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Cardiovascular physiology MCQs 24th April 2012 You may do this paper as an open book exam but to get the most learning, please attempt without the book. This will show you where your knowledge gaps are. Physiology – Circulation MCQs 1. Which of the following is incorrect about B cells? a. Can bind directly to antigens b. B cells contact to helper T cells is not always required to produce full activation and antibody formation c. Activated B cells can transform into memory B cells and plasma cells d. Immunoglobulins are the secreted form of antigen-binding receptors on the B cell membrane 2. Which of the following is incorrect about Platelets? a. Thrombopoietin is involved in regulation of platelet production b. Membranes contain receptors for ADP and fibrinogen c. Aggregate at sites of vascular injury d. alpha-granules contain non-protein substances like serotonin 3. With respect to ABO system, which is correct? a. Inherited as mendelian recessive b. A and B antigens are complex oligosaccharides that terminate in a terminal fructose molecule c. Antibodies against red cell agglutinogens are called agglutinins d. Type AB individuals develop anti-A and anti-B antibodies 4. Which of the following is not a congenital condition? a. Hageman trait b. Haemophilia A c. Hypoprothrombinemia d. Parahemophilia 5. Which of the following has the slowest rate of conduction (m/s)? a. SA node b. Bundle of His c. Purkinje System d. Atrial pathways 6. With respect to the cardiac cycle, which of the following is false? a. End-diastolic ventricular volume is about 130mls b. Ejection fraction is a valuable index of ventricular function c. 60% of ventricular filling occurs passively during diastole d. Highest rate at which the ventricle can contract is theoretically 400/min 7. Which of the following will not increase cardiac output? a. Eating b. Moderate changes in environmental temperature c. Pregnancy d. exercise 8. Heterometric regulation of cardiac output relates to? a. Changes in cardiac muscle length b. Changes in contractility c. Changes in muscle tension d. Changes in systolic ventricular volume 9. The following all depress cardiac output except? a. Hypocapnia b. Hypoxia c. Acidosis d. Procainamide 10. When considering oxygen consumption by the heart, which of the following is true? a. Stroke work of the left ventricle is 9 times that of the right ventricle b. O2 consumption by the beating heart is about 6ml/100g/min at rest c. Cardiac venous O2 tension is low d. Increased preload causes a greater increase in cardiac O2 consumption than an increase in afterload 11. Regarding capillaries, which is false? a. Total area of all capillary walls in the body exceeds 6300 m2 in the adult b. Walls are made up of a single layer of endothelial cells c. Junctions between skeletal endothelial cells can allow passage of molecules up to 100 nm in diameter d. Pericytes warp around capillaries and can release vasoactive agents 12. The permeability of capillaries is expressed in terms of their hydraulic conductivity. Which of the following type of capillaries have the highest hydraulic conductivity? a. Brain b. Skin c. Skeletal muscle d. Lung 13. With respect to laminar flow in blood vessels, which is incorrect? a. There is a layer of blood in contact with blood vessel wall that does not move b. Turbulence occurs less frequently in anaemia c. Flow will not be turbulent if the Reynolds number (Re) is less than 2000 d. Blood flows through vessels in a parabolic distribution 14. When considering viscosity and resistance of blood, which is false? a. haematocrit is the percentage of the volume of blood occupied by red blood cells b. whole blood is 1.8 times as viscous as water c. vascular hindrance relates to the radius of the blood vessel d. viscosity is affected by the composition of plasma and the resistance of cells to deformation 15. Which of the following does not cause an increase in interstitial fluid volume and oedema? a. Substance P b. Decrease in osmotically active substances in the interstitial space c. Decreased plasma protein levels d. Venous obstruction 16. The following are all vasodilators except a. Potassium b. Adenosine c. Lactate d. Decreased CO2 tension 17. Regarding Nitric Oxide (NO), which is true? a. Nitric oxide synthase (NOS) 1 is found in macrophages and immune cells b. NOS 1 and NOS 3 are activated by intracellular calcium concentrations c. NO is activated in the presence of haemoglobin d. Platelet aggregation inhibits NO release 18. Which of the following is a stimulator of endothelin-1 secretion? a. Angiotensin II b. Nitric oxide c. PGE2 d. Prostacyclin 19. All of the following will cause vasoconstriction of arterioles except: a. Endothelin-1 b. Decreased local temperature c. Circulating Na-K ATPase inhibitor d. Decreased discharge of noradrenergic vasomotor nerves 20. Increased baroreceptor discharge produces all of the following except: a. Vasodilation b. Venodilation c. Drop in blood pressure d. Tachycardia 21. Heart Rate is not slowed by: a. Fear b. Increased intracranial pressure c. hypoxia d. expiration 22. Which of the following tissues has the highest oxygen consumption (ml/100g/min)? a. Brain b. Skin c. Skeletal muscle d. kidney 23. Regarding Cerebrospinal fluid (CSF), which of the following is false? a. Bulk Flow of CSF into venous blood is unidirectional b. In adults, free communication appears to occur between brain interstitial fluid and CSF c. Osmolality of CSF is less than plasma d. 50-70% of CSF is formed in the choroid plexuses 24. All of the following are referred to collectively as the circumventricular organs except: a. Neurohypophysis b. Anterior pituitary c. Area postrema d. Subfornical organ 25. Concerning dynamics of blood flow, all are true except: a. Arterioles are the major site of blood flow resistance b. The probability of turbulence within a vessel can be expressed as the Reynold’s number c. Forward flow is continuous because of vessel wall recoil during systole d. Veins are capacitance vessels and small arteries and arterioles are resistance vessels 26. Considering vasodilator metabolites, which is correct? a. Nitric oxide synthase (NOS) in immune cells is activated by cytokines instead of calcium b. Endothelin receptors are coupled via G protein to adenylyl cyclase c. Vasopressin, angiotensin II and bradykinin are all vasodilators d. Atrial natiuretic peptide (ANP) is released in response to hypovolaemia 27. Regarding the normal physiology of the heart, which is true? a. The end diastolic ventricular volume is about 90 mls b. The ejection fraction is approximately 85% c. The end-systolic ventricular volume is approximately 50mls d. Peak right ventricular pressure is about 120 mmHg 28. Regarding the normal ECG, which is false? a. The PR interval is 0.18 seconds b. QT interval is 0.8 seconds c. Ventricular repolarisation occurs during the ST interval d. Right axis deviation is when the electrical axis falls to the right of +110 degrees 29. All of the following are true with respect to human immunoglobulins functions except for: a. A function of IgG is complement activation b. A function of IgD is localised protection in external secretions c. Antigen recognition by B cells is not a function of IgA d. Histamine release is a function of IgE 30. Regarding hypertension, which of the following is false? a. Plasma renin levels can be low in up to 25% of patients with essential hypertension b. The incidence of atherosclerosis increases in hypertension c. Coarctation of the thoracic aorta increases rennin secretion and increases peripheral resistance d. Estrogen increases angiotensin secretion which can lead to hypertension 31. Which of the following are not compensatory reactions activated by haemorrhage? a. Increased secretion of vasopressin b. Increased secretion of erythropoietin c. Venodilation d. Vasoconstriction 32. All of the following are types of obstructive shock except: a. Congestive heart failure b. Pulmonary embolism c. Cardiac tumour d. Cardiac tamponade 33. Which of the following is not increased with isotonic exercise? a. diastolic pressure b. Total peripheral resistance c. Oxygen consumption d. Cardiac output 34. Regarding foetal circulation, which is false? a. 55% of foetal cardiac output goes through the placenta b. Haemoglobin F binds 2,3-DPG more effectively than Haemoglobin A c. By age 4 months post-partum, 90% of circulating haemoglobin is Haemoglobin A d. Blood in the umbilical vein is believed to be 80% saturated with oxygen 35. Which of the following is incorrect of cutaneous circulation? a. Contraction of precapillary sphincters causes White Reaction b. Triple response is lost after total sympathectomy c. Reactive hyperaemia can be prevented if limb circulation is occluded in an atmosphere of 100% O2. d. When skin appears cold and blue, the arterioles are constricted and capillaries are dilated 36. Regarding brain metabolism, which is false? a. Oxygen, glucose and glutamine are utilised for brain metabolism b. Occlusion of blood supply to the brain can cause unconsciousness in as little as 10 seconds c. Parkinsonism can occur due to hypoxia of the basal ganglia d. Respiratory quotient of cerebral tissue is 0.95-0.99 37. When considering venous circulation, which of the following is incorrect? a. Pressure in the venules is higher than in large veins b. Drop in venous pressure during expiration aids venous return c. Venous flow is pulsatile close to the heart d. Heartward movement of blood is decreased in patients with varicose veins 38. The opening of which channel completes the pre-potential for pacemaker cells? a. Ca+2 T channel b. K+ channel c. Na-K ATPase channel d. Ca+2 L channel 39. Regarding systole and diastole, which is false? a. cardiac muscle can contract and repolarise faster with higher heart rates b. diastole shortens more than systole at high heart rates c. theoretically, ventricles could contract up to 400 times per minute d. ventricular filling is always adequate up to a heart rate of 180 40. Which of the following is incorrect with respect to heart sounds? a. S1 is caused by vibrations from the closure of AV valves b. S4 can be heard with high atrial pressures c. S4 can be heard in patients with ventricular hypertrophy d. S2 is caused by the closure of AV valves 41. Which of the following is incorrectly paired? a. aortic stenosis systolic murmur b. pulmonary insufficiency systolic murmur c. mitral stenosis diastolic murmur d. tricuspid stenosis diastolic murmur 42. Which of the following will not decrease End Diastolic Volume? a. intrapericardial tumour b. myocardial infarction c. infiltrative disease of the myocardium d. increase in the normal negative intrathoracic pressure 43. Which of the following changes in cardiac function has only a minimal rise with isometric exercise? a. O2 usage (ml/min) b. pulse rate (per min) c. cardiac output (L/min) d. Stroke volume (mls) 44. Regarding bone marrow, which is incorrect? a. normally 85% of cells in the marrow are white blood cell producing myeloid type b. yellow marrow = fat infiltrated marrow c. haematopoietic stem cells = capable of producing all blood cell types d. progenitor cells = committed stem cells 45. Which of the following proteins is not part of the fibrinolytic system? a. fibrin b. plasmin c. thrombomodulin d. tissue plasminogen activator 46. Which of the following blood vessels has the largest approximate total crosssectional area (cm2)? a. vena cava b. venule c. arteriole d. vein 47. Which of the following does not lead to an increase in interstitial fluid volume? a. venular constriction b. gravity c. incompetent heart valves d. increased plasma protein levels 48. Which of the following will lead to arteriolar dilation? a. thromboxane A2 b. decreased local pH c. neuropeptide Y d. circulating Na+K+ATPase inhibitor 49. Neurons located in the Rostal Ventrolateral Medulla (RVLM) are a major contributor to neural control of the vascular system. Which of the following would not lead to excitatory inputs to the RVLM? a. pain pathways b. carotid and aortic chemoreceptors c. carotid and aortic baroreceptors d. somatosympathetic reflex 50. Regarding peripheral chemoreceptors, which is false? a. chemoreceptor discharge can lead to Mayer waves b. chemoreceptors are primarily activated by reduction in PaCO2 c. increased vagal nerve activity is a direct effect of chemoreceptor activation d. chemoreceptors exert their main effect on respiration 51. The Dromotropic effect is: a. sympathetic impulses causing increased heart rate b. sympathetic impulses causing increased contractile force c. sympathetic impulses increasing rate of transmission in the cardiac connective tissue d. parasympathetic impulses causing increased contractile force 52. Regarding lymphatics, which is the incorrect statement? a. initial lymphatics have valves to help with fluid flow b. tissue fluid enters initial lymphatics via loose junctions between endothelial cells that form the walls c. fluid within initial lymphatics is massaged by muscle contractions of the associated organs d. 25 -50% of circulating plasma protein is returned to the bloodsteam daily via the lymphatics 53. When considering transportation across capillary walls, which is false? a. diffusion is more important than filtration b. diffusion depends upon Starling Forces c. Flow limited exchange means that diffusion can be increased by increasing blood flow through the tissue d. capillary filtration coefficient is proportional to the permeability of the capillary wall and the area available for filtration 54. Which of the following statements regarding capillaries is incorrect? a. pericytes are wrapped around the outside and are contractile b. sinusoidal capillaries of the liver are extremely porous c. pre-capillary sphincters are unresponsive to vasoconstrictor molecules d. kidney endothelial cells are attenuated to form gaps called fenestrations 55. Which of these is not a Vitamin K dependent clotting factor? a. Factor IX b. Prothrombin c. Protein C d. Factor XII 56. Regarding circulatory changes in exercise which is true? a. fall in tissue pO2 and rise in pCO2 help increase skeletal muscle blood flow b. a decrease in accumulated potassium increases skeletal muscle blood flow c. the maximum heart rate achieved in exercise increases with age d. training will decrease VO2max (maximal oxygen consumption) 57. In Myocardial infarction which is false? a. accelerated opening of potassium channels is responsible in part for ST segment elevation in the infarcted muscle b arrhythmias occuring in the first 30 mins after infarction are usually due to reentry mechanisms c. Q waves and poor R wave progression are late signs of infraction d. endocardial lesions lead to interruption of symphathetic nerve fibres 58. Regarding components of blood which is false? a. Granulocytes can contain neutrophils, eosinophils and basophils b. erythrocytes are derived from megakaryocytes c. neutrophils make up around 50 to 70% of circulating white cells d. splenectomy can lead to thrombocytosis 59. Regarding clotting factors which is true? a. a deficiency in factor VIII explains the haemorrhagic tendency in liver disease b. the vitamin K dependent clotting factors include II, V and VII c. Christmas disease is the deficiency of factor IX d. Factor VIII deficiency has sex linked inheritance 60. Flow along collecting lymphatics is aided by all the following except: a. lymphatic vessel valves b. negative intrathoracic pressure during expiration c. suction affect of high velocity flow of blood in veins d. smooth muscle peristaltic action 61. Regarding the blood-brain barrier, which statement is true? a. glucose diffuses rapidly across the BBB b. P-gylcoprotein is required to transport certain drugs into the brain c. Kernicterus occurs when the BBB is immature d. Movement of H2O and CO2 is subject to regulation 62. According to the Munro-Kellie doctrine, the volume within the cranium must remain relatively constant. Regarding this, which of the following statements is false? a. a rise in venous pressure decreases cerebral blood flow b. acceleration upwards causes a drop in brain arterial pressure c. straining or valsalva manoeuvres cause an increase in brain venous pressure d. any change in venous pressure causes a compensatory change in ICP 63. Which of the following statements regarding brain metabolism is true? a. glutamine is converted to glutamate with ammonia b. glucose enters the brain actively by GLUT-2 transporter c. Insulin is required by most cerebral cells to utilise glucose d. during starvation, up to 30% of normal glucose uptake is converted to amino acids, lipids and proteins 64. Regarding the electrical events that occur during ECG intervals, which is correct? a. PR atrial depolarization and conduction through AV node b. QRS ventricular depolarization and atrial depolarization c. QT ventricular depolarization and atrial repolarization d. ST ventricular depolarization 65. Which of the ECG findings is not associated with a K+ of 2.0? a. upright T wave b. U wave c. ST segment depression d. PR prolongation 66. Regarding the cardiac cycle, which is true? a. during isovolumetric contraction all of the heart valves are closed b. v waves occur in phase 3 of the cycle c. the peak right ventricular pressure is 30mmHg in systole d. left ventricular pressure exceeds aortic pressure throughout systole 67. Regarding cardiac output, which of the following is correct? a. sleep reduces cardiac output b. rapid arrhythmias decrease cardiac output c. eating decreases cardiac output d. standing increases cardiac output 68. Which of the follwing is false of the heart murmurs? a. aortic stenosis is systolic murmur b. tricuspid stenosis is often a diastolic murmur c. pulmonary regurgitation is a an early systolic murmur d. mitral prolapse is heard as a systolic murmur 69. Which is true regarding hypovolemic shock? a. lactic acidosis increases myocardial contractility b. moderate haemorrhage is a blood loss of 5-15mL/kg with increased heart rate c. in severe blood loss bradycardia is never a feature d. warm peripheries, rapid pulse, thirst, restlessness are all signs 70. When considering cardiac contractility, which is false? a. Catecholamines increase contractility via adrenergic receptors and G protein signalling b. Caffeine increases contractility by prolonged intracellular cAMP presence c. Digitalis increases contractility by activating adenylyl cyclase d. Hypoxia, acidosis and procainamide depress contractility 71. Which of the following has the lowest proportion of blood flow to the organ in ml/100g/min in a resting state? a. heart muscle b. kidneys c. liver d. brain 72. Which of the following has the highest percentage of total oxygen consumption at rest? a. kidneys b. brain c. liver d. heart muscle 73. Which of the following is false regarding Cerebrospinal fluid (CSF)? a. about 50 -70% of the CSF is formed in the choroid plexus b. the concentration of glucose in the CSF is higher than in plasma c. the extracellular fluid in humans makes up about 15% of the brain volume d. in humans, the rate of CSF production is about 550ml/day 74. Which of the following about foetal circulation is true? a. the blood in the umbilical vein is approximately 80% saturated b. the ductus arteriosus constricts within 24 hours after birth c. the ductus closure can be produced by drugs that enhance the effect of cyclooxygenase d. uterine blood flow increases 40 fold during the course of pregnancy 75. Arteriole constriction is produced by which of the following? a. increased CO2 b. decreased local pH c. Endothelin – 1 d. decreased sympathetic nerve discharge 76. Which is true with regard to the pathways involved in medullary control of the cardiovascular system? a. the RVLM is sometimes called a vasomotor area b. inflation of the lungs causes vasoconstriction and increased blood pressure c. inhibitory inputs affecting activity of the RVLM include the somatosympathetic reflex d. prolonged severe pain causes vasoconstriction and fainting 77. Which is false with regard to baroreceptors? a. the carotid sinus and aortic arch receptors monitor the arterial circulation b. baroreceptors are chemoreceptors which are activated by reduction in PaO2 c. Cardiopulmonary receptors are low-pressure, volume receptors d. arterial baroreceptors are located in the tunica adventitia of the vessel wall\ 78. Endothelin-1 is: a. not found in the brain or kidneys b. stored in secretory granules c. inhibited by insulin d. stimulated by Angiotensin II and catecholamines 79. With regard to natriuretic hormones, which is true? a. ANP is secreted by the heart b. BNP does not act on the kidneys c. Natriuretic hormones are released in response to hypovolemoa d. Natriuretic hormones act by augmenting the action of vasoconstrictor agents 80. Regarding brain metabolism a. Cerebral Metabolic Rate for O2 (CMRO2) is approximately 10% of total body resting O2 consumption b. vegetative structures of the brain are more sensitive to hypoxia than the cerebral cortex c. glucose utilisation at rest is inversely proportional to blood flow and O2 consumption of the brain at rest d. glutamate-glutamine conversion in the brain is the opposite reaction to that which occurs in the kidney 81. Which of the following is a correct statement regarding heart failure? a. It occurs when the heart is unable to pump enough blood to meet the needs of the tissues. b. It is never associated with sudden death. c. In systolic failure ejection fraction is maintained. d. In diastolic failure stroke volume is reduced. 82. Which is incorrect with regards to cardiac output (CO)? a. CO is affected by Cardiac Rate (CR) or Stroke Volume (SV) or both. b. CO is decreased during exercise. c. CR and SV may be affected by neural input to cardiac myocytes. d. CR and SV may be affected by hormonal input to cardiac myocytes. 83. Which is true of the cardiac cycle? a. Late in diastole the atrioventricular (AV) valves are closed. b. The rate of filling declines as the ventricles contract. c. 70% of ventricular filling occurs passively during diastole. d. Isometric ventricular contraction lasts about 0.5 seconds. 84. With regards to the heart sounds, which is correct? a. The first sound is caused by closure of the aortic and pulmonary valves. b. The second sound is caused by closure of the mitral and tricuspid valves. c. Murmurs are primarily normal sounds. d. Aortic stenosis produces a systolic murmur. 85. Starling’s law of the heart: a. Explains the relationship between contractility and preload of the heart. b. Does not apply in heart failure. c. Causes Frank-Starling Curve to shift upward and to the left as contractility is decreased. d. Causes Frank-Starling Curve to shift downward and to the right with sympathetic stimulation. 86. Which organ has the greatest blood flow per 100g of tissue? a. Kidneys b. Liver c. Brain d. Heart 87. Which is incorrect regarding the blood-brain barrier? a. It is due to tight junctions between endothelial cells and between epithelial cells in the choroid plexus. b. It prevents both free and protein-bound steroids from entering the brain. c. Diffusion of glucose into CSF is enhanced by GLUT transporters. d. A variety of drugs cross the cerebral capillaries but are immediately transported back out again. 88. Which of the following is true about coronary blood flow? a. Flow to the coronary arteries supplying the atria and right ventricle is significantly reduced during systole. b. Flow to the subendocardial portion of the left ventricle occurs only during diastole. c. Left ventricular coronary flow is increased in tachycardia. d. A low diastolic aortic pressure increases the coronary blood flow. 89. When is the pressure difference between the heart and aorta the least? a. Right ventricle during systole b. Right ventricle during diastole c. Left ventricle during systole d. Left ventricle during diastole 90. Which vessel usually has the lowest pO2? a. Umbilical vein b. Umbilical artery c. Maternal uterine vein d. Maternal femoral vein 91. Which of the following DOES NOT cause increased interstitial fluid oedema ? a. Substance P b. Inadequate lymph flow c. Heart failure d. Increased plasma protein 92. Regarding haematopoiesis in adults, which is false? a. Extramedullary haematopoiesis can occur in the liver and spleen b. Bone marrow in the tibia becomes largely inactive by age 20 c. 90% of cells in marrow belong to the myeloid series d. 25% of red marrow cells are maturing red cells 93. In the development of blood cells which is the incorrect pairing? a. GM-CSF : RBC b. IL3 : basophil c. IL5: basophil d. M-CSF : monocyte 94. Regarding haemoglobin, which is true ? a. UV light therapy is used to break down Bilirubin into biliverdin for haemolytic jaundice in infants b. Carboxyhaemoglobin is formed by a reaction between carbon dioxide and haemoglobin c. Adult haemoglobin consists of 3 alpha chains and 1 beta chain d. Methaemoglobin is produced after oxidative stress 95. Regarding Red Blood cell antigens, which is the true statement? a. Red blood cell antigens are called agglutinogens b. Type O blood contains anti-A and anti-B agglutinins c. Plasma from AB blood type will agglutinate with red cells type A, B and AB d. Blood type AB is the least common blood type