. Estrogen increases angiotensin secretion which can lead to
hypertension

31. Which of the following are not compensatory reactions activated by

haemorrhage?
a. Increased secretion of vasopressin
b. Increased secretion of erythropoietin
c. Venodilation
d. Vasoconstriction

32. All of the following are types of obstructive shock except:

a. Congestive heart failure
b. Pulmonary embolism
c. Cardiac tumour
d. Cardiac tamponade

33. Which of the following is not increased with isotonic exercise?

a. diastolic pressure
b. Total peripheral resistance
c. Oxygen consumption
d. Cardiac output
 34. Regarding foetal circulation, which is false?
a. 55% of foetal cardiac output goes through the placenta
b. Haemoglobin F binds 2,3-DPG more effectively than Haemoglobin A
c. By age 4 months post-partum, 90% of circulating haemoglobin is
Haemoglobin A
d. Blood in the umbilical vein is believed to be 80% saturated with
oxygen

35. Which of the following is incorrect of cutaneous circulation?

a. Contraction of precapillary sphincters causes White Reaction
b. Triple response is lost after total sympathectomy
c. Reactive hyperaemia can be prevented if limb circulation is occluded
in an atmosphere of 100% O2.
d. When skin appears cold and blue, the arterioles are constricted and
capillaries are dilated

36. Regarding brain metabolism, which is false?

a. Oxygen, glucose and glutamine are utilised for brain metabolism
b. Occlusion of blood supply to the brain can cause unconsciousness in as
little as 10 seconds
c. Parkinsonism can occur due to hypoxia of the basal ganglia
d. Respiratory quotient of cerebral tissue is 0.95-0.99

37. When considering venous circulation, which of the following is incorrect?

a. Pressure in the venules is higher than in large veins
b. Drop in venous pressure during expiration aids venous return
c. Venous flow is pulsatile close to the heart
d. Heartward movement of blood is decreased in patients with varicose
veins

38. The opening of which channel completes the pre-potential for pacemaker
cells?
a. Ca+2 T channel
b. K+ channel
c. Na-K ATPase channel
d. Ca+2 L channel

39. Regarding systole and diastole, which is false?

a. cardiac muscle can contract and repolarise faster with higher heart rates
b. diastole shortens more than systole at high heart rates
c. theoretically, ventricles could contract up to 400 times per minute
d. ventricular filling is always adequate up to a heart rate of 180

40. Which of the following is incorrect with respect to heart sounds?

a. S1 is caused by vibrations from the closure of AV valves
b. S4 can be heard with high atrial pressures
c. S4 can be heard in patients with ventricular hypertrophy
d. S2 is caused by the closure of AV valves

41. Which of the following is incorrectly paired?

 a. aortic stenosis systolic murmur
b. pulmonary insufficiency systolic murmur
c. mitral stenosis diastolic murmur
d. tricuspid stenosis diastolic murmur

42. Which of the following will not decrease End Diastolic Volume?
a. intrapericardial tumour
b. myocardial infarction
c. infiltrative disease of the myocardium
d. increase in the normal negative intrathoracic pressure

43. Which of the following changes in cardiac function has only a minimal rise
with isometric exercise?
a. O2 usage (ml/min)
b. pulse rate (per min)
c. cardiac output (L/min)
d. Stroke volume (mls)

44. Regarding bone marrow, which is incorrect?

a. normally 85% of cells in the marrow are white blood cell producing
myeloid type
b. yellow marrow = fat infiltrated marrow
c. haematopoietic stem cells = capable of producing all blood cell types
d. progenitor cells = committed stem cells

45. Which of the following proteins is not part of the fibrinolytic system?
a. fibrin
b. plasmin
c. thrombomodulin
d. tissue plasminogen activator

46. Which of the following blood vessels has the largest approximate total cross-
sectional area (cm2)?
a. vena cava
b. venule
c. arteriole
d. vein

47. Which of the following does not lead to an increase in interstitial fluid volume?
a. venular constriction
b. gravity
c. incompetent heart valves
d. increased plasma protein levels

48. Which of the following will lead to arteriolar dilation?

 a. thromboxane A2
b. decreased local pH
c. neuropeptide Y
d. circulating Na+K+ATPase inhibitor

49. Neurons located in the Rostal Ventrolateral Medulla (RVLM) are a major
contributor to neural control of the vascular system. Which of the following would
not lead to excitatory inputs to the RVLM?
a. pain pathways
b. carotid and aortic chemoreceptors
c. carotid and aortic baroreceptors
d. somatosympathetic reflex

50. Regarding peripheral chemoreceptors, which is false?

a. chemoreceptor discharge can lead to Mayer waves
b. chemoreceptors are primarily activated by reduction in PaCO2
c. increased vagal nerve activity is a direct effect of chemoreceptor activation
d. chemoreceptors exert their main effect on respiration

51. The Dromotropic effect is:

a. sympathetic impulses causing increased heart rate
b. sympathetic impulses causing increased contractile force
c. sympathetic impulses increasing rate of transmission in the cardiac
connective tissue
d. parasympathetic impulses causing increased contractile force

52. Regarding lymphatics, which is the incorrect statement?

a. initial lymphatics have valves to help with fluid flow
b. tissue fluid enters initial lymphatics via loose junctions between endothelial
cells that form the walls
c. fluid within initial lymphatics is massaged by muscle contractions of the
associated organs
d. 25 -50% of circulating plasma protein is returned to the bloodsteam daily
via the lymphatics

53. When considering transportation across capillary walls, which is false?

a. diffusion is more important than filtration
b. diffusion depends upon Starling Forces
c. Flow limited exchange means that diffusion can be increased by increasing
blood flow through the tissue
d. capillary filtration coefficient is proportional to the permeability of the
capillary wall and the area available for filtration

54. Which of the following statements regarding capillaries is incorrect?

 a. pericytes are wrapped around the outside and are contractile
b. sinusoidal capillaries of the liver are extremely porous
c. pre-capillary sphincters are unresponsive to vasoconstrictor
molecules
d. kidney endothelial cells are attenuated to form gaps called fenestrations

55. Which of these is not a Vitamin K dependent clotting factor?

a. Factor IX
b. Prothrombin
c. Protein C
d. Factor XII

56. Regarding circulatory changes in exercise which is true?

a. fall in tissue pO2 and rise in pCO2 help increase skeletal muscle blood flow
b. a decrease in accumulated potassium increases skeletal muscle blood flow
c. the maximum heart rate achieved in exercise increases with age
d. training will decrease VO2max (maximal oxygen consumption)

57. In Myocardial infarction which is false?

a. accelerated opening of potassium channels is responsible in part for ST
segment elevation in the infarcted muscle
b arrhythmias occuring in the first 30 mins after infarction are usually due to
reentry mechanisms
c. Q waves and poor R wave progression are late signs of infraction
d. endocardial lesions lead to interruption of symphathetic nerve fibres

58. Regarding components of blood which is false?

a. Granulocytes can contain neutrophils, eosinophils and basophils
b. erythrocytes are derived from megakaryocytes
c. neutrophils make up around 50 to 70% of circulating white cells
d. splenectomy can lead to thrombocytosis

59. Regarding clotting factors which is true?

a. a deficiency in factor VIII explains the haemorrhagic tendency in liver
disease
b. the vitamin K dependent clotting factors include II, V and VII
c. Christmas disease is the deficiency of factor IX
d. Factor VIII deficiency has sex linked inheritance

60. Flow along collecting lymphatics is aided by all the following except:
a. lymphatic vessel valves
b. negative intrathoracic pressure during expiration
c. suction affect of high velocity flow of blood in veins
d. smooth muscle peristaltic action

61. Regarding the blood-brain barrier, which statement is true?

 a. glucose diffuses rapidly across the BBB
b. P-gylcoprotein is required to transport certain drugs into the brain
c. Kernicterus occurs when the BBB is immature
d. Movement of H2O and CO2 is subject to regulation

62. According to the Munro-Kellie doctrine, the volume within the cranium must
remain relatively constant. Regarding this, which of the following statements is
false?
a. a rise in venous pressure decreases cerebral blood flow
b. acceleration upwards causes a drop in brain arterial pressure
c. straining or valsalva manoeuvres cause an increase in brain venous pressure
d. any change in venous pressure causes a compensatory change in ICP

63. Which of the following statements regarding brain metabolism is true?

a. glutamine is converted to glutamate with ammonia
b. glucose enters the brain actively by GLUT-2 transporter
c. Insulin is required by most cerebral cells to utilise glucose
d. during starvation, up to 30% of normal glucose uptake is converted to
amino acids, lipids and proteins

64. Regarding the electrical events that occur during ECG intervals, which is correct?
a. PR atrial depolarization and conduction through AV node
b. QRS ventricular depolarization and atrial depolarization
c. QT ventricular depolarization and atrial repolarization
d. ST ventricular depolarization

65. Which of the ECG findings is not associated with a K+ of 2.0?

a. upright T wave
b. U wave
c. ST segment depression
d. PR prolongation

66. Regarding the cardiac cycle, which is true?

a. during isovolumetric contraction all of the heart valves are closed
b. v waves occur in phase 3 of the cycle
c. the peak right ventricular pressure is 30mmHg in systole
d. left ventricular pressure exceeds aortic pressure throughout systole

67. Regarding cardiac output, which of the following is correct?

a. sleep reduces cardiac output
b. rapid arrhythmias decrease cardiac output
c. eating decreases cardiac output
d. standing increases cardiac output

68. Which of the follwing is false of the heart murmurs?

 a. aortic stenosis is systolic murmur
b. tricuspid stenosis is often a diastolic murmur
c. pulmonary regurgitation is a an early systolic murmur
d. mitral prolapse is heard as a systolic murmur

69. Which is true regarding hypovolemic shock?

a. lactic acidosis increases myocardial contractility
b. moderate haemorrhage is a blood loss of 5-15mL/kg with increased heart rate
c. in severe blood loss bradycardia is never a feature
d. warm peripheries, rapid pulse, thirst, restlessness are all signs

70. When considering cardiac contractility, which is false?

a. Catecholamines increase contractility via adrenergic receptors and G protein
signalling
b. Caffeine increases contractility by prolonged intracellular cAMP presence
c. Digitalis increases contractility by activating adenylyl cyclase
d. Hypoxia, acidosis and procainamide depress contractility

71. Which of the following has the lowest proportion of blood flow to the organ in
ml/100g/min in a resting state?
a. heart muscle
b. kidneys
c. liver
d. brain

72. Which of the following has the highest percentage of total oxygen consumption at
rest?
a. kidneys
b. brain
c. liver
d. heart muscle

73. Which of the following is false regarding Cerebrospinal fluid (CSF)?

a. about 50 -70% of the CSF is formed in the choroid plexus
b. the concentration of glucose in the CSF is higher than in plasma
c. the extracellular fluid in humans makes up about 15% of the brain volume
d. in humans, the rate of CSF production is about 550ml/day

74. Which of the following about foetal circulation is true?

a. the blood in the umbilical vein is approximately 80% saturated
b. the ductus arteriosus constricts within 24 hours after birth
c. the ductus closure can be produced by drugs that enhance the effect of
cyclooxygenase
d. uterine blood flow increases 40 fold during the course of pregnancy

75. Arteriole constriction is produced by which of the following?

 a. increased CO2
b. decreased local pH
c. Endothelin – 1
d. decreased sympathetic nerve discharge

76. Which is true with regard to the pathways involved in medullary control of the
cardiovascular system?
a. the RVLM is sometimes called a vasomotor area
b. inflation of the lungs causes vasoconstriction and increased blood pressure
c. inhibitory inputs affecting activity of the RVLM include the
somatosympathetic reflex
d. prolonged severe pain causes vasoconstriction and fainting

77. Which is false with regard to baroreceptors?

a. the carotid sinus and aortic arch receptors monitor the arterial circulation
b. baroreceptors are chemoreceptors which are activated by reduction in PaO2
c. Cardiopulmonary receptors are low-pressure, volume receptors
d. arterial baroreceptors are located in the tunica adventitia of the vessel wall\

78. Endothelin-1 is:

a. not found in the brain or kidneys
b. stored in secretory granules
c. inhibited by insulin
d. stimulated by Angiotensin II and catecholamines

79. With regard to natriuretic hormones, which is true?

a. ANP is secreted by the heart
b. BNP does not act on the kidneys
c. Natriuretic hormones are released in response to hypovolemoa
d. Natriuretic hormones act by augmenting the action of vasoconstrictor agents

80. Regarding brain metabolism

a. Cerebral Metabolic Rate for O2 (CMRO2) is approximately 10% of total
body resting O2 consumption
b. vegetative structures of the brain are more sensitive to hypoxia than the
cerebral cortex
c. glucose utilisation at rest is inversely proportional to blood flow and O2
consumption of the brain at rest
d. glutamate-glutamine conversion in the brain is the opposite reaction to that
which occurs in the kidney

81. Which of the following is a correct statement regarding heart failure?

a. It occurs when the heart is unable to pump enough blood to meet the
needs of the tissues.
b. It is never associated with sudden death.
c. In systolic failure ejection fraction is maintained.
d. In diastolic failure stroke volume is reduced.
82. Which is incorrect with regards to cardiac output (CO)?
a. CO is affected by Cardiac Rate (CR) or Stroke Volume (SV) or both.
b. CO is decreased during exercise.
c. CR and SV may be affected by neural input to cardiac myocytes.
d. CR and SV may be affected by hormonal input to cardiac myocytes.

83. Which is true of the cardiac cycle?

a. Late in diastole the atrioventricular (AV) valves are closed.
b. The rate of filling declines as the ventricles contract.
c. 70% of ventricular filling occurs passively during diastole.
d. Isometric ventricular contraction lasts about 0.5 seconds.

84. With regards to the heart sounds, which is correct?

a. The first sound is caused by closure of the aortic and pulmonary
valves.
b. The second sound is caused by closure of the mitral and tricuspid
valves.
c. Murmurs are primarily normal sounds.
d. Aortic stenosis produces a systolic murmur.

85. Starling’s law of the heart:

a. Explains the relationship between contractility and preload of the heart.
b. Does not apply in heart failure.
c. Causes Frank-Starling Curve to shift upward and to the left as
contractility is decreased.
d. Causes Frank-Starling Curve to shift downward and to the right with
sympathetic stimulation.

86. Which organ has the greatest blood flow per 100g of tissue?
a. Kidneys
b. Liver
c. Brain
d. Heart

87. Which is incorrect regarding the blood-brain barrier?

a. It is due to tight junctions between endothelial cells and between
epithelial cells in the choroid plexus.
b. It prevents both free and protein-bound steroids from entering the
brain.
c. Diffusion of glucose into CSF is enhanced by GLUT transporters.
d. A variety of drugs cross the cerebral capillaries but are immediately
transported back out again.

88. Which of the following is true about coronary blood flow?

 a. Flow to the coronary arteries supplying the atria and right ventricle is
significantly reduced during systole.
b. Flow to the subendocardial portion of the left ventricle occurs only
during diastole.
c. Left ventricular coronary flow is increased in tachycardia.
d. A low diastolic aortic pressure increases the coronary blood flow.

89. When is the pressure difference between the heart and aorta the least?
a. Right ventricle during systole
b. Right ventricle during diastole
c. Left ventricle during systole
d. Left ventricle during diastole

90. Which vessel usually has the lowest pO2?

a. Umbilical vein
b. Umbilical artery
c. Maternal uterine vein
d. Maternal femoral vein

91. Which of the following DOES NOT cause increased interstitial fluid oedema ?
a. Substance P
b. Inadequate lymph flow
c. Heart failure
d. Increased plasma protein

92. Regarding haematopoiesis in adults, which is false?

a. Extramedullary haematopoiesis can occur in the liver and spleen
b. Bone marrow in the tibia becomes largely inactive by age 20
c. 90% of cells in marrow belong to the myeloid series
d. 25% of red marrow cells are maturing red cells

93. In the development of blood cells which is the incorrect pairing?

a. GM-CSF : RBC
b. IL3 : basophil
c. IL5: basophil
d. M-CSF : monocyte

94. Regarding haemoglobin, which is true ?

a. UV light therapy is used to break down Bilirubin into biliverdin for
haemolytic jaundice in infants
b. Carboxyhaemoglobin is formed by a reaction between carbon dioxide
and
haemoglobin
c. Adult haemoglobin consists of 3 alpha chains and 1 beta chain
d. Methaemoglobin is produced after oxidative stress

95. Regarding Red Blood cell antigens, which is the true statement?
a. Red blood cell antigens are called agglutinogens
b. Type O blood contains anti-A and anti-B agglutinins
c. Plasma from AB blood type will agglutinate with red cells type A, B
and AB
d. Blood type AB is the least common blood type