BECOM 2 Exam 2 – 2020

Session 38 – Cardiac Histology

1. Which of the following locations is the start of the lymphatic system?

1. The Heart

2. The Right Lymphatic Duct

3. The Thoracic Duct

4. The Lymphatic Capillaries 

5. The Lymph Nodes
   

   Reveal Answer
   Answer D.

2. Which of the following is a defining and unique characteristic of the endocardium?

1. Loose Connective Tissue

2. Cardiac Muscle Tissue

3. Purkinje Fiber

4. Unilocular Fat Cells

5. Simple Squamous Cells
   

   Reveal Answer
   Answer C.

3. Which of the following is a defining and unique characteristic of the epicardium?

1. Loose Connective Tissue

2. Cardiac Muscle Tissue

3. Purkinje Fiber

4. Unilocular Fat Cells

5. Simple Squamous Cells
   

   Reveal Answer
   Answer D.

4. In which of the following way is cardiac muscle tissue different from skeletal muscle tissue?

1. Cardiac muscle tissue has a triad while skeletal muscle has a triad

2. Cardiac muscle tissue is connected by gap junctions while skeletal muscle is not

3. Cardiac muscle tissue has multiple nuclei while skeletal muscle has a single nuclei

4. Cardiac muscle tissue is striated while skeletal muscle is not

5. Cardiac muscle tissue depends entirely on exogenous calcium while skeletal muscle does not
   

   Reveal Answer
   Answer B.

5. Which of the following are found in the lateral portion of intercalated disks ?

1. Zonula Adherens 

2. Zonula Occludins

3. Macula Adherens 

4. Desmosomes 

5. Gap Junctions
   

   Reveal Answer
   Answer E.

6. Which of the following would expect to find only in long lived cells such as cardiac cells and neurons?

1. Lipofuscin Granules 

2. Increased mitochondria concentrations

3. T Tubules

4. Abundant intercellular connections

5. Increased exogenous lipid accumulation
   

   Reveal Answer
   Answer A.

7. After being shocked by lightening a patient is rushed to the emergency room and it is reveled that there was damage to the upper portion of the R atria. Which of the following structures in the conductance system of the heart is most likely affected?

1. SA Node

2. AV Node

3. Bundle of His

4. Right and Left Bundle Branches

5. Purkinje Fibers
   

   Reveal Answer
   Answer A.

8. Which of the following is a visible characteristic useful in identifying veins in histological pictures?

1. A round lumen

2. Simple squamous epithelium in the tunica intima 

3. A lack of valves

4. A thick tunica media

5. A thick tunica externa
   

   Reveal Answer
   Answer E.

9. In which type of blood vessels would you find the largest total cross sectional area?

1. Elastic Arteries

2. Muscular Arteries

3. Arterioles 

4. Capillaries 

5. Venules 

6. Medium Veins

7. Large Veins
   

   Reveal Answer
   Answer D.

10. In which type of blood vessels would you find the lowest pressure?

1. Elastic Arteries

2. Muscular Arteries

3. Arterioles 

4. Capillaries 

5. Venules 

6. Medium Veins

7. Large Veins
   

   Reveal Answer
   Answer G.

11. In which type of blood vessels would you find the most muscle proportion?

1. Elastic Arteries

2. Muscular Arteries

3. Arterioles 

4. Capillaries 

5. Venules 

6. Medium Veins

7. Large Veins
   

   Reveal Answer
   Answer C.

Session 39 – Heart Development I

12. In the development of the single large-lumen umbilical vein connected to the ductus arteriosus in the liver from the two paired umbilical veins, which of the following correctly describes the normal course of development?

1. Distal part of left umbilical vein and proximal part of right umbilical vein is obliterated, then the proximal part of the left umbilical vein is obliterated while the distal part of the right umbilical vein increases in size

2. Distal parts of both umbilical veins are obliterated, then the proximal part of the right umbilical vein is obliterated while the proximal part of the left umbilical vein increases in size

3. Distal parts of both umbilical veins are obliterated, then the proximal part of the left umbilical vein is obliterated while the proximal part of the right umbilical vein increases in size

4. Proximal parts of both umbilical veins are obliterated, then the distal part of the left umbilical vein is obliterated while the distal part of the right umbilical vein increases in size

5. Proximal parts of both umbilical veins are obliterated, then the distal part of the right umbilical vein is obliterated while the distal part of the left umbilical vein increases in size
   

   Reveal Answer
   Answer E. (Lecture 39 & 40 – Heart Development I & II, slide 10 – Umbilical Veins)

13. Which process of vein transformation (from embryo to adult) is correctly described for the normal human circulatory development?

1. An anastomosis between the left and right anterior cardinal veins forms the left brachiocephalic vein

2. The left anterior cardinal vein forms the superior vena cava

3. The right posterior cardinal vein forms the inferior vena cava

4. The right vitelline vein forms the azygous vein

5. The umbilical veins form the portal vein
   

   Reveal Answer
   Answer A. A is correct; B, the RIGHT COMMON CARDINAL VEIN forms the superior vena cava; C, the right VITELLINE vein forms the inferior vena cava; D, the right POSTERIOR CARDINAL vein forms the azygous vein; E, the VITELLINE VEINS form the portal vein. (The Developing Human, Chapter 13 – Cardiovascular System, Fig. 13.5A-C; Lecture 39 & 40 – Heart Development I & II, slide 10 – Umbilical Veins)

14. Which of the following correctly identifies the vein and blood supply it receives?

1. Anterior and posterior cardinal veins, from common cardinal veins

2. Anterior cardinal veins, from placenta

3. Posterior cardinal veins, from cephalad region of fetus

4. Umbilical veins, from caudal region of fetus

5. Vitelline veins, from yolk sac
   

   Reveal Answer
   Answer E. A, reversed, the common cardinal veins receive blood from the anterior and posterior cardinal veins; B, anterior cardinal veins, CEPHALAD region; C, posterior cardinal veins, CAUDAL region; D, umbilical veins, PLACENTA; E is correct. (The Developing Human, Chapter 13 – Cardiovascular System, Development of Veins Associated with Embryonic Heart; and Fig. 13.2; Lecture 39 & 40 – Heart Development I & II, slide 6 – Development of Venous System)

15. Which of the following cardinal veins is normally obliterated completely (no longer persists past the development of the embryo)?

1. Distal section of the left subcardinal vein

2. Distal section of the right supracardinal vein

3. Proximal section of the left subcardinal vein

4. Proximal section of the right subcardinal vein

5. Proximal section of the right supracardinal vein
   

   Reveal Answer
   Answer C. A becomes the left gonadal vein. B becomes the inferior vena cava (inferior to renal veins). C is obliterated. D becomes the inferior vena cava (superior to renal veins). E becomes the azygous vein. (The Developing Human, Chapter 13 – Cardiovascular System, Fig. 13.4A-D; Lecture 39 & 40 – Heart Development I & II, slide 14 – Cardinal Veins)

16. Which of the following correctly describes the sections of the tubular heart  (after the fusion of the heart tubes around week three), in the order through which blood would flow?

1. Bulbus cordis, sinus venosus, primordial atrium, ventricle, truncus arteriosus

2. Sinus venosus, primordial atrium, bulbus cordis, ventricle, truncus arteriosus

3. Sinus venosus, primordial atrium, ventricle, bulbus cordis, truncus arteriosus

4. Truncus arteriosus, bulbus cordis, ventricle, primordial atrium, sinus venosus

5. Truncus arteriosus, ventricle, bulbus cordis, primordial atrium, sinus venosus
   

   Reveal Answer
   Answer C. (The Developing Human, Chapter 13 – Cardiovascular System, Fig. 13.7D; Lecture 39 & 40 – Heart Development I & II, slide 25 – Formation of Cardiac Loop)

Session 40 – Heart Development II

17. The coronary sinus results from which embryological structure?

1. Left anterior cardinal vein

2. Left sinus horn

3. Left vitelline vein

4. Right sinus horn

5. Right vitelline vein
   

   Reveal Answer
   Answer B. A becomes the oblique vein of the left atrium; B becomes the coronary sinus. C is obliterated. D and E become part of the inferior vena cava. (The Developing Human, Chapter 13 – Cardiovascular System, Fig. 13.415A-B; Lecture 39 & 40 – Heart Development I & II, slide 29 – Development of Sinus Venosus)

18. The foramen secundum allows continued shunting of oxygenated blood from the right atrium to the left atrium prior to birth. It forms at the end of the fourth week as a result of which process?

1. The apoptotic loss of cells in the central region of the septum primum

2. The apoptotic loss of cells in the central region of the septum secundum

3. The approaching endocardial cushions towards each other

4. The final crescentic free edge of the septum primum as it expands towards the endocardial cushions

5. The final crescentic free edge of the septum secundum as it expands towards the endocardial cushions
   

   Reveal Answer
   Answer A. A is the foramen secundum; B does not occur; C is the atrioventricular canals; D is the foramen primum; E is the foramen ovale. (The Developing Human, Chapter 13 – Cardiovascular System, Partitioning of the Primordial Heart; Lecture 39 & 40 – Heart Development I & II, slide 34-35 – Septum Formation in Common Atrium)

19. During your OB/GYN rotation, an infant is born cyanotic due to a heart defect. Which heart disorders can you immediately rule out as not being a possible exclusive diagnosis?

1. Atresia of aortic valve

2. Persistent truncus arteriosus

3. Probe patency of foramen ovale

4. Tetralogy of Fallot

5. Tricuspid atresia
   

   Reveal Answer
   Answer C.  If probe patency is the only defect of the heart, it will not cause cyanosis. The patient will present with a murmur due to mild inappropriate mixing of the blood between the atria. All other listed diagnoses would present as a cyanotic newborn due to significant deoxygenated blood leaving through the aorta for systemic circulation. (The Developing Human, Chapter 13 – Cardiovascular System, Birth Defects of the Heart and Great Vessels; Lecture 39 & 40 – Heart Development I & II, slides 46, 48, 49, 51, 54 – Transposition of Great Vessels)

20. Which of the following cardiac alterations is consistent for the diagnosis of Tetralogy of Fallot?

1. Aortic infundibular stenosis

2. Hypotrophy of right ventricular wall

3. Interventricular septal defect

4. Overriding pulmonary trunk arising from septal defect

5. Patent foramen ovale
   

   Reveal Answer
   Answer C. (The Developing Human, Chapter 13 – Cardiovascular System, Birth Defects of the Heart and Great Vessels; Lecture 39 & 40 – Heart Development I & II, slide 48 – Tetralogy of Fallot)

22. Your OB/GYN attending informs you that the cyanotic newborn developed its conotruncal septum via a straight course. What is the most likely diagnosis of the newborn?

1. Persistent truncus arteriosus

2. Tetralogy of Fallot

3. Transposition of the great vessels

4. Tricuspid atresia

5. Ventricular septal defect

Session 41 – Cardiac Electrophysiology I

23. Noncontractile cells are capable of autorhythmicity, which of the following is associated with a small bundle of specialized cardiac cells at the base of the right atrium near the septum?

1. Sinoatrial node

2. Atrioventricular node

3. Bundle of His

4. Purkinje fibers

5. Bundle of Hers
   

   Reveal Answer
   Answer B.

24. A patient presents with a resting heart rate of 60, patient is not in the world’s best shape so you suspect that which autorhythmic tissue is responsible for the rate?

1. SA node

2. AV node

3. Bundle of His

4. Purkinje

5. Bundle of Hers
   

   Reveal Answer
   Answer B.

25. Which of the following is the term for the subsidiary pacemaker in the AV firing in response to a long SA pause?

1. Ectopic Heart rhythm

2. Alternate pacemaker disorder

3. Escape junctional beat

4. SA node deletion

5. AV node deletion
   

   Reveal Answer
   Answer C.

26. Which of the following is a reason for delaying action potential at the AV node?

1. Required to allow for the symmetrical contraction of the ventricle 

2. Allows complete atrial filling

3. Allows aortic valve to close 

4. Ensures atrial contraction before ventricular contraction

5. Allows for Sodium to build up for a faster contraction
   

   Reveal Answer
   Answer D.

27. Which of the following is characteristic of pacemaker potential?

1. Stable membrane potential 

2. Hypopolarization due to potassium efflux

3. Sodium influx prevents excessive hyperpolarization

4. Opening of Fast-Na channels is responsible for depolarization

5. Opening of Calcium channels repolarize the membrane
   

   Reveal Answer
   Answer C.

28. El-hefe really stressed the importance of which channel in maintaining autorhythmicity of pacemaker potential?

1. Funny Na+ channels

2. Fast Ca++ channels

3. Voltage gated Na+ channels

4. Fast Na+ channels

5. NA+/K+ pump
   

   Reveal Answer
   Answer A.

29. Which Chronotropic agent is correctly matched with its receptor and influence on the heart?

1. NE; Beta 2; Increase HR

2. Ach; M1; Decrease HR

3. NE; M1; Decrease HR

4. Ach; M2; Increase HR

5. NE; Beta 1; Increase HR
   

   Reveal Answer
   Answer E.

30. What is the purpose of cardiac contractile cells exhibiting a prolonged positive phase accompanied by a prolonged period of contraction?

1. Allows for complete ventricular filling

2. Ensures adequate ejection time

3. Allows for Atrial filling

4. Allows for Stronger contraction

5. Ensures that the heart has rhythm
   

   Reveal Answer
   Answer B.

Session 42 – Cardiac Electrophysiology II

31. Which of the following is a result of hyperkalemia as it relates to a cardiac action potential?

1. Increased membrane potential

2. Decreased membrane potential

3. Activation of fast sodium channels

4. Increased phase 0 slope

5. Increased phase 3 slope
   

   Reveal Answer
   Answer B.

32. Entry through which primary ion/channel pump is responsible for the larger release of calcium during a cardiac action potential?

1. DHP

2. Na+/Ca++ exchanger

3. RyR

4. SERCA

5. Calcium Leak Channels
   

   Reveal Answer
   Answer C.

33. A decreased amount of ATP will result in which of the following scenarios?

1. Prolonged plateau phase

2. Increased refractory period

3. Decreased phase 2

4. Decreased probability of arrhythmias

5. Activation of fast sodium channels
   

   Reveal Answer
   Answer C.

34. Which of the following is a characteristic of early afterdepolarization?

1. Occurs in phase 3 or 4

2. Tachycardia

3. Reduced calcium removal

4. Bradycardia

5. Short QT syndrome
   

   Reveal Answer
   Answer D.

35. Sympathetic activation of the protein Phospholamban results in what two events?

1. Phosphorylation; increased calcium SR uptake

2. Phosphorylation; decreased calcium SR uptake

3. Dephosphorylation; increased calcium SR uptake

4. Dephosphorylation; decreased calcium SR uptake
   

   Reveal Answer
   Answer A.

Session 43 – Electrocardiogram

36. Which part of an ECG using Lead II constitutes the depolarization of the heart?

1. P wave and T wave

2. P wave and QRS complex

3. P wave and S wave

4. T wave and QRS complex

5. Only P wave
   

   Reveal Answer
   Answer B. The P wave and QRS constitute the depolarization of the heart while the T wave is the repolarization.

37. Which tissue in the heart conducts the cardiac impulse the fastest?

1. SA Node

2. Junctional Tissue

3. Purkinje Fibers

4. Ventricular Myocardium

5. Specialized Atrial Fibers
   

   Reveal Answer
   Answer C. Although the SA Node is autorythmical and is the pacemaker for the heart, the Purkinje fibers main function is to propogate the signal throughout all the heart tissue. Thus the Purkinje fibers have the fastest conduction in the heart.

38. What might you expect to see on a Lead II ECG when someone has failure of the SA node?

1. A wider T wave because the cardiac tissue needs more time to repolarize.

2. An absent T wave because the cardiac tissue does not need to repolarize.

3. No change because the signal will be propagated by the AV node.

4. Narrower R-R intervals because the heart would speed up to compensate for the lack of signal from the SA node.

5. A large downward S wave.
   

   Reveal Answer
   Answer E. The cardiac tissue would not need more time to repolarize , and there would still be a T wave because the tissue would still need to repolarize. The signal would most likely be taken over by the AV node which would cause the R-R ratios to be further apart, slowing the heart rate. Answer choice E is correct because the signal would have to move backwards as well as forwards throughout the heart, which means the signal would be moving the opposite way of the current being put through the heart by the ECG, thus a large downward signal would be seen correlating with an S wave.

39. What degree is the vector pointing in a Lead II ECG?

1. -30

2. -150

3. 0

4. 60

5. 120
   

   Reveal Answer
   Answer D.

40. What degree is the vector pointing in an aVL ECG?

1. -30

2. -150

3. 0

4. 60

5. 120
   

   Reveal Answer
   Answer A.

41. How would you determine the Mean Electrical Axis of the heart?

1. Add the vectors in the heart during depolarization together and divide by 4

2. Add the vectors in the heart during repolarization together and divide by 4

3. Add the vectors in the heart during depolarization together

4. Add the vectors in the heart during repolarization together

5. Add the vectors in the heart during depolarization and repolarization together
   

   Reveal Answer
   Answer C.

42. What would be found on an ECG in someone with an atrial flutter?

1. Fibrillating waves

2. Waves with a saw-tooth appearance

3. Uniform prolonged PR interval

4. An irregularly irregular rhythm

5. Complete heart block
   

   Reveal Answer
   Answer B. Fibrillating waves are found in atrial fibrillation, a uniform prolonged PR interval is found in first degree heart block, an irregularly irregular rhythm is made up, and complete heart block would be shown as a complete interruption of A-V conduction. The F wave’s sawtooth appearance is shown in the inferior leads, but in V1-V3 they look very similar to P waves.

43. You receive an ECG of your patient Stan Osis and see that his P-R interval keeps increasing and suddenly it loses the QRS signal and restarts, you believe Mr. Osis is suffering from which type of AV conduction block?

1. First Degree

2. Second Degree Type I

3. Second Degree Type II

4. Third Degree

5. Bundle Branch Block
   

   Reveal Answer
   Answer B. Second Degree Type I, also known as Wenkebach AV conduction block, this type of blockage is identified by a longer and longer PR interval followed by no QRS complex, and the pattern continues. If 2 or more P waves were nonconducted and every 2nd or 3rd QRS complex was dropped, it would be indicative of a Second Degree type II block. First degree would be shown as uniformed prolonged PR interval, and third degree would be completely irregular because of complete interruption of A-V conduction.

Session 44 – Cardiac Cycle I

44. Which of the following situations is an attribute of Preload?

1. Preload is independent of venous return

2. An increase in preload diminishes the force of contraction

3. Preload is the initial stretching of cardiomyocytes prior to contraction

4. Preload is unrelated to maximal ventricular filling

5. Atrioventricular valve stenosis would increase preload
   

   Reveal Answer
   Answer C.

45. Which of the following is NOT an attribute of Afterload?

1. The pressure the heart must work against to eject blood during systole.

2. Afterload is proportional to the mean arterial pressure. 

3. Aortic valve stenosis will cause an increase in LV afterload.

4. Aortic valve regurgitation will cause an increase in LV afterload 

5. Systemic HTN will cause an increase in LV afterload.
   

   Reveal Answer
   Answer D.

46. Identify the correct statement as it applies to Wiggers diagram?

1. Isovolumetric contraction of the LV occurs when ventricular volume is at its lowest.

2. During Isovolumetric relaxation, closing of the mitral and tricuspid valves gives rise to the 2nd heart sound, “dub”.

3. The R-S phase during the QRS complex signals rapid ejection of blood from the LV through aortic semilunar valve. 

4. At the end of Isovolumetric relaxation, the AV valve opens and atrial contraction initiates ventricular filling. 

5. During the end of the ventricular ejection phase, LV pressure dips below that of aortic pressure resulting in semilunar valve closing and entry into isovolumetric relaxation.
   

   Reveal Answer
   Answer E.

47. Identify the correct statement as it applies to Wiggers diagram?

1. AV valve opening precedes the ejection phase of the left ventricle as blood is rapidly ejected from the left ventricle. 

2. A greater aortic pressure compared to left ventricular pressure results in AV valve closing leading to isovolumetric relaxation. 

3. During Isovolumetric relaxation, the brief increase in aortic pressure results from the backflow of systemic circulation against the aortic valve. 

4. Left ventricular volume increases from Isovolumetric contraction to Isovolumetric relaxation. 

5. Left ventricular volume decreases from Isovolumetric relaxation to Isovolumetric contraction.
   

   Reveal Answer
   Answer C.

48. You’re attending wants you to calculate the stroke volume of your tachycardic patient In order to facilitate his request, you correctly….?

1. Subtract the EDV from the ESV

2. Subtract the SV from the EDV

3. Divide the SV from the EDV

4. Subtract the ESV from the EDV

5. Add the EDV to the ESV
   

   Reveal Answer
   Answer D.

49. Your attending asks you to auscultate a classic aortic valve stenosis on your patient. Where do you place your stethoscope? Don’t embarrass yourself…

1. L 2nd intercostal space

2. R 3rd intercostal space

3. R 2nd intercostal space

4. L 3rd intercostal space

5. L 5th intercostal space
   

   Reveal Answer
   Answer C.

Session 45 – Cardiac Cycle II

50. Mike recently had his annual checkup where his doctor discovered a murmur that occurred right before the usual first heart “lub” Which of the following would generate this abnormal sound?

1. Aortic stenosis

2. A leaky mitral valve

3. Severe anemia

4. Atrophy of the Left ventricle

5. Hypertrophy of the Left ventricle
   

   Reveal Answer
   Answer E. This would be an S4 sound (abnormality) which is caused by filling a stiff ventricle. An atrophic ventricle would be a stiffening of the ventrical

51. Which of the following would cause a Systolic murmur?

1. Regurgitation of the semilunar valve

2. Heart Failure causing an atrial kick

3. Ventricular septal defect

4. A pulse that beats right before the murmur is heard

5. A pulse that beats right after the murmur is heard
   

   Reveal Answer
   Answer C The pulse beating right after the murmur is heard would be a sign that there was a systolic murmur, but would not be a cause of the murmur. The pulse right before would be a symptom of a diastolic murmur. A and B are examples of causes of diastolic murmur, not a systolic murmur.

52. Which of the following is seen during the C arterial pressure wave?

1. Bulging of the closed AV valves into the atrium

2. Venous blood pooling behind closed AV valves

3. AV valve opens, ventricles relax

4. Blood flows from the atria to the ventricle

5. Isovolumetric relaxation
   

   Reveal Answer
   Answer A.

53. While on your cardiology rotation, your attending tried to stump you by asking what condition the above image is indicating with the red lines?

1. Bicuspid stenosis

2. Tricuspid stenosis

3. Atrial fibrillation

4. Atrial flutter

5. Pulsus alternans
   

   Reveal Answer
   Answer B.

54. Which of the following would be indicative of aortic stenosis?

1. Elevated systolic pressure and normal diastolic pressure

2. Elevated systolic pressure and suppressed aortic valve closure

3. Depressed diastolic pressure and slow rise in arterial pressure

4. Depressed diastolic pressure and depressed systolic pressure

5. Depressed systolic pressure  and slow rise in arterial pressure
   

   Reveal Answer
   Answer E \.

Session 46 – Cardiac Output

55. While performing the Valsalva maneuver the right atrial pressure is increased. In what way does this affect cardiac output?

1. Venous return is decreased; cardiac output is increased

2. Afterload is increased; cardiac output is reduced

3. Preload is reduced; cardiac output is reduced

4. Preload is increased; cardiac output is increased

5. Afterload is increased; cardiac output is increased
   

   Reveal Answer
   Answer C.

56. Cardiac scarring results in a loss of starling adaptation due to…

1. Decreased afterload

2. Decreased recoil

3. Decreased preload

4. Decreased compliance

5. Decreased tension
   

   Reveal Answer
   Answer D.

57. The administration of cardiac glycosides can have what effect on cardiac output?

1. Increased Preload

2. Increased End Systolic Volume

3. Increased Stroke Volume

4. Increased Heart Rate

5. Increased End Diastolic Volume
   

   Reveal Answer
   Answer C.

58. While investigating a patient’s decreased stroke volume you start looking for a reason why. What could be that reason?

1. Increased Heart Rate

2. Increased Venous Return

3. Increased Contractility

4. Increased End Diastolic Volume

5. Decrease End Systolic Volume
   

   Reveal Answer
   Answer A.

59. How does exercise manage increase cardiac output in spite of an increased heart rate? Exercise causes an….

1. Increase in preload, decrease in contractility, and decrease in afterload

2. Decrease in preload, contractility, and afterload

3. Increase in preload, contractility, and afterload

4. Decrease in preload, decrease in contractility and increase in afterload

5. Increase in preload, increase in contractility, and decrease in afterload
   

   Reveal Answer
   Answer E.

Session 47 – Hemodynamics and Capillary Circulation – Garrett

60. Which of the following has the greatest influence on the resistance of a blood vessel?

1. Pressure

2. Length

3. Viscosity

4. Radius

5. Flow
   

   Reveal Answer
   Answer D.

61. Which of the following is the major determinant to the direction of blood flow?

1. Resistance

2. Pressure difference

3. Radius

4. Conductance

5. Viscosity
   

   Reveal Answer
   Answer B.

62. Which of the following determinants of viscosity is most drastically and directly affected by anemia?

1. Hematocrit

2. Fibrinogen

3. Velocity

4. Temperature

5. Radius
   

   Reveal Answer
   Answer A.

63. Which form of resistance is where the sum of the parts is less than the smallest individual resistance?

1. Antiseries

2. Series

3. Parallel

4. Antiparallel

5. Straight
   

   Reveal Answer
   Answer C.

64. If total cardiac out put is 5000 mL/min with a TPR of 0.02 mmHg/mL/min and left renal blood flow is 500 mL/min with a left renal arterial pressure of 100 mmHg and left renal venous pressure of 10 mmHg, what is the resistance of the left kidney?

1. 0.02 mmHg/mL/min

2. 0.20 mmHg/mL/min

3. 50 mL/min/mmHg

4. 0.18 mmHg/mL/min

5. 5.55 mL/min/mmHg
   

   Reveal Answer
   Answer D.

65. At which point or location in the vessel is the velocity of the blood flow the highest?

1. Towards the venous end

2. As it approaches the capillaries 

3. In the center of the vessel

4. Where it approaches a sharp turn

5. Toward the vessel walls
   

   Reveal Answer
   Answer C.

66. Which of the following would NOT result in turbulent blood flow?

1. Blood flow is too rapid

2. Blood moving through capillary beds

3. Blood flow through an obstruction

4. Blood flow making a sharp turn

5. Blood flow through a rough surface
   

   Reveal Answer
   Answer B.

67. While doing research looking at various vessels throughout the body, your preceptor mentions that a certain vessel has a Reynold’s number of 3500. What does this tell you about the blood flow?

1. It will be laminar

2. It is passing through a normal open valve

3. There is an increased likelihood of turbulence 

4. It is probably passing through a vessel with a small diameter

5. It will definitely be turbulent flow
   

   Reveal Answer
   Answer E.

68. Filtration is most likely to happen in which of the following locations in a capillary?

1. At the venous end

2. Where the interstitial fluid pressure is the highest 

3. In the middle

4. Where the Plasma colloid osmotic pressure is the highest

5. At the arterial end
   

   Reveal Answer
   Answer E.

69. What is the net filtration pressure if the capillary hydrostatic pressure is 35 mmHg, the capillary colloid osmotic pressure is 20 mmHg, the interstitial hydrostatic pressure is 12 mmHg and the interstitial colloid osmotic pressure is 9 mmHg?

1. 18 mmHg

2. -12 mmHg

3. 12 mmHg

4. -18 mmHg

5. 34 mmHg
   

   Reveal Answer
   Answer C.

Session 48 – Blood Pressure Regulation

70. Math is fun, given a systolic pressure of 144 and a diastolic pressure 99, calculate the Mean Arterial Pressure (assume all pressures in mmHg)?

1. 129

2. 114

3. 93.33

4. 120

5. 45
   

   Reveal Answer
   Answer B.

71. Which of the following causes an elevation of systolic blood pressure?

1. Decrease in Stroke Volume

2. Decrease in Ejection Velocity

3. Decrease in Arterial resistance

4. Decreased Preload

5. Decrease in Heart Rate
   

   Reveal Answer
   Answer E.

72. Which of the following statements is true regarding diastolic blood pressure (DBP)?

1. It is unaffected by resistance

2. An increase in Stroke volume will decrease DBP

3. A decrease in compliance of the aorta decreases DBP

4. DBP is a result of the ejection through the aorta

5. An increase in heart rate lowers DBP
   

   Reveal Answer
   Answer C.

73. An 85 yo patient comes to your office for an annual checkup, which of the following can you expect as a result decreased compliance due to his age?

1. Systolic hypotension

2. Decrease Afterload

3. Decrease Systolic volume

4. Arterial Stiffening

5. Decrease TPR
   

   Reveal Answer
   Answer D.

74. More Math, Calculate Cardiac output given the following values: TPR of 2 mmHg/L/min, Bp of 120/80? Units left out for difficulty 

1. 46.7

2. 50

3. 186.6

4. 200

5. 120
   

   Reveal Answer
   Answer A.

75. Patient presents with a rare clinical abnormality of the sympathetic nervous stimulation of Beta 2 receptors, which of the following actions of autonomic innervations is damaged?

1. Heart Rate contractility

2. Kidney Renin Secretion

3. Adrenal Medulla secretion

4. Blood vessel vasodilation

5. Kidney Constricting Arterioles
   

   Reveal Answer
   Answer D.

76. Which of the Following is not a long term control of Blood pressure?

1. RAAS 

2. ANP

3. Hypothalamic Mechanisms

4. Supramedullary Neural Mechanism

5. Renal Mechanisms
   

   Reveal Answer
   Answer D.

77. Which of the following is accurate regarding the Renin-Angiotensin-Aldosterone System?

1. Granular cells produce angiotensin II

2. ACE converts angiotensinogen to angiotensin I

3. Liver constantly produces angiotensinogen

4. Angiotensin II is the inactivated form

5. The purpose of the System is to decrease blood pressure
   

   Reveal Answer
   Answer C.

78. Atrial Natriuretic peptide is secreted in response to increased blood volume. Which of the following is not directly targeted due to its release?

1. Hypothalamus 

2. Thalamus

3. Kidney

4. Adrenal Cortex

5. Medulla oblongata
   

   Reveal Answer
   Answer B.

79. A patient presents with a blood pressure drop below 60 mmHg, which neural control mechanism was just activated (specific to below 60)?

1. Carotid and Aortic Chemoreceptors

2. Atrial and Pulmonary Artery Reflexes

3. CNS ischemic response

4. Arterial Baroreceptor Reflex

5. Bainbridge Reflex
   

   Reveal Answer
   Answer C.

Session 49 – Coronary Circulation

80. Which of the following is not a metabolic coronary vasodilator?

1. Oxygen

2. CO2

3. Guanine nucleotides

4. Adenosine

5. Adenine nucleotides
   

   Reveal Answer
   Answer C.

81. Administration of an ACE inhibitor will have which of the following effect?

1. Vasoconstriction 

2. Increased GFR 

3. Higher risk of myocardial infarction 

4. vasodilation 

5. Increased concentration of Angiotensin II
   

   Reveal Answer
   Answer D.

82. Normal coronary flow in a resting human being is closest to which value?

1. 25 ml/min 

2. 225 ml/min 

3. 2,225 ml/min 

4. 2.25 L/min 

5. 22.5 L/min
   

   Reveal Answer
   Answer B.

83. Which of the following results in the greatest increase in coronary blood flow?

1. Low pressure, small radius 

2. Low pressure, large radius 

3. High pressure, small radius 

4. High pressure, large radius
   

   Reveal Answer
   Answer D.

84. Which layer experiences the highest degree of systolic vascular compression?

1. Fibrous pericardium 

2. Serous pericardium 

3. Epicardium 

4. Myocardium 

5. Endocardium
   

   Reveal Answer
   Answer E.

Session 50 – Genetic Disorders of the Cardiovascular System

85. What inheritance pattern does Vascular Ehlers-Danlos Syndrome exhibit?

1. Autosomal Dominant

2. Autosomal Recessive

3. X-Linked Dominant

4. X-Linked Recessive

5. None, it is a sporadic mutation
   

   Reveal Answer
   Answer A. Vascular Ehlers-Danlos Syndrome is an autosomal dominant disorder whereas Cardiac-Valvular Ehlers-Danlos Syndrome is an autosomal recessive disorder.

86. Why is congestive heart failure a result of Marfan Syndrome?

1. There is an excess of fibrillin in the heart muscle causing the heart to stretch extra increasing the preload

2. Tricuspid regurgitation results in right ventricular hypertrophy causing CHF

3. Aortic regurgitation results in a hypertrophic left ventricle causing dilated cardiomyopathy leading to CHF

4. SA node ceases to fire causing bradycardia leading to CHF

5. Syncope causes sudden cardiac arrest which shows CHF upon postmortem autopsy.
   

   Reveal Answer
   Answer C.

87. Which of the following disorders is referred to as a channelopathy?

1. Marfan Syndrome

2. Vascular Ehlers-Danlos Syndrome

3. Cardiac-Valvular Ehlers-Danlos Syndrome

4. Arrhythmogenic Right Ventricular Cardiomyopathy

5. Brugada Syndrome
   

   Reveal Answer
   Answer E. Part of Brugada syndrome can be caused by a mutation of the SCN5A channel which is a sodium channel, therefore it is considered a channelopathy.

88. What is typically seen on an EKG of someone with Brugada Syndrome?

1. Long QT interval on a V2 Lead

2. Normal QRS complex width and amplitude on all leads

3. Atrial Flutter

4. ST segment elevation on Lead III

5. Deep S waves on a V1 Lead
   

   Reveal Answer
   Answer E.

89. Arrhythmogenic Right Ventricular Cardiomyopathy causes a loss of ______.

1. Left Ventricular epicardium

2. Left Ventricular myocardium

3. Right Ventricular myocardium

4. Right Ventricular nodes

5. Complete Right Atrium
   

   Reveal Answer
   Answer C.

Session 54 – Histology of the Respiratory System

90. During your rotation in pathology, you and your peer review a cross sectional diagram of an alveolar network of cells to prep for your day of lung histology. Your peer identifies several alveolar pores and inquires to you about their function. You correctly explain to him that…

1. Alveolar pores function as a thoroughfare for dust cells to clear alveolar debri.

2. Alveolar pores serve as conduits for pulmonary capillaries to perfuse lung alveoli.

3. Alveolar pores function as integrated connections for surfactant to bathe alveoli.

4. Alveolar pores allow for the concerted passage of air between alveoli during breathing.

5. Alveolar pores are the ducts between alveoli that allow basal cells to differentiate and ascend as Type I pneumocytes.
   

   Reveal Answer
   Answer D.

91. Your patient presents to you with stabbing pain in their left flank that came about during an evening run. They deny any history of cigarette use, vaping, or smoking marijuana. Spirometry tests are normal for age and weight. Patient works in an office and denies exposure to airborne irritants. Radiographic imaging is negative for pneumothorax but depicts inflamed tissue in the serosa surrounding the left lung with no fluid accumulation. Patient claims dehydration and exacerbation of symptoms with deep rapid breaths during exercise. Given these symptoms, you preemptively expect the diagnosis to be:

1. Pleural effusion

2. Bronchial pneumonia

3. Pleurisy

4. Emphysema

5. Asthma
   

   Reveal Answer
   Answer C.

92. A 67 year old male presents to you with shortness of breath. They claim a history of smoking cigarettes: 1 pack per day for 25 years with cessation 17 years ago. You take a lung biopsy, and pathology confirms an 8mm invasive cancer of the patient’s left bronchiole. The diagnosis is most likely:

1. Adenocarcinoma in situ

2. Invasive adenocarcinoma

3. Squamous cell carcinoma in situ

4. Cystic fibrosis

5. Minimally invasive adenocarcinoma
   

   Reveal Answer
   Answer B.

93. A 53 year old physically fit female presents to your clinic with dyspnea. She claims that symptoms began when she would go hiking and have progressively become worse to where she is struggling to breathe at rest. She claims a history of cigarette smoking: ½ a pack per day for 10 years with cessation 23 years ago. She has slight cyanosis in her fingertips and lips, and states that she “just can’t catch her breath.” Lung biopsy shows excessive dilation and enlargement of bronchioles with pulmonary and alveolar cell loss. You’re diagnosis is:

1. Mesothelioma

2. Extensive adenocarcinoma

3. Emphysema

4. Dilated squamous cell carcinoma

5. Small lung cell carcinoma
   

   Reveal Answer
   Answer C.

94. A 23 year old female presents to your clinic with a declining loss of smell and taste. She is a professional UFC fighter and claims several concussions and multiple nasal fractures. Radiographic imaging displays an intact cribriform plate, but your nasal endoscopic investigation reveals severely xerotic and erythematous olfactory epithelia. Knowing that olfactory transduction requires dissolving odorant molecules for smell detection, you suspect an issue with what key player in the patient’s olfactory epithelium?

1. Pseudostratified columnar cells

2. Type II Pneumocytes

3. Irregular Hyaline Cartilage Plates

4. Lamina Propria

5. Bowman’s Glands
   

   Reveal Answer
   Answer E.

Session 55 – Lung Volumes

95. Paul comes into your office because he has had a cough that just won’t go away. He claims that he has been “coughing up junk” for the past month and he thought it was just a cold, but now he has started to see blood in his phlegm. You suspect COPD. Which of the following would you expect to hear and why?

1. Wheezing on both inspiration and expiration due to an irritation in the lungs collapsing the airways

2. Wheezing on expiration because of a lack of surfactant in the lung causing irritation with maximum forced exhale due to his feeling like he cannot breathe

3. Wheezing on inspiration because of a lack of surfactant in the lung causing irritation with maximum forced inhalation due to his feeling like he cannot breathe 

4. Wheezing on expiration because of a decreased diameter causing the respiratory system to collapse on an already inflamed area

5. Wheezing on inspiration because of a decreased diameter causing the respiratory system to collapse on an already inflamed area
   

   Reveal Answer
   Answer D.

96. Quinton was recently diagnosed with lung cancer. The initial volume of his lung was 5.2 L and the pressure in his lungs was 12 mmHg. A spirometer showed that his lung volume has fallen to 2.6 L. What is the new pressure in his lungs?

1. 6 mmHg

2. 12 mmHg

3. 24 mmHg

4. 31 mmHg

5. 18 mmHg
   

   Reveal Answer
   Answer C.

97. Robert has emphysema. He is unable to forcibly exhale and instead takes breaths that go above his tidal volume to the maximum capacity his lungs have to inhale to compensate for his constant feeling like he cannot breathe. Your preceptor is in an exceptionally grumpy mood and rapid fires off questions one of which is the calculation to tell the measurement of his breaths? Thinking all the way back to your first year as a medical student, you tell him which of the following?

1. IRV+ TV

2. IRV+ ERV

3. ERV+RV

4. VC+RV

5. ERV+ TV
   

   Reveal Answer
   Answer A.

98. For your summer research project, you are comparing the residual volume in the lungs of rats that were exposed to second-hand smoke from cigarettes vs marijuanna. After 7 minutes the concentration of nitrogen in 100ml is 5% nitrogen, what would the normal residual volume be?

1. 4.5 ml

2. 5 ml

3. 5.5 ml

4. 6 ml

5. 6.25 ml
   

   Reveal Answer
   Answer E. This is a question that involves using the nitrogen washout test. 

P1(0.8)=0.05(100ml)