1. Which of the following locations is the start of the lymphatic system?
The Right Lymphatic Duct
The Thoracic Duct
The Lymphatic Capillaries
The Lymph NodesAnswer D.
2. Which of the following is a defining and unique characteristic of the endocardium?
Loose Connective Tissue
Cardiac Muscle Tissue
Unilocular Fat Cells
Simple Squamous CellsAnswer C.
3. Which of the following is a defining and unique characteristic of the epicardium?
Loose Connective Tissue
Cardiac Muscle Tissue
Unilocular Fat Cells
Simple Squamous CellsAnswer D.
4. In which of the following way is cardiac muscle tissue different from skeletal muscle tissue?
Cardiac muscle tissue has a triad while skeletal muscle has a triad
Cardiac muscle tissue is connected by gap junctions while skeletal muscle is not
Cardiac muscle tissue has multiple nuclei while skeletal muscle has a single nuclei
Cardiac muscle tissue is striated while skeletal muscle is not
Cardiac muscle tissue depends entirely on exogenous calcium while skeletal muscle does notAnswer B.
5. Which of the following are found in the lateral portion of intercalated disks ?
Gap JunctionsAnswer E.
6. Which of the following would expect to find only in long lived cells such as cardiac cells and neurons?
Increased mitochondria concentrations
Abundant intercellular connections
Increased exogenous lipid accumulationAnswer 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?
Bundle of His
Right and Left Bundle Branches
Purkinje FibersAnswer A.
8. Which of the following is a visible characteristic useful in identifying veins in histological pictures?
A round lumen
Simple squamous epithelium in the tunica intima
A lack of valves
A thick tunica media
A thick tunica externaAnswer E.
9. In which type of blood vessels would you find the largest total cross sectional area?
Large VeinsAnswer D.
10. In which type of blood vessels would you find the lowest pressure?
Large VeinsAnswer G.
11. In which type of blood vessels would you find the most muscle proportion?
Large VeinsAnswer C.
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?
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
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
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
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
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 sizeAnswer 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?
An anastomosis between the left and right anterior cardinal veins forms the left brachiocephalic vein
The left anterior cardinal vein forms the superior vena cava
The right posterior cardinal vein forms the inferior vena cava
The right vitelline vein forms the azygous vein
The umbilical veins form the portal veinAnswer 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?
Anterior and posterior cardinal veins, from common cardinal veins
Anterior cardinal veins, from placenta
Posterior cardinal veins, from cephalad region of fetus
Umbilical veins, from caudal region of fetus
Vitelline veins, from yolk sacAnswer 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)?
Distal section of the left subcardinal vein
Distal section of the right supracardinal vein
Proximal section of the left subcardinal vein
Proximal section of the right subcardinal vein
Proximal section of the right supracardinal veinAnswer 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?
Bulbus cordis, sinus venosus, primordial atrium, ventricle, truncus arteriosus
Sinus venosus, primordial atrium, bulbus cordis, ventricle, truncus arteriosus
Sinus venosus, primordial atrium, ventricle, bulbus cordis, truncus arteriosus
Truncus arteriosus, bulbus cordis, ventricle, primordial atrium, sinus venosus
Truncus arteriosus, ventricle, bulbus cordis, primordial atrium, sinus venosusAnswer C. (The Developing Human, Chapter 13 – Cardiovascular System, Fig. 13.7D; Lecture 39 & 40 – Heart Development I & II, slide 25 – Formation of Cardiac Loop)
17. The coronary sinus results from which embryological structure?
Left anterior cardinal vein
Left sinus horn
Left vitelline vein
Right sinus horn
Right vitelline veinAnswer 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?
The apoptotic loss of cells in the central region of the septum primum
The apoptotic loss of cells in the central region of the septum secundum
The approaching endocardial cushions towards each other
The final crescentic free edge of the septum primum as it expands towards the endocardial cushions
The final crescentic free edge of the septum secundum as it expands towards the endocardial cushionsAnswer 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?
Atresia of aortic valve
Persistent truncus arteriosus
Probe patency of foramen ovale
Tetralogy of Fallot
Tricuspid atresiaAnswer 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?
Aortic infundibular stenosis
Hypotrophy of right ventricular wall
Interventricular septal defect
Overriding pulmonary trunk arising from septal defect
Patent foramen ovaleAnswer 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?
Persistent truncus arteriosus
Tetralogy of Fallot
Transposition of the great vessels
Ventricular septal defect
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?
Bundle of His
Bundle of HersAnswer 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?
Bundle of His
Bundle of HersAnswer B.
25. Which of the following is the term for the subsidiary pacemaker in the AV firing in response to a long SA pause?
Ectopic Heart rhythm
Alternate pacemaker disorder
Escape junctional beat
SA node deletion
AV node deletionAnswer C.
26. Which of the following is a reason for delaying action potential at the AV node?
Required to allow for the symmetrical contraction of the ventricle
Allows complete atrial filling
Allows aortic valve to close
Ensures atrial contraction before ventricular contraction
Allows for Sodium to build up for a faster contractionAnswer D.
27. Which of the following is characteristic of pacemaker potential?
Stable membrane potential
Hypopolarization due to potassium efflux
Sodium influx prevents excessive hyperpolarization
Opening of Fast-Na channels is responsible for depolarization
Opening of Calcium channels repolarize the membraneAnswer C.
28. El-hefe really stressed the importance of which channel in maintaining autorhythmicity of pacemaker potential?
Funny Na+ channels
Fast Ca++ channels
Voltage gated Na+ channels
Fast Na+ channels
NA+/K+ pumpAnswer A.
29. Which Chronotropic agent is correctly matched with its receptor and influence on the heart?
NE; Beta 2; Increase HR
Ach; M1; Decrease HR
NE; M1; Decrease HR
Ach; M2; Increase HR
NE; Beta 1; Increase HRAnswer E.
30. What is the purpose of cardiac contractile cells exhibiting a prolonged positive phase accompanied by a prolonged period of contraction?
Allows for complete ventricular filling
Ensures adequate ejection time
Allows for Atrial filling
Allows for Stronger contraction
Ensures that the heart has rhythmAnswer B.
31. Which of the following is a result of hyperkalemia as it relates to a cardiac action potential?
Increased membrane potential
Decreased membrane potential
Activation of fast sodium channels
Increased phase 0 slope
Increased phase 3 slopeAnswer B.
32. Entry through which primary ion/channel pump is responsible for the larger release of calcium during a cardiac action potential?
Calcium Leak ChannelsAnswer C.
33. A decreased amount of ATP will result in which of the following scenarios?
Prolonged plateau phase
Increased refractory period
Decreased phase 2
Decreased probability of arrhythmias
Activation of fast sodium channelsAnswer C.
34. Which of the following is a characteristic of early afterdepolarization?
Occurs in phase 3 or 4
Reduced calcium removal
Short QT syndromeAnswer D.
35. Sympathetic activation of the protein Phospholamban results in what two events?
Phosphorylation; increased calcium SR uptake
Phosphorylation; decreased calcium SR uptake
Dephosphorylation; increased calcium SR uptake
Dephosphorylation; decreased calcium SR uptakeAnswer A.
36. Which part of an ECG using Lead II constitutes the depolarization of the heart?
P wave and T wave
P wave and QRS complex
P wave and S wave
T wave and QRS complex
Only P waveAnswer 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?
Specialized Atrial FibersAnswer 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?
A wider T wave because the cardiac tissue needs more time to repolarize.
An absent T wave because the cardiac tissue does not need to repolarize.
No change because the signal will be propagated by the AV node.
Narrower R-R intervals because the heart would speed up to compensate for the lack of signal from the SA node.
A large downward S wave.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?
40. What degree is the vector pointing in an aVL ECG?
41. How would you determine the Mean Electrical Axis of the heart?
Add the vectors in the heart during depolarization together and divide by 4
Add the vectors in the heart during repolarization together and divide by 4
Add the vectors in the heart during depolarization together
Add the vectors in the heart during repolarization together
Add the vectors in the heart during depolarization and repolarization togetherAnswer C.
42. What would be found on an ECG in someone with an atrial flutter?
Waves with a saw-tooth appearance
Uniform prolonged PR interval
An irregularly irregular rhythm
Complete heart blockAnswer 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?
Second Degree Type I
Second Degree Type II
Bundle Branch BlockAnswer 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.
44. Which of the following situations is an attribute of Preload?
Preload is independent of venous return
An increase in preload diminishes the force of contraction
Preload is the initial stretching of cardiomyocytes prior to contraction
Preload is unrelated to maximal ventricular filling
Atrioventricular valve stenosis would increase preloadAnswer C.
45. Which of the following is NOT an attribute of Afterload?
The pressure the heart must work against to eject blood during systole.
Afterload is proportional to the mean arterial pressure.
Aortic valve stenosis will cause an increase in LV afterload.
Aortic valve regurgitation will cause an increase in LV afterload
Systemic HTN will cause an increase in LV afterload.Answer D.
46. Identify the correct statement as it applies to Wiggers diagram?
Isovolumetric contraction of the LV occurs when ventricular volume is at its lowest.
During Isovolumetric relaxation, closing of the mitral and tricuspid valves gives rise to the 2nd heart sound, “dub”.
The R-S phase during the QRS complex signals rapid ejection of blood from the LV through aortic semilunar valve.
At the end of Isovolumetric relaxation, the AV valve opens and atrial contraction initiates ventricular filling.
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.Answer E.
47. Identify the correct statement as it applies to Wiggers diagram?
AV valve opening precedes the ejection phase of the left ventricle as blood is rapidly ejected from the left ventricle.
A greater aortic pressure compared to left ventricular pressure results in AV valve closing leading to isovolumetric relaxation.
During Isovolumetric relaxation, the brief increase in aortic pressure results from the backflow of systemic circulation against the aortic valve.
Left ventricular volume increases from Isovolumetric contraction to Isovolumetric relaxation.
Left ventricular volume decreases from Isovolumetric relaxation to Isovolumetric contraction.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….?
Subtract the EDV from the ESV
Subtract the SV from the EDV
Divide the SV from the EDV
Subtract the ESV from the EDV
Add the EDV to the ESVAnswer 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…
L 2nd intercostal space
R 3rd intercostal space
R 2nd intercostal space
L 3rd intercostal space
L 5th intercostal spaceAnswer C.
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?
A leaky mitral valve
Atrophy of the Left ventricle
Hypertrophy of the Left ventricleAnswer 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?
Regurgitation of the semilunar valve
Heart Failure causing an atrial kick
Ventricular septal defect
A pulse that beats right before the murmur is heard
A pulse that beats right after the murmur is heardAnswer 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?
Bulging of the closed AV valves into the atrium
Venous blood pooling behind closed AV valves
AV valve opens, ventricles relax
Blood flows from the atria to the ventricle
Isovolumetric relaxationAnswer 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?
Pulsus alternansAnswer B.
54. Which of the following would be indicative of aortic stenosis?
Elevated systolic pressure and normal diastolic pressure
Elevated systolic pressure and suppressed aortic valve closure
Depressed diastolic pressure and slow rise in arterial pressure
Depressed diastolic pressure and depressed systolic pressure
Depressed systolic pressure and slow rise in arterial pressureAnswer E \.
55. While performing the Valsalva maneuver the right atrial pressure is increased. In what way does this affect cardiac output?
Venous return is decreased; cardiac output is increased
Afterload is increased; cardiac output is reduced
Preload is reduced; cardiac output is reduced
Preload is increased; cardiac output is increased
Afterload is increased; cardiac output is increasedAnswer C.
56. Cardiac scarring results in a loss of starling adaptation due to…
Decreased tensionAnswer D.
57. The administration of cardiac glycosides can have what effect on cardiac output?
Increased End Systolic Volume
Increased Stroke Volume
Increased Heart Rate
Increased End Diastolic VolumeAnswer C.
58. While investigating a patient’s decreased stroke volume you start looking for a reason why. What could be that reason?
Increased Heart Rate
Increased Venous Return
Increased End Diastolic Volume
Decrease End Systolic VolumeAnswer A.
59. How does exercise manage increase cardiac output in spite of an increased heart rate? Exercise causes an….
Increase in preload, decrease in contractility, and decrease in afterload
Decrease in preload, contractility, and afterload
Increase in preload, contractility, and afterload
Decrease in preload, decrease in contractility and increase in afterload
Increase in preload, increase in contractility, and decrease in afterloadAnswer E.
60. Which of the following has the greatest influence on the resistance of a blood vessel?
61. Which of the following is the major determinant to the direction of blood flow?
62. Which of the following determinants of viscosity is most drastically and directly affected by anemia?
63. Which form of resistance is where the sum of the parts is less than the smallest individual resistance?
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?
5.55 mL/min/mmHgAnswer D.
65. At which point or location in the vessel is the velocity of the blood flow the highest?
Towards the venous end
As it approaches the capillaries
In the center of the vessel
Where it approaches a sharp turn
Toward the vessel wallsAnswer C.
66. Which of the following would NOT result in turbulent blood flow?
Blood flow is too rapid
Blood moving through capillary beds
Blood flow through an obstruction
Blood flow making a sharp turn
Blood flow through a rough surfaceAnswer 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?
It will be laminar
It is passing through a normal open valve
There is an increased likelihood of turbulence
It is probably passing through a vessel with a small diameter
It will definitely be turbulent flowAnswer E.
68. Filtration is most likely to happen in which of the following locations in a capillary?
At the venous end
Where the interstitial fluid pressure is the highest
In the middle
Where the Plasma colloid osmotic pressure is the highest
At the arterial endAnswer 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?
34 mmHgAnswer C.
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)?
71. Which of the following causes an elevation of systolic blood pressure?
Decrease in Stroke Volume
Decrease in Ejection Velocity
Decrease in Arterial resistance
Decrease in Heart RateAnswer E.
72. Which of the following statements is true regarding diastolic blood pressure (DBP)?
It is unaffected by resistance
An increase in Stroke volume will decrease DBP
A decrease in compliance of the aorta decreases DBP
DBP is a result of the ejection through the aorta
An increase in heart rate lowers DBPAnswer 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?
Decrease Systolic volume
Decrease TPRAnswer 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
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?
Heart Rate contractility
Kidney Renin Secretion
Adrenal Medulla secretion
Blood vessel vasodilation
Kidney Constricting ArteriolesAnswer D.
76. Which of the Following is not a long term control of Blood pressure?
Supramedullary Neural Mechanism
Renal MechanismsAnswer D.
77. Which of the following is accurate regarding the Renin-Angiotensin-Aldosterone System?
Granular cells produce angiotensin II
ACE converts angiotensinogen to angiotensin I
Liver constantly produces angiotensinogen
Angiotensin II is the inactivated form
The purpose of the System is to decrease blood pressureAnswer 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?
Medulla oblongataAnswer B.
79. A patient presents with a blood pressure drop below 60 mmHg, which neural control mechanism was just activated (specific to below 60)?
Carotid and Aortic Chemoreceptors
Atrial and Pulmonary Artery Reflexes
CNS ischemic response
Arterial Baroreceptor Reflex
Bainbridge ReflexAnswer C.
80. Which of the following is not a metabolic coronary vasodilator?
Adenine nucleotidesAnswer C.
81. Administration of an ACE inhibitor will have which of the following effect?
Higher risk of myocardial infarction
Increased concentration of Angiotensin IIAnswer D.
82. Normal coronary flow in a resting human being is closest to which value?
22.5 L/minAnswer B.
83. Which of the following results in the greatest increase in coronary blood flow?
Low pressure, small radius
Low pressure, large radius
High pressure, small radius
High pressure, large radiusAnswer D.
84. Which layer experiences the highest degree of systolic vascular compression?
85. What inheritance pattern does Vascular Ehlers-Danlos Syndrome exhibit?
None, it is a sporadic mutationAnswer 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?
There is an excess of fibrillin in the heart muscle causing the heart to stretch extra increasing the preload
Tricuspid regurgitation results in right ventricular hypertrophy causing CHF
Aortic regurgitation results in a hypertrophic left ventricle causing dilated cardiomyopathy leading to CHF
SA node ceases to fire causing bradycardia leading to CHF
Syncope causes sudden cardiac arrest which shows CHF upon postmortem autopsy.Answer C.
87. Which of the following disorders is referred to as a channelopathy?
Vascular Ehlers-Danlos Syndrome
Cardiac-Valvular Ehlers-Danlos Syndrome
Arrhythmogenic Right Ventricular Cardiomyopathy
Brugada SyndromeAnswer 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?
Long QT interval on a V2 Lead
Normal QRS complex width and amplitude on all leads
ST segment elevation on Lead III
Deep S waves on a V1 LeadAnswer E.
89. Arrhythmogenic Right Ventricular Cardiomyopathy causes a loss of ______.
Left Ventricular epicardium
Left Ventricular myocardium
Right Ventricular myocardium
Right Ventricular nodes
Complete Right AtriumAnswer C.
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…
Alveolar pores function as a thoroughfare for dust cells to clear alveolar debri.
Alveolar pores serve as conduits for pulmonary capillaries to perfuse lung alveoli.
Alveolar pores function as integrated connections for surfactant to bathe alveoli.
Alveolar pores allow for the concerted passage of air between alveoli during breathing.
Alveolar pores are the ducts between alveoli that allow basal cells to differentiate and ascend as Type I pneumocytes.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:
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:
Adenocarcinoma in situ
Squamous cell carcinoma in situ
Minimally invasive adenocarcinomaAnswer 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:
Dilated squamous cell carcinoma
Small lung cell carcinomaAnswer 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?
Pseudostratified columnar cells
Type II Pneumocytes
Irregular Hyaline Cartilage Plates
Bowman’s GlandsAnswer E.
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?
Wheezing on both inspiration and expiration due to an irritation in the lungs collapsing the airways
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
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
Wheezing on expiration because of a decreased diameter causing the respiratory system to collapse on an already inflamed area
Wheezing on inspiration because of a decreased diameter causing the respiratory system to collapse on an already inflamed areaAnswer 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?
18 mmHgAnswer 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?
ERV+ TVAnswer 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?
6.25 mlAnswer E. This is a question that involves using the nitrogen washout test.
99. Which of the following would not decrease lung compliance?
AgingAnswer A. Emphysema would increase lung compliance by decreasing the elastic recoil. There would be little pressure difference to change the volume of the lungs. This makes it harder for them to exhale and they tend to take short shallow breaths because of it
100. An infant is born premature and is experiencing acute respiratory distress. What is the most likely cause?
The infant’s lungs are malformed
The infant lacks surfactant
The infant has not learned how to breathe properly
The infant is anemic and cannot properly ferry O2 throughout its body
The infant was born with only one lungAnswer B.
101. How does surfactant actually work to ensure our alveoli do not collapse on a daily basis?
It reinforces the alveoli making them more rigid
It gets rid of dipalmitoylphosphatidylcholine (DPPC) found in the alveoli
It increases the amount of lecithin and sphingomyelin found in the alveoli
It reduces surface tension at the gas-liquid interface
It helps to redirect incoming negative pressure towards larger alveoliAnswer D.
102. How will a loss of surfactant lead to pulmonary edema?
DPPC pulls in more fluid from capillaries in the lung
An increase in interstitial hydrostatic pressure due to alveoli collapse will pull fluid from capillaries in the lung
An decrease in interstitial hydrostatic pressure due to alveoli collapse will pull fluid from capillaries in the lung
Surfactant directly inhibits the influx of fluid
An increase in interstitial pressure will pull fluid from capillaries in the lungAnswer C.
103. While performing an Expiratory Volume test on a patient, what ratio (FEV1/FVC) will corresponds with its respiratory disease?
92%; Obstructive Respiratory Disease
80%; Obstructive Respiratory Disease
45%; Restrictive Respiratory Disease
50%; Obstructive Respiratory Disease
67%; Restrictive Respiratory DiseaseAnswer D.
104. During which phase of breathing would you expect the transairway pressure to become negative and collapse?
Beginning of inspiration
End of inspiration
Before beginning of next inspirationAnswer C.
105. Which of the following measurements is often considered as better or more sensitive than the FEV1?
106. Which of the following spirometry graphs below is typical of an individual with COPD?
- Answer B.
107. Which of the following would cause a decrease max inspiratory flow?
Destruction of elastin fibers
Tumor in a major airway
Weak signaling from the pneumotaxic center
Destruction of collagen fibers
108. Which of the following values would be increased for someone with an obstructive lung disease but decreased for someone with a restrictive lung disease?
Slope of FV curve
109. Major differences in FVC and SVC is indicative of which of the following?
Large airway collapse
Restrictive lung diseases
Situs inversusAnswer A.
110. Which of the following would NOT constitute as dead space?
The middle of over expanded alveoli in an individual with emphysema
Hypoxic alveoli due to a pulmonary embolismAnswer D.
111. What is the volume of a persons dead space if they have an aveolar ventilation of 6000 mL/min, a respiration rate (RR) of 16 and a standard value tidal volume?
500 mLAnswer C.
112. In the graph above, which depicts assessing anatomic dead space, what is the cause of the increase in N2 concentration in phase IV?
N2 gas has a lower diffusion constant than O2 and thus takes longer to empty from the lungs
Phase IV is due to air trapping, so after the individual stops exhaling so forcefully the nitrogen can escape
The individual forcefully exhales, emptying the lungs of N2 in additional areas
Nitrogen gas analyzers often take time to adjust to changing concentrations so this is a normal delay
The individual has been snorkeling in shallow water because apparently that makes a differenceAnswer C.
113. What is the dead space volume of an individual with a PECO2 of 30 mmHg, a PACO2 of 40 mmHg, and a normal tidal volume capacity?
200 mLAnswer B.
114. Which of the following is the closest value of the alveolar ventilation of an individual with a PaCO2 of 40 mmHg and a VECO2 of 210 mL/min?
5.5 L/minAnswer C.
115. What would the appoximate alveolar partial pressure of oxygen be if an individual is at sea level with an arterial CO2 value of 40 mmHg?
120 mmHgAnswer C.
116. Which of the following changes would result in the associated change in volume of gas diffusion (Fick’s)?
Increase in pressure ; decrease volume
Increase in molecular weight ; increased volume
Decrease solubility ; decreased volume
Decrease thickness ; decreased Volume
Increase surface area ; decreased volumeAnswer C.
117. Which of the following has the lowest solubility coefficient?
118. Which of the following has the lowest diffusion coefficient?
119. Exercising decreases the time spent in the capillaries.Iif the time drops to 0.2 seconds, which of the following is the lease affected in reaching diffusion equilibrium?
All are significantly altered.Answer A.
120. In which of the following situations would Alveolar Po2 not equal blood Po2?
Partially Saturated Hemoglobin
Fully Saturated Hemoglobin
Fully saturated Fetal Hemoglobin
Fully saturated Sickle HemoglobinAnswer B.
121. Which of the following Concentrations is lowest in dead space air?
None of the AboveAnswer B.
122. Which of the following would result in the greatest increase of tissue carbon dioxide pressure?
Decreased blood flow, increased cellular metabolic rate
Decreased blood flow, decreased cellular metabolic rate
Increased blood flow, increased cellular metabolic rate
Increased blood flow, decreased cellular metabolic rate
123. Which scenario causes a shift to the left in an oxygen-hemoglobin dissociation curve?
Increased hydrogen concentration
Carbon monoxide poisoning
124. Which correlates to the oxygen arterial end and carbon dioxide venous end of the pulmonary capillary?
PO2 = 104, PCO2 = 45
PO2 = 104, PCO2 = 40
PO2 = 40, PCO2 = 45
PO2 = 40, PCO2 = 40
PO2 =25, PCO2 = 50Answer D.
125. High altitude will cause a decrease in all of the following but which quantity?
Oxygen pressure of alveoli
Oxygen pressure of arteries
Oxygen-Hemoglobin binding %
Alveolar-artery oxygen pressure gradientAnswer E.
126. 2,3-BPG displays which of the following characteristics?
Increased levels due to hypothyroidism
High affinity for HbF
Decreased levels due to chronic anemia
Left shift of the oxygen-hemoglobin dissocation curve
Affinity for deoxygenated Hb > affinity for oxygenated HbAnswer E.
127. Calculate the total blood oxygen content with an arterial oxygen pressure of 90mmHg and an oxygen-hemoglobin saturation percentage of 85%. Assume normal hemoglobin and dissolved oxygen levels.
17.35 O2/mlAnswer E.
128. Match the following form of oxygen and carbon dioxide with its relative percentage in blood.
Dissolved oxygen = 97%, dissolved CO2 = 23%
Dissolved oxygen = 3%, dissolved CO2 = 70%
Oxygen-Hb = 97%, bicarbonate = 7%
Oxygen-Hb = 97%, bicarbonate = 70%
Oxygen-Hb = 97%, dissolved CO2 = 23%Answer D.
129. Which part of the medullary respiratory center is not active during quiet breathing?
Dorsal Respiratory Group
Ventral Respiratory Group
Pneumotaxic CenterAnswer D.
130. Paul Monary is having rapid-shallow breathing due to pain when he inhales deeply. Which pulmonary receptor is responsible for this symptom?
Pulmonary Stretch Receptors
Chest Wall Proprioceptors
Merkel ReceptorsAnswer C.
131. An unconscious male is brought to the ER. Upon a blood analysis his pH is elevated and you see his QT interval is prolonged on an ECG. Upon further examination his facial muscles contract when CN VII is tapped and you notice his hand curls in when taking his blood pressure with the cuff. Your patient is most likely experiencing ________ from _______ due to hyperventilation?
Respiratory Alkalosis; Hypocalcemia
Respiratory Alkalosis; Hypokalemia
Respiratory Acidosis; Hypocalcemia
Respiratory Acidosis; Hypokalemia
Respiratory Acidosis; HyperkalemiaAnswer A. Key terms to pick up in this question are elevated pH, prolonged QT, + Chvostek and Trousseau signs, and hyperventilation. Hyperventilation causes respiratory alkalosis because the patient is blowing off CO2 leading to elevated pH, and the rest of the symptoms are hallmarks of Hypocalcemia. Hypokalemia would cause a generalized overall weakness without the positive Chvostek and Trousseau signs. (The patient does not necessarily have to be unconscious)
132. Which of the following directly stimulates the chemosensitive area to increase ventilation?
H2CO3Answer D. CO2 indirectly stimulates the chemosensitive area because it can cross the blood brain barrier, go through the bicarbonate reaction, and yield H+ as a product. NO causes vasodilation, among other things, but does not directly stimulate the chemosensitive area.
133. What is the correct order for the afferent nerves of the peripheral chemoreceptors that detect changes in O2?
Aortic Arch → Carotid Bodies → CN IX → Nucleus Tract Solitarius
Aortic Arch → Vagus Nerve → Hering Nerves → Nucleus Tract Solitarius
Carotid Bodies → Vagus Nerve → Nucleus Tract Solitarius
Carotid Bodies → Hering Nerves → Vagus Nerve → Nucleus Tract Solitarius
Carotid Bodies → Hering Nerves → CN IX → Nucleus Tract SolitariusAnswer E. Remember that these peripheral chemoreceptors will be stimulated strongly when PaO2 < 60mmHg and weakly when PaO2 is 60-80mmHg, but do not respond when PaO2 >100mmHg
134. Which of the following statements is NOT true as it applies to Pulmonary Circulation?
A high number of pulmonary vessels in parallel help keep the pulmonary vascular resistance very low.
An increase in cardiac output results in a decrease in pulmonary vascular resistance.
Pulmonary capillary resistance increases with decreased cardiac output.
Decreased pulmonary venous pressure results in decreased pulmonary vascular resistance.
Pulmonary capillary recruitment and and distension keep resistance low.Answer D.
135. During Tidal Volume breathing…?
The apex region of the lung acts like a shunt.
Gravity causes the blood of the pulmonary circulation to be equally distributed.
Blood would rather go towards the apex of the lung.
The base of the lung is the least compliant part of the lung
The base of the lung is the most ventilated part of the lung.Answer E.
136. Which of the following correctly characterizes one of the three functional zones of the lung?
Zone 1 resembles a shunt.
Zone 2: Pv > Pa > PA
Zone 3 resembles a dead space
Zone 1: PA > Pv > Pa
Zone 3: Pa > Pv > PAAnswer E.
137. Your patient presents with a collapsed left lung. Identify the correct physiological attribute that applies to his condition?
The Intrapleural pressure has become more positive.
Hypoxia-induced vasoconstriction would shunt blood flow towards the apex of the collapsed lung near the respiratory bronchioles.
A decrease in surface tension would pull fluid from the capillaries into the interstitial space resulting in pulmonary edema.
Surfactant loss as a result of lung collapse would increase the distensibility of the collapsed lung.
Pulmonary resistance would be decreased as a result of increased venous pressure.Answer E. The Intrapleural Pressure would become MORE NEGATIVE. Think of putting your thumb on the open cap of a plastic syringe and pulling. By increasing the volume in a closed container, you are causing the pressure inside to become more negative. Hypoxia induced vasoconstriction would shunt blood flow towards the working lung. Fluid would be pulled into the interstitial space following a collapsed lung, but this would be due toINCREASED SURFACE TENSION, not decreased. Surfactant loss would decrease lung compliance. Pulmonary capillary distension and recruitment, enable this circulatory system to decrease vascular resistance with increased cardiac output and increased venous pressure.
138. Identify the correct statement as it applies to Pulmonary Circulation?
↑ V/Q results in a dead space
During inspiration, there is increased pressure placed on the extra-alveolar vessels.
RV and TLC represent the lung volumes where there is the least pulmonary vascular resistance.
During expiration, there is decreased pressure placed on the extra-alveolar vessels.
Decreased pressure is placed on the alveolar vessels during inspiration.Answer A.
Session 62 – Respiratory Integration I – Ben slide 1-15
139. When treating a hypoxic patient, which of the following conditions can directly result from giving the hypoxic patient oxygen?
Metabolic acidosis, due to exhausted compensation by the kidneys
Metabolic alkalosis, due to kidneys dumping bicarbonate into the blood
No effect on blood pH, due to bicarbonate buffer system in the blood
Respiratory acidosis, due to accumulation of carbon dioxide in the blood
Respiratory alkalosis, due to reduction of carbon dioxide in the bloodAnswer D. The situation described is hypoventilation induced-hypercapnia. A hypoxic patient hyperventilates to compensate. Sometimes when given oxygen, the patient switches to hypoventilation, causing carbon dioxide to accumulate in the blood, resulting in systemic respiratory acidosis. (Lecture 62 – Respiratory Integration, slide 2 & 3)
140. In the case of your airplane decompressing, oxygen masks will fall from the ceiling. Passengers are instructed to breathe normally, despite stressing circumstances, to avoid which of the following conditions?
Using up all the shared oxygenAnswer D. Hyperventilating would cause the passenger to expel a higher quantity of carbon dioxide, lowing blood pH, moving them into respiratory alkalosis. (Lecture 62 – Respiratory Integration, slide 4)
141. Which of the following correctly describes the events incurred during the body’s adaptation to altitude?
The ambient air at altitude contains a decreased partial pressure of oxygen and increased partial pressure of carbon dioxide
The body will enact hyperventilation initially to increase the oxygen content of the blood, then need to compensate for decreased carbon dioxide levels by relatively hypoventilating
The initial compensation for the hypoxic conditions is the dumping of bicarbonate into the blood by the kidneys
The initial compensation for the hypoxic conditions is hypoventilating to reduce the hypercapnic state
The production of erythropoietin to stimulate red blood cell production results in a increase in arterial carbon dioxideAnswer B.
142. When a swimmer holds their breath to dive below the surface, shallow water blackout can occur by which of the following mechanisms?
Hyperventilating prior to diving results in hyperoxia which is toxic to the retinas, affecting visual proprioception
Hyperventilating prior to diving results in hypocapnia and reduced sensitivity to hypoxia in an earlier onset hypoxic state
Hypoventilating prior to diving results in an earlier onset hypoxic state
Hypoventilating prior to diving results in hypercapnia and reduced sensitivity to hypoxia
Hypoventilating prior to diving results in hypocapnia and reduced sensitivity to hypoxiaAnswer B. (Lecture 62 – Respiratory Integration, slide 13-15)
143. You and five friends plan a snorkeling trip. Unfortunately, each one of your friends has one of the following conditions. Risk of shallow water blackout is the greatest increased risk for your friend with which of the following conditions?
Pulmonary segmental resectionAnswer B. Patients with COPD tend to display a loss of sensitivity to hypercapnia due to being in a constant state of mild hypercapnia in their lung condition. This insensitivity to carbon dioxide is similar to the effect that hyperventilating prior to free diving can have on one’s carbon dioxide detection for breath-holding-induced hypoxia. Without this ability to sense increased carbon dioxide, the freediver can become hypoxic to the state of blackout before their body senses the dangerous levels of carbon dioxide. (Lecture 62 – Respiratory Integration, slide 13-15)
144. The first rule of scuba diving is to always keep breathing. The second rule of scuba diving is to follow your bubbles if you get lost. Rule number two helps save divers who have become afflicted with which of the following at depth?
Increased air viscosity
Seaweed entanglementAnswer D. Accumulation of arterial nitrogen gas can cause disorientating (almost drunken) behavior in scuba divers. By following their bubbles back to the surface, they avoid getting lost underwater and run out of oxygen in their air tank before being able to orientate and surface. (Lecture 62 – Respiratory Integration, slide 16)
145. A patient in the ER arrives with complaints of soreness in her joints following a rapid ascent to the surface from a depth of 100′ when she noticed that her air gauge read 500psi. She also states that due to the rapid ascent, she was unable to make a required decompression safety stop at 15′. You formulate that she is experiencing decompression sickness (also known as the bends) as a result which is characterized by accumulation of which blood gas in the joints?
Answer D. When breathing, gases dissolve in the blood relative to the surrounding pressure. At depth, the greater surrounding pressure causes a greater quantity of gases to dissolve into the blood. As a diver resurfaces and returns to sea-level pressure, the gases move down the pressure gradient and leave the blood to be expired via the alveoli. If the diver resurfaces too quickly to process through respiration, the gases form embolisms in the blood or leave the blood and enter the tissues. The gas with the greatest movement is nitrogen, and it tends to be most noticeable in the joint capsules (where the body “bends”), though it also affects the brain (nitrogen narcosis), heart, and general tissues. (Lecture 62 – Respiratory Integration, slide 16)
146. Liz is an experienced diver, but recently when she was taking pictures of the coral reef off the coast of the Bahamas, she got overly excited and came up from the water really quickly causing the bends (decompression sickness). Which of the following would she be least likely to experience?
Pain in the joints
Increased N2 content
Increased O2 content
Air embolismAnswer D. The only one of these that we did not discuss in class was the pain in the joints which comes about as the dissolved N2 in the body gets into and settles in the joints
147. In moderate exercise, which way does the O2 dissociation curve shift?
Left because of the increased need for O2
Right because of the decreased 2,3BPG
Left because of the hypoxic drive
Right because of the lactic acid
Left because of the decrease in pHAnswer D.
148. Which of the following is reduced in strenuous exercise?
All of the above
None of the aboveAnswer F.
149. Which of the following is not a direct reason for oxygen debt?
Increase in body temp
Epinephrine levels up
Increase in Hydrogen
Increased cortisolAnswer D. Breathing heavier is our response to oxygen debt, not something that causes it
150. In Cystic Fibrosis, what vitamin deficiencies would you expect to see?
A, C, D
D, E, K
A, B, C
A, E, K
B, K, EAnswer D.
151. A patient presenting with liver and lung damage resulting from neutrophil elastase will most likely have a mutation in which gene?
152. A patient with a known mutation in the FLCN gene will have a similar inheritance pattern to which disorder?
Tay SachsAnswer A.
153. In what cells are you likely to find the type IIb sodium-phosphate transporter that are coded by the SLC34A2 gene?
Type I alveolar cells
Type II alveolar cells
Type III alveolar cells
Basket cellsAnswer B.
154. What mutation is responsible for approximately 50% of patients who present with short ribs, narrow chest, and small pelvis?