Download Difficulty Level 2

Anatomy & Physiology II Exam Bank – Topic 2 Heart
Objectives 1-8 Heart Anatomy, Systemic, Pulmonary, and Coronary Circulation
Difficulty Level 1
The fibrous pericardium
a. is in contact with the heart
b. is a serous membrane
The majority of the heart wall is the
a. epicardium
b. myocardium
c. is also known as the epicardium
d. forms the outer layer of the pericardial
sac
c. endocardium
d. Pericardium
Which of the following distribute deoxygenated blood to the lungs and oxygenated blood to the systemic
circulation?
a. atria
c. ventricles
b. aorta
d. pulmonary veins
The valve located between the right atria and right ventricle is the
a. tricuspid
c. aortic semilunar
b. bicuspid
d. pulmonary semilunar
In which heart chamber will you find the moderator band?
a. right atria
c. left atria
b. right ventricle
d. left ventricle
The papillary muscles
a. are attached to the chordae tendineae
b. are found in the atria
c. are attached to the semilunar valves
d. are attached to the fossa ovale
The apex of the heart lies in the
a. second intercostal space
b. lies in the fifth intercostal space
c. lies at the level of T5-T8
d. none of the above statements are true
Which of the following structures returns blood to the right atrium?
1. superior vena cava
2. coronary sinus
3. inferior vena cava
4. pulmonary veins
a. 1 and 2
c. 1, 2, and 3
b. 2 and 4
d. 1, 2, 3, and 4
The bulk of the heart wall is
a. epicardium
b. myocardium
c. endocardium
d. fibrous pericardium
Place the following tissue layers in the order that they occur, from superficial (external) to deep (internal):
1.
2.
3.
4.
5.
visceral serous pericardium
myocardium
fibrous pericardium
endocardium
parietal serous pericardium
a. 5,1,3,2,4
b. 5,3,1,2,4
c. 3,1,5,4,2
d. 3,5,1,2,4
e. 4,2,3,5,1
The coronary arteries are a branch off the __________. All but one of the cardiac veins drains into the
________.
a. aorta, coronary sinus
c. pulmonary trunk, right atria
b. aorta, right atria
d. pulmonary trunk, coronary sinus
Sympathetic stimulation ________ heart rate; parasympathetic stimulation _______heart rate.
a. increases, increases,
c. increases, decreases
b. decreases, increases
d. increases, no effect
During routine physical examination of a young boy, a patent (open) foramen ovale was diagnosed. Where is
the foramen ovale located?
a. in the anterior interventricular sulcus
b. in the interatrial septum
c. in the coronary sinus
d. in the pulmonary trunk
e. in the interventricular septum
Venous blood from the myocardium enters the right atrium via the:
a. superior vena cava
b. coronary sinus
c. inferior vena cava
d. sinuses of Valsalva
e. pulmonary veins
Which of the following is the correct circulatory sequence for blood to pass through part of the heart?
a. right atrium ® tricuspid valve ® right ventricle ® pulmonary semilunar valve
b. right atrium ® bicuspid valve ® right ventricle ® pulmonary semilunar valve
c. left atrium ® tricuspid valve ® left ventricle ® aortic semilunar valve
d. left atrium ® bicuspid valve ® left ventricle ® pulmonary semilunar valve
The pericardial cavity is located between the:
a. fibrous pericardium and the parietal layer of the serous pericardium
b. parietal and visceral layers of the serous pericardium
c. visceral layer of the serous pericardium and the epicardium
d. the epicardium and the myocardium
e. the myocardium and the endocardium
When cardiac muscle cells are deprived of oxygen for long periods of time, the cells die. This is called:
a. angina pectoris
b. myocardial infarction
c. fibrillation
d. heart block
e. ischemia
All of the arteries in an adult body carry oxygenated blood with the exception of the:
a. aorta
b. pulmonary artery
c. marginal artery
d. right coronary artery
e. circumflex artery
Which of the following vessels are major branches of the left coronary artery?
a. circumflex and anterior interventricular
b. marginal and circumflex
c. marginal and posterior interventricular
d. marginal and anterior interventricular
e. circumflex and posterior interventricular
The papillary muscles and the chordae tendindeae play an important role in the operation of the:
a. AV node
b. interventricular sulcus
c. AV bundle
d. AV valves
e. auricles
Blood returning from areas of the body below the diaphragm is carried to the heart by the:
a. superior vena cava
b. coronary sinus
c. inferior vena cava
d. pulmonary trunk
e. aorta
The following is a list of vessels and structures associated with the heart. What is the correct order for the flow
of blood entering the heart from systemic circulation?
1. right atrium 2. left atrium
5. vena cavae 6. Aorta
a.
b.
c.
d.
e.
1,2,7,8,4,5,6,5
5,1,3,7,8,2,4,6
1,7,3,8,2,4,6,5
5,1,3,8,7,2,4,6
5,3,1,7,8,4,2,6
3. right ventricle
4. left ventricle
7. pulmonary trunk 8. pulmonary veins
The valve located between the right atria and right ventricle is the __________, and the valve that is located
between the left atrium and the left ventricle is____________
a. tricuspid, seminlunar
c. aortic semilunar, bicuspid
b. bicuspid, tricuspid
d. tricuspid, mitral
This is also known as the visceral pericardium
a. epicardium
b. myocardium
c. endocardium
The layers of the heart wall from superficial to deep (outside to inside) are:
a. epicardium, myocardium, and endocardium c. epicardium, endocardium, and myocardium
b. myocardium, endocardium, and epicardium d. endocardium, myocardium, and epicardium
What is the function of pericardial fluid?
a. help the heart float buoyantly within the cavity
b. aid in repair if the heart gets damaged
c. enable the heart to move and beat inside the cavity without creating friction
d. prevent the heart from drying out when in contact with air
Freshly oxygenated blood from the pulmonary veins, is received by the heart into the _________ ________ and
is later pumped into the _________ circulation by the ventricle
a. left atrium; pulmonary
c. left atrium; systemic
b. right atrium; pulmonary
d. right atrium; systemic
The role of the coronary arteries is to:
a. direct blood to the aorta
b. move blood from the atria to ventricles
c. direct blood to the pulmonary veins
d. supply blood to heart tissue and myocardium
Small muscles attached to the chordae tendinae are the
a. papillary muscles
c. trabeculae carnae
b. pectinate muscles
d. moderator band
Freshly oxygenated blood is received by the heart into the ____ and is later pumped into the ____ circulation.
a. left atrium; pulmonary
c. right atrium; systemic
b. right atrium; pulmonary
d. left atrium; systemic
Mesothelial cells that secrete lubricating fluid are found in the:
a. fibrous pericardium
b. serous pericardium
c. endocardium
d. myocardium
e. none of the above
A valve damaged by rheumatic fever fails to open completely. This is called:
a. stenosis
b. heart block
c. ischemia
d. myocardial infarction
e. fibrillation
The anterior interventricular artery and the great cardiac vein are located in the:
a. anterior interventricular sulcus
b. coronary sulcus
c. posterior interventricular sulcus
d. interventricular septum
e. interatrial septum
The right coronary artery divides to form the posterior interventricular artery and the ______.
a. aorta
b. marginal artery
c. circumflex artery
d. coronary sinus
e. anterior interventricular artery
Labeling : Use the attached diagram to label the following. Please label the
structures or the area where the structure is found. Please use the name and
not just the number, and please make your own lines.
L1. left ventricle
L3. interventricular septum
L5. aortic semilunar valve
L7. apex
L2. mitral valve
L4. pulmonary trunk
L6. myocardium
L8. sinoatrial node
Diagram for Labeling I – Make your own lines!
Which of the following electrically insulates the atria from the ventricles?
a. epicardium
d. fibrous pericardium
b. AV node
e. myelin sheath
c. fibrous skeleton
Difficulty Level 2
Which pairing is incorrect?
a. crista terminalis, right atria
b. moderator band, right ventricle
c. trabeculae carni, left ventricle
d. pulmonary veins right atria
Which of the following statements concerning the fibrous skeleton of the heart is incorrect?
a. it electrically insulated the atria from the c. it functions to support the valve openings
ventricles
b. provides a rigid source of attachment for d. it is composed mainly of cartilage
the cardiac muscle
Which of the following statements concerning the heart is false?
a. the heart lies medial to the lungs
b. the middle layer of the heart is called the myocardium
c. the apex of the heart lies to the left of the midline, in the 5th intercostal space
d. the heart lies in the mediastinum
e. the heart lies posterior to the esophagus
Which of the following is not attached to the right atrium?
a. coronary sinus
b. pulmonary artery
c. inferior vena cava
d. superior vena cava
e. anterior cardiac veins
The left ventricular wall of the heart is thicker than the right ventricular wall in order to
a. provide greater pressure to pump blood c. provide greater pressure to pump blood
into the pulmonary circulation
into the systemic circulation
b. decrease friction of the ventricle from
d. accommodate a greater volume of blood
the respiratory diaphragm
All of the following statements about circulation of blood are true EXCEPT:
a. The systemic circulation circuit receives blood from the left ventricle.
b. The pulmonary circulation transports blood from the heart to the lungs and back to the heart.
c. The first blood vessel in the systemic circuit is the aorta.
d. The coronary circulation is part of the pulmonary circuit.
e. The right side of the heart is the pump for the pulmonary circuit
Select the correct statement about the heart valves
a. the mitral valve separates the right atrium c. the tricuspid valve divides the left atrium
and the right ventricle
from the left ventricle
b. the AV valves are supported by chordae d. semilunar valves control the flow of blood
tendinae so that they do not blow back
into the heart
up into the atria during ventricular
contraction
Which of the following is not associated with the atrioventricular valves?
a. chordae tendinae
c. pulmonary trunk
b. papillary muscles
d. left ventricle
Difficulty level 3
A 52 year old man was brought into the emergency room with severe chest pain. Angiography reveals a severe
coronary obstruction and lack of blood flow to the right lateral wall of the heart. Which artery would be most
likely occlude?
a. marginal artery
c. circumflex artery
b. anterior interventricular artery
d. posterior interventricular artery
An occlusion is found in your patient’s circumflex artery. Where do you predict myocardial infarction?
a. anterior right atrium
b. posterior left ventricle
c. interventricular septum
d. apex
e. posterior right ventricle
Bill is a very fit 70 year old individual who exercises regularly and has no symptoms of cardiovascular disease.
However, at his last doctor’s visit, a routine sonogram revealed that his right marginal artery had significant
blockage. Why was Bill’s heart able to function normally despite the blockage
a. thin blood found in the blood vessels
c. aged heart required less blood to function
b. The infarctions increased the circulation of blood
d. anastomoses and collaterals provided
through the coronary system
alternate route of circulation
If the mitral valve was blocked blood would back up into the:
a. Right Atrium
b. Right Ventricle
c. Left Atrium
d. Left Ventricle
Each of the cardiac valves
a. opens and in response to changes in pressure
d.
A and C are correct
b. ensures one-way blood flow through the heart.
e.
All of these are correct
c.
attaches to the ventricular walls via chordae tendinae
Blood flow in coronary circulation increases during:
a. diastole
b. systole
c. remains constant during the cardiac cycle
A medical student examines a valve that has been removed from a heart. He observes that the valve has 3
crescent moon shaped cusps, but no chordae tendinae. What conclusion could he draw based on those
observations?
a.
b.
c.
d.
e.
The valve is the tricuspid valve.
The valve is the bicuspid valve.
The valve is the pulmonary semilunar valve.
The valve is the aortic semilunar valve.
The valve could be either the aortic or the pulmonary semilunar valve.
Why doesn’t a significant amount of blood flow back into the vena cavae and coronary sinus during atrial
contraction?
a. the semilunar valves block the venous openings
b. the tricuspid valve blocks the venous openings
c. the contraction of the atria compresses and closes the venous openings
d. the bicuspid valve blocks the venous openings
e. the venous valves block the venous openings
A 35 year old man was shot and killed during an armed robbery. The bullet entry wound was in the left, 5th
intercostal space just below the left nipple. What structure was likely damaged?
a. apex of the heart
c. tricuspid valve
b. base of the heart
d. pulmonary trunk
A narrow tricuspid valve would cause
a. left atrial enlargement c. right atrial enlargement
b. liver enlargement
d. A and C
e. B and C
Objectives 9, 10, and 11 – Cardiac Muscle, Autorhythmic and Contractile Cells,
Intrinsic Conduction System
Difficulty Level 1
What channels in the autorhythmic cells allow ions to leak in, producing the pacemaker potential?
a. sodium
c. calcium
b. potassium
d. Chloride
Given these structures of the conduction system of the heart, identify the order in which the impulses are
relayed
1. AV node 2. Purkinje fibers 3. SA node 4. interventricular bundle of His 5. bundle branches
a. 3, 1, 4, 5, 2
c. 1, 3, 4, 5, 2
b. 3, 1, 5, 4, 2
d. 1, 2, 3, 4, 5
The upstroke (depolarization) of the SA nodal action potential is produced by opening a channel that is
a. primarily permeable to Na+
b. primarily permeable to K+
c. equally permeable to Ca+ and K+
d. Primarily permeable to Ca+
Select the appropriate choice that lists the inherent pacing rates from fastest to slowest:
a. sinoatrial node, purkinje fibers,
c. sinoatrial node, atrioventricular node,
atrioventricular node
purkinje fibers
b. purkinje fibers, atrioventricular node,
d. atrioventricular node, sinoatrial node,
sinoatrial node
purkinje fibers
Which of the following statements describes cardiac muscle tissue?
a. cells are striated
b. cells contain myoglobin
c. cells are connected by gap junctions
d. cells are connected by desmosomes
e. all of these statements describe cardiac muscle tissue
The papillary muscles and the chordae tendindeae play an important role in the operation of the:
a. AV node
b. interventricular sulcus
c. AV bundle
d. AV valves
e. Auricles
Which of the following is a part of the conduction system of the heart?
1. AV node
2. Bachman's bundle
3. Bundle of His(AV bundle)
5. Purkinji fibers 6. Bundle branches
7. AV valve
a. 1, 4, 3, 6, 5
b. 1,7, 3, 4, 5, 6
c. 1, 3, 4, 5, 6, 2
d. All of the above
4. SA node
The plateau phase of the contractile cell action potential
a. is due to the entry of calcium into the cell c. is due to potassium leaving the cell
b. is due to the entry of sodium into the cell
Which of the following is not part of the conduction system of the heart?
a. pukinje fibers
d. AV valve
b. SA node
e. all of these are parts of the cardiac
conduction system
c. bundle of his
Which component of the cardiac conduction system is located on the right atrial wall near the entrance of the
superior vena cava?
a. sinoatrial node
c. atrioventricular bundle (of His)
b. atrioventricular node
d. purkinje fibers
The conduction of the electrical impulse from the atria to the ventricles is delayed at the
a. sinoatrial node
c. left bundle branch
b. atrioventricular node
d. purkinje fibers
The normal pacemaker of the heart is the
a. sinoatrial node
b. atrioventricular node
c. atrioventricular bundle (of His)
d. purkinje fibers
e. none of the above
The primary pacemaker of the heart is the
a. Purkinje fiber
b. AV bundle (bundle of His)
c. right bundle branch
d. SA node
e. left bundle branch
Cardiac muscle cells are like skeletal muscle cells in that they:
a. have gap junctions
c. have intercalated discs
b. have I and A bands
d. all of the above
This chest pain is associated with cardiac ischemia.
a. angina pectoris
b. pericarditis
c. valvular stenosis
d. Heartburn
The plateau phase seen during the action potential of contractile cells is due to:
(ECF- extracellular fluid; ICF- intracellular fluid)
a. K+ diffusing from ECF to ICF
d. Ca2+ diffusing from ECF to ICF
+
b. Na diffusing from ECF to ICF
e. Ca2+ diffusing from ICF to ECF
c. Na+ diffusing from ICF to ECF
About 99% of cardiac myocytes are contractile cells.
a. true
b. false
Difficulty Level 2
Contractions in cardiac muscle cells cannot sum, or exhibit tetanus, because:
a. their action potential includes a long absolute refractory period
b. the cells are connected to each other by intercalated discs
c. the sarcoplasmic reticulum is poorly developed
d. they are autorhythmic
e. the autonomic nervous system prevents rapid action potentials
You have discovered a drug that blocks passive sodium channels of autorhythmic cells of the heart. Which of
the following phases of the action potential would be most directly affected?
a. Depolarization
c. repolarization
b. pacemaker potential
The physiological function of the relatively slow conduction through the AV node is to allow sufficient time for
a.
b.
c.
d.
e.
blood to flow from the aorta into arterioles
blood to flow from vena cava into the atria
filling of the ventricles
contraction of the atria
repolarization of the ventricles
The phases of a ventricular muscle cell’s action potential are represented by the lettered points on the diagram
below. At which point on the ventricular action potential is the membrane potential most dependant on
calcium (Ca2+) movement through the membrane?
a.
b.
c.
d.
e.
Point 0
Point 1
Point 2
Point 3
Point 4
The SA (sinoatrial) node is the normal pacemaker for the heart because:
a. it is the most richly innervated structure in the heart
b. cells found here are the only ones capable of generating action potentials
c. cells found here have the highest rate of action potential generation
d. cells here have the most stable membrane potential
e. cells found here are the least sensitive to drugs and hormones
Which of the following statements concerning the sinoatrial node is incorrect?
a. It is the normal pacemaker of the heart c. it is located at the inferior portion of the
of the interatrial septum
b. It’s intrinsic depolarization rate is 100
d. it consists of autorhythmic cells
depolarizations a minute
You have discovered a drug that blocks sodium channels of contractile cells of the heart. Which of the
following phases of the action potential would be most directly affected?
a. depolarization
b. plateau
c. repolarization
The pacemaker potential
a. is associated with the action potential of
cardiac contractile cells
c. would be exhibited by the action
potentials generated by specialized cells
found in the sinoatrial node
b. is due to the gradual increase in the entry d. is due to the entry of calcium into the cell
of potassium into the cell
The absolute refractory period of contractile cardiac myocytes
a. is shorter than the absolute refractory
c. is due to the long pacemaker potential
period of skeletal muscle cells
phase of the cardiac action potential
b. ensures that there is adequate time for
d. is short so that tetany of cardiac muscle
blood to fill the heart chamber
cells can occur
Cardiac muscle tissue is characterized by all of these, EXCEPT:
a. long, multinucleated, cylindrical cells
b. bifurcated (branched) cells
c. intercalated discs
d. numerous large mitochondria
e. striations
Which of these is stimulated first by the Purkinje fibers?
a. the ventricular myocardium c. the atrial myocardium
b. the papillary muscles
d. the atrioventricular valves
Difficulty Level 3
A 45 year-old man is given antihypertensive drugs that lower calcium influx into ventricular cells during
ventricular excitation. What effect does this have on the force of ventricular contraction?
a. There would be no effect on ventricular c. The force of ventricular contraction would
contraction.
decrease.
b. The force of ventricular contraction would
increase.
The function of the autorhythmic cells of the heart is to
1. Initiate the action potential that stimulates contractile activity of cardiac myocytes
2. contract during systole and relax during diastole
3. set the heart rate
4. generate the pressure to eject blood from the chamber
a. 1 and 3
c. 1, 2, and 3
b. 2 and 4
d. 1, 2, 3, and 4
If the pacemaker of the heart is not working properly, a junctional rhythm shows up on the EKG. Which
autorhythmic area will set the pace if the normal pacemaker is not working?
a) the fibrillator
b) junctional syncytia
c) AV node
d) SA node
The absolute refractory period of cardiac muscle fibers
a. is a time interval during which another contraction is initiated.
b. is much shorter than their contraction period.
c. prevents tetany and allows the heart to act as a pump.
d. a and b are correct.
e. a, b and c are correct
A patient has massive myocardial infarction in the interventricular septum. His death, 7 days later, might have
been due to death of cells in the:
a.
b.
c.
d.
e.
AV bundle of His
SA node (sinoatrial)
AV node ( atrioventricular)
Pectinate muscles
Papillary muscles
Objectives 12, 13 – Electrocardiography, Common Arrhythmias
Difficulty Level 1
In an electrocardiogram, the T wave represents:
a. atrial depolarization
b. atrial repolarization
c. ventricular depolarization
d. ventricular replorization
e. atrial hyperpolarization
The P wave in a normal electrocardiogram indicates
a. atrial depolarization
b. atrial repolarization
c. ventricular depolarization
d. ventricular repolarization
The QRS complex of the ECG is associated with
a. atrial depolarization
b. ventricular depolarization
c. atrial repolarization
d. ventricular repolarization
e. b and c
Atrial Repolarization is represented by:
a. QRS complex
c. T wave
b. P wave
d. masked by QRS
In third degree heart block:
A. All SA Node impulses reach the heart
B. Some SA Node impulses reach the heart while others don’t
C. No SA Node impulses reach the heart
Bundle branch block is characterized in the ECG by:
a. elevated ST segment
b. double peaked (M Shape) QRS Complex
c. Absent P wave
d. Inverted T wave
Without stimulation from the vagus, the average heart rate would be close to:
a. 200 bpm c. 100 bpm
b. 75 bpm
d. 45 bpm
c.
A single ectopic pacemaker fires at an atrial rate of >200beats/minute
a. Atrial fibrillation
c. atrial flutter
b. Sinus tachycardia
d. ventricular fibrillation
Chose the incorrect pairing:
a. P wave, atrial depolarization
b. QRS, ventricular depolarization
c. T wave, ventricular repolarization
d. all of the above are correct
_____________ is occurring during the QRS complex of an EKG.
a. atrial depolarization b. ventricular depolarization
c. atrial fibrillation
d. ventricular filling
Difficulty Level 2
Haphazard, asynchronous ventricular contractions and the absence of a pulse is characteristic of:
a. atrial flutter
d. first degree AV block
b. atrial septal defect
e. sinus tachycardia
c. ventricular fibrillation
An elderly man was admitted to the emergency room with severe cardiac failure. An ECG demonstrated atrial
flutter. What do you expect to see on his ECG tracing?
a. saw toothed P waves with an atrial rate of c. no discernable waveforms at all
> 200/minute
b. irregular rhythm with an atrial rate of
d. prolonged PR intervals
> 350/minute
An elderly woman was admitted to the emergency room with severe cardiac failure. An ECG demonstrated
atrial fibrillation. What do you expect to see on her ECG tracing?
a. saw toothed P waves with an atrial rate of c. no discernable waveforms at all
> 200/minute
b. irregular rhythm with an atrial rate of
d. prolonged PR intervals
> 350/minute
An elderly woman was admitted to the emergency room with severe cardiac failure. An ECG demonstrated
atrial fibrillation. What do you expect to see on her ECG tracing?
a. prolonged QRS complex
b. prolonged PR segment
c. no discernable waveforms at all
d. multiple small, barely visible P waves preceding each QRS complex; atrial rate
greater than 350/minutes
Difficulty Level 3
A patient’s ECG contains a prolonged P-Q interval, but is otherwise unremarkable. Which of the following is
true of this patient’s condition?
a. The patient is having an acute myocardial infarction b. The patient is normal
c. The patient probably is having first degree AV Block
Which of the following correlations between cardiac contractions and ECG waves is correct?
a. Atrial systole persists through the S-T segment.
b. All chambers are contracted during the period between the T wave and the next P wave.
c. Ventricular systole begins after the QRS complex appears.
d. Atrial diastole precedes the appearance of the QRS complex.
e. Ventricular diastole precedes the appearance of the T wave.
An ECG (EKG) rhythm strip shows the following: atrial rate, 75 bpm and regular; ventricular rate 50 bpm and
regular; complete dissociation (no relationship between) the P waves and the QRS complexes; QRS complexes
of normal shape and duration. Which of the following might be the problem?
a. sinus bradycardia
d. right or left bundle branch block
b. sinus tachycardia
e. complete (third degree) AV block
c. atrial flutter
What is indicated by this EKG?
a. sinus rhythm
b. arrhythmia
c. ventricular fibrillation
d. atrial flutter
Objective 14 – Cardiac Cycle
Difficulty Level 1
The tricuspid valve is closed
a. when the ventricle is in diastole
c. while the atrium is in systole
b. by movement of blood from the atruim to d. when the ventricle is in systole
the ventricle
The aortic semilunar valve opens when:
a. the ventricle is in diastole
b. the arterial pressure is lower than the
ventricular pressure
c. the atrium is in systole
d. all of the above
The second heart sound occurs when
a. the AV valves close
b. the semilunar valves close
The second heart sound “DUP” represents the:
a. opening of the semi-lunar valves
c. blood is ejected from the ventricles
d. blood is ejected from the atria
c. closure of the semi-lunar valves
b. opening of the atrioventricular (AV) valves d. closure of the (AV) valves
During the normal cardiac cycle, the atria contract when they are directly stimulated by the
a. SA node
c. vagus nerve
b. AV node
d. sympathetic cardiac nerves
During systole the pressure in the heart chamber is
a. increasing
b. Decreasing
The first heart sound (lub) is caused by the
a. closing of the AV valves
b. closing of the semilunar valves
c. does not change
c. opening of the AV valves
d. opening of the semilunar valves
When the heart rate is 75 beats per minute the duration of the cardiac cycle is
a. 0.8 sec
c. 1.2 sec
b. 1.0 sec
d. 1.4 sec
Sympathetic stimulation ________ heart rate; parasympathetic stimulation _______heart rate.
a. increases, increases,
c. increases, decreases
b. decreases, increases
d. increases, no effect
Which heart vessel receives blood during right ventricular systole?
a. aorta
c. pulmonary veins
b. vena cava
d. pulmonary trunk
Isovolumetric contraction_____________
a. refers to the period during ventricular
systole when the ventricles are
completely closed chambers
b. occurs while the AV (atrio-ventricular)
valves are open
c. occurs only in people with heart defects
d. occurs after the the aortic and pulmonary
valves close
During ventricular diastole, the ventricles are __________ and ventricular pressure is ___________.
a. contracting; falling
b. contracting; rising
c. relaxing; falling
d. relaxing; rising
When the left ventricle contracts the diameter of the ventricular chamber:
a. increases
c. remains the same
b. Decreases
Which of the following is greater in left ventricular systole?
a. ventricular pressure
c. pressure in the aorta
b. atrial pressure
d. pulmonary pressure
The amount of blood contained in a ventricle at the end of atrial systole is the
a. stroke volume b. ejection fraction
c. end-diastolic volume
d. end-systolic volume
e. cardiac output
During the cardiac cycle, there is an interval during which cardiac fibers are contracting but not shortening. The
intraventricular pressure increases, but the ventricular volume remains the same. What is this interval called?
a. atrial systole
b. atrial diastole
d. isovolumetric relaxation
c. ventricular diastole
e. isovolumetric contraction
Venous blood returns from the coronary circulation by way of :
a) the superior vena cava b) the coronary sinus
c) the inferior vena cava d) the pulmonary veins
The volume of blood ejected from each ventricle during one cardiac cycle is
a. cardiac reserve
c. end diastolic volume
b. end systolic volume
d. stroke volume
Difficulty Level 2
The second heart sound is heard during which phase of the cardiac cycle?
a. isovolumetric relaxation
c. ventricular ejection
b. isovolumetric contraction
d. ventricular filling
The first heart sound is due to:
a. closure of the mitral valve
b. closure of aortic valve
e. Both a and b
c. closure of the tricuspid
d. closure of the pulmonary valve
The first heart sound is caused by the closing of the _________ valves. It occurs at the beginning of ventricular
___________.
a. atrioventricular; diastole
c. semilunar; diastole
b. atrioventricular; systole
d. semilunar; systole
The left ventricular wall of the heart is thicker than the right ventricular wall in order to
a. provide greater pressure to pump blood c. provide greater pressure to pump blood
into the pulmonary circulation
into the systemic circulation
b. decrease friction of the ventricle from
d. accommodate a greater volume of blood
the respiratory diaphragm
While the semilunar valves are open during a normal cardiac cycle, the pressure in the left ventricle is
a. greater than the pressure in the aorta
c. less than the pressure in the left atrium
b. less than the pressure in the aorta
d. lower than the pressure in the right
ventricle than the pressure
During the period of ventricular filling ________
a. pressure in the heart is at its peak
c. the atria remain in diastole
b. blood flows passively through the atria
d. it is represented by the P wave on the
and the open AV valves into the ventricles
ECG
During ventricular systole:
a.
b.
c.
d.
the atria are contracting
the AV valves are closed
the pressure inside the ventricles is less than in the atria
blood is ejected into the atria
All of the following statements about incontinent valves( valve insufficiency )are true, except:
a. it can lead to backward flow of blood
c. it can lead to low pulse pressure
b. it can lead to decreased volume of blood d. it can lead to cardiac cell hypertrophy
in the chamber
During late ventricular diastole
a. ventricular contraction occurs
b. arteries are gaining pressure
c. ventricular Pressure is higher than atrial pressure
d. atrial systole occur
During which of the following is blood neither flowing into or out of the ventricles?
1. isovolumetric contraction
2. diastole
3. isovolumetric relaxation
4. systole
a. 1 and 3
b. 2 and 4
During ventricular systole:
a. blood moves into arteries
b. pressure increases in the ventricles
c. 1 and 4
d. 2 and 3
c. pressure gradually increases in the artery
d. all of the above
As pressure rises in the arteries:
a. Pressure in the ventricles decrease
b. The mitral/pulmonary valve close
c. The ventricles approach isovolumetric relaxation phase
d. All of the above
Difficulty Level 3
A 45 year-old man is given antihypertensive drugs that lower calcium influx into ventricular cells during
ventricular excitation. What effect does this have on the force of ventricular contraction?
a. There would be no effect on ventricular c. The force of ventricular contraction would
contraction.
decrease.
b. The force of ventricular contraction would
increase.
During ventricular systole:
a. Arterial pressure decreases
b. Atrial pressure rises
c. Ventricular pressure increases
d. Both a and c
e. Both b and c
Which of the following describe the relaxation period of the cardiac cycle?
a. It is a time when the atria are contracted.
b. It is a time that becomes shorter as the heart rate increases.
c. It is a time when the AV valves are closed.
d. It is the time when the ventricles receive most of the blood from the aorta.
e. It is a time when the SL valves are open
.
Explain the following briefly (in a sentence or two) and also indicate on the above diagram where they
would occur
a.
b.
c.
d.
e.
f.
g.
h.
i.
Define end systolic volume. At which point would you measure end systolic volume? ( Use letter C and
indicate in the diagram)
Point where dicrotic notch occurs on the diagram by the letter D. What is dicrotic notch
What is atrial systole and where is it represented in the diagram? ( Use letter A to point in the diagram)
Define stroke volume. Where is it represented in the diagram(Use letter E to point in the diagram)
Indicate the point when the atrioventricular valves close ( use the letter B to point)
Point where the first heart sound occurs on the diagram. Describe what happens to the valves
Point where the second heart sound occurs on the diagram. Describe what happens to the valves
Define end diastolic volume. At which point would you measure end diastolic volume? ( Use Letter Y to
indicate on the diagram)
When do the AV valves close? Point where this occurs in the diagram. Use letter Z to indicate on the
diagram
Objectives 15, 16, and 17
Cardiac output, Regulation and Congestive Cardiac
Failure
Difficulty Level 1
Increased venous return results in
a. increased stroke volume
b. increased cardiac output
c. increased heart rate
d. both a and b
When the heart rate is 75 beats per minute the duration of the cardiac cycle is
a. 0.8 sec
c. 1.2 sec
b. 1.0 sec
d. 1.4 sec
Negative chronotropic factors
a. increase heart rate
b. decrease heart rate
c. increase contractility
d. decrease contractility
Sympathetic stimulation ________ heart rate; parasympathetic stimulation _______heart rate.
a. increases, increases,
c. increases, decreases
b. decreases, increases
d. increases, no effect
Increased venous return results in
a. increased preload
b. decreased preload
c. decreased stroke volume
d. decreased end diastolic volume
Parasympathetic fibers are found in the _______nerves and release ________
a. cardiac, norepinephrine
c. vagus, norepinephrine
b. cardiac, acetylcholine
d. vagus, acetylcholine
The volume of blood ejected from each ventricle during one cardiac cycle is
a. cardiac reserve
c. end diastolic volume
b. end systolic volume
d. stroke volume
Sympathetic innervation of cardiac muscle originates from:
a. Cranial Nerve X (Vagus Nerve)
b. L1 - L2 segments of the spinal cord
c. the hypothalamus
d. Cranial Nerve IX (Glossopharyngeal Nerve)
e. T1 - T5 segments of the spinal cord
An increase in venous return will cause the ventricles to contract more forcefully. This is the:
a. Bainbridge reflex
b. Frank Starling Law
c. Harvey’s Law of Circulation d. Malpighi effect
According to the Frank-Starling Law, when end diastolic volume increases slightly, stroke volume:
a. decreases
b. increases
c. stays the same
Which of the following would be expected to slow heart rate and decrease cardiac output?
a. epinephrine b. norepinephrine
c.
Ach
d. increased calcium levels
The volume of blood ejected from each ventricle during a contraction is called a:
a. end diastolic volume
d. cardiac reserve
b. end systolic volume
e. stroke volume
c. cardiac output
The volume of blood left in the ventricle after a contraction is called :
a. end diastolic volume
d. cardiac reserve
b. end systolic volume
e. stroke volume
c. cardiac output
The maximal volume of blood filling each ventricle at the end of diastole is:
a. end diastolic volume
d. cardiac reserve
b. end systolic volume
e. stroke volume
c. cardiac output
Stroke volume is increased by which of the following?
a. increased afterload
c. increased heart rate
b. decreased contractility
d. increased ejection fraction
A patient’s maximum cardiac output is 20 L/min. Her resting cardiac output is 5 L/min. What is the patient’s
cardiac reserve?
a. 15 L/min
b. 4 L/min
c. 100 L/min
d. 50 L/min
Receptors activated in the Bainbridge reflex are found in:
a. aorta
b. right atrium
c. right atrium
d. superior vena cava
If the body is too cold, the heart rate slows. This is a
a. positive chronotropic effect
c. negative ionotropic effect
b. positive ionotropic effect
d. negative chronotropic effect
Stroke volume is defined as:
a. the volume of blood returned to the ventricles from veins during the cardiac cycle
b. the volume of blood ejected from a ventricle per minute
c. the volume of blood ejected from a ventricle per systole
d. the volume of blood remaining in a ventricle after systole
The cardiovascular control center is found in the:
a. pons
c. cerebellum
b. medulla d. aorta
A drug that acts as a “positive inotropic agent”:
a. decreases stroke volume
b. increases venous return
c. repolarizes the sinoatrial (SA) node
d. increases the contractility of the heart
Difficulty Level 2
Factors that increase heart rate include all except
a. Norepinephrine
b. Thyroid hormone
c. Acetylcholine
d. Excess Ca ++
Cardiac output
a. increases as stroke volume decreases
b. averages about 5 liters per minute
c. decreases as heart rate increases
d. a, b, and c are correct
A 62 year old man is brought to your emergency room in a hypertensive crisis (BP = 250/180 mmHg). He was
given an infusion of nitroprusside which is known to decrease afterload.
What is afterload?
a. venous return
b. a measure of contractility
c. arterial pressure
d. end systolic volume
e. resting heart rate
Factors that increase contractility include all of the following, except
a. acetylcholine
c. calcium channel blockers
b. Excess H+
d. Thyroxine
Each of the following will increase cardiac output except
a. increased venous return
c. increased sympathetic stimulation
b. increased parasympathetic stimulation
d. increased heart rate
According to the right atrial (Bainbridge) reflex, when right atrial pressure increases
a. heart rate decreases
c. pulmonary arterial pressure decreases
b. heart rate increases
d. venous return increases
The atrial reflex, or Bainbridge reflex, results from stretch receptors in the right atrial wall being stimulated.
What is the response?
a. increased heart rate
b. decreased heart rate
c. no change in heart rate d. fibrillation
High arterial pressure, such as that due to atherosclerosis, will directly affect the __________ of the heart
a. preload
b. contractility
c. afterload d. ejection
The Frank-Starling law of the heart states that
a.
b.
c.
d.
e.
that increased filling time will decrease the force of contraction by the ventricles.
the right and left ventricles must pump equal amounts of blood with each heart beat
a healthy heart will pump out all the blood that entered during the previous diastole.
the greater the preload on cardiac muscle fibers, the weaker the force of contraction will be.
the greater the preload on cardiac muscle fibers, the greater the force of contraction will be
Something that increases contractility, has a _____________________, such as epinephrine and hypercalcemia.
a. positive chronotropic effect b. negative chronotropic effect
c. positive ionotropic effect
d. negative ionotropic effect
If the heart rate (HR) is 70 beats per minute and the stroke volume (SV) is 80 ml, what is cardiac output?
a. 5600 liters/min
b. 5.6 liters/min
c. 1.14 liters/min
d.
560liters/hour
Which of these does not affect the stroke volume?
a. stretch of the cardiac muscle before contraction
b. contractility of the cardiac muscle
c. the pressure the ventricles are working against
d.
hypernaturemia
Cardiac output is increased by which of the following?
a. Increase in afterload c. Decrease in contractility
b. Increase in heart rate d. Decrease in preload
Difficulty Level 3
Select the correct statement regarding cardiac output
a. a slow heart rate increases end diastolic c. decreased venous return will result in
volume and stroke volume
increased stroke volume
b. stroke volume increases when end
d. None of the above
diastolic volume decreases
Factors that increase preload are
a. increased venous return, negative
c. increased diastolic filling time, positive
inotropic factors
inotropic factors
b. increased end diastolic volume, increased d. increased heart rate, positive
stroke volume
chronotropic factors
A patient with left sided heart failure may have edema in his:
a. lungs
b. brain
c. upper appendages
d. abdomen
e. entire systemic circulation
Given the following:
1. increased venous return
3. decreased end systolic volume
2. increased afterload
4. increased end diastolic volume
Which combination would result in an increase in stroke volume?
a. 2,3, and 4
c. 1, 3, and 4
b. 1, 2, and 3
d. 1,2,3, and 4
If the vagal nerves to the heart were cut, the result would be that ________.
a. the heart would stop, since the vagal
c. the AV node would become the
nerves trigger the heart to contract
pacemaker of the heart
b. the heart rate would increase by about 25 d. parasympathetic stimulation would
beats per minute
increase, causing a decrease in heart rate
Who is likely to have the highest heart rate (all other things being equal)?
a. a patient with hypothyroidism c. a patient with hypocalcaemia (low plasma calcium)
b. a patient with a fever
d. a patient with an overactive vagus nerve
A patient has pulmonary edema but not peripheral edema. Which of the following is probably true of the
patient’s heart?
a. the patient’s left ventricle is failing
c.
the patient’s left atrium is failing.
b. the patient’s right ventricle is failing. D. the patient’s right atrium is failing
A patient has an EDV of 90 mL and an ESV of 40 mL with a heart rate of 50. What is this patient’s cardiac
output?
a. 6500 mL/min or 6.5 L/min
c. 2000 mL/min or 2.0 L/min
b. 4500 mL/min or 4.5 L/min
d. 2500 mL/min or 2.5 L/min
e. 180 mL/min or 0.18 L/min
Cardiac output is:
a. the volume of blood ejected from the left ventricle into the aorta.
b. the volume of blood ejected from the right ventricle into the pulmonary trunk.
c. the product of the stroke volume and the heart rate.
d. A and B are correct.
e. A, B and C are correct.
Too much fluid in the pericardial space results in:
a. pericarditis b. cardiac tamponade c. myocardial infarction
d. atrial flutter
Cardiac output: 5.6 liters/min; heart rate: 70 bpm. From the given values, calculate the stroke volume.
a. 8 ml
c. 12.5 ml
b. 392 ml
d. 80 ml
A 42 year old woman with hypotension and recurrent light headedness and episodes of fainting is given
atropine, a positive chronotropic agent. Her symptoms are relieved because:
a. her heart rate increased
d. ejection fraction increased
b. her venous return increased
e. blood viscosity increased
c. contractility increased
If the end diastolic volume (EDV) is 120 ml and the end systolic volume (ESV) is 30 ml, what is the ejection
fraction?
a. 75%
c. 25%
b. 100%
d. 50%
Increased venous blood flow to the atrium
a. causes cells of the SA node to depolarize
faster
b. will result in increased heart rate
c. triggers the atrial bainbridge reflex
d. all of the above
e. b and c only
An increase in extracellular potassium levels could cause
a. an increase in stroke volume
c. a decrease in heart rate
b. an increase in the force of contraction
d. both a and b
Failure of the right side of the heart results in:
a. systemic edema(swelling of the arms and ankles)
b. difficulty breathing
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
COMPLETION
Indicate whether the condition in the first column will increase (I) or decrease (D) the value in the second
column.
An increase in sympathetic activity
A decrease in cardiac contractility
An increase in end diastolic volume
An increase in afterload
A decrease in thyroid hormone levels
_____ heart rate
_____ stroke volume
_____ preload
_____ end systolic volume
_____ heart rate
MATCHING
Match the following terms to the correct statement:
a. angina pectoris
c. anastomosis
b. ischemia
1. insufficient blood supply to an organ
2. chest pain resulting from ischemia
3. union or joining of two blood vessels or nerves
a. Purkinje fibers
b. AV bundle
4.
5.
6.
7.
8.
9.
c. SA node
d. AV node
The pacemaker of the heart
Found in the interventricular septum
Network found in the ventricular myocardium
The point in the conduction system of the heart where the impulse is temporarily delayed
Cells have the slowest inherent firing rate
Cells have the highest inherent firing rate
a. Pulmonary valve
b. Aortic valve
10.
11.
12.
13.
c. Mitral valve
d. Tricuspid valve
Prevents backflow into the left ventricle
Prevents backflow into the right atrium
Prevents backflow into the left atrium
Prevents backflow into the right ventricle
SHORT ANSWER
State the voltage gated channels responsible for the following stages of the action potential in cardiac
contractile cells:
a. Depolarization_____________________
b. Repolarization_____________________
c. Plateau_____________________
Name the 3 channels essential for generating the cardiac action potential in cardiac autorhythmic cells and
indicate which way they move (circle the correct movement)
a. ___________ channels
into or out of
b. ___________ channels
into or out of
c. ___________ channels
into or out of
How do the waves of depolarization generated by the autorhythmic cells spread to the contractile cells
Trace the pathway of a drop of blood from the right atrium to the aorta
Calculate the cardiac output given the following values:
Stroke volume = 60 ml
Heart rate = 65 bpm
Given the following values calculate stroke volume, ejection fraction and cardiac output:
End diastolic volume = 100ml
End systolic volume = 30ml
Heart rate = 70 bpm
Your Uncle Joe has just recovered from a bout with bacterial endocarditis. As a result scar tissue stiffens the
edges of the heart valves. What condition will this cause? How would you pick up this condtion in a routine
examination? Be as specific as you can
People with peripheral artery disease are often given calcium channel antagonists which will dilate blood
vessels. How would the cardiac action potential change if extracellular calcium was lowered?
Regarding the action potential recording below:
a.
Is this a potential from a autorhythmic or contractile cell?
b.
Explain the ion movements (ie, which ion(s) and if they are moving into or out of the cell that
are reflected in
Phase 1 on the action potential graph:
Phase 2 on the action potential graph:
Phase 3 on the action potential graph:
Identify the structure of the heart that matches the statement:
This structure propagates action potentials from the right atrium to the left atrium
____________________
This molecule binds to O2 in cardiac muscle cells:
____________________
This is the middle layer of the wall of the heart
____________________
This is a shallow depression in the interatrial septum;
it is a remnant of fetal circulation
____________________
This is another name for the visceral layer of the serous ____________________
pericardium
These structures enable muscle cells to adhere to each ____________________
other while contracting and relaxing
Explain the different between each of the following pairs of terms:
infarction and ischemia:
atrial flutter and atrial fibrillation:
valve stenosis and valve incontinence (insufficiency):
end diastolic volume and end systolic volume:
conducting artery and distributing artery:
Draw a typical EKG. Label the waves and intervals. Indicate what is happening in the heart during the waves
and intervals.
List the structures of the cardiac conduction system in the correct order. Indicate where these structures are
located.
What is the difference between a negative ionotropic effect and a negative chronotropic effect?
Circle the correct choice in each instance to complete the statements:
During left ventricular filling, ventricular pressure must be (greater/less than) atrial pressure, whereas during
ventricular ejection, ventricular pressure must be be (greater/less than) aortic pressure. Atrial pressure is
always (greater than/less than) aortic pressure. During isovolumetric relaxation, ventricular pressure is (greater
than/less than) atrial pressure and is (greater than/less than) aortic pressure.
A healthy female gymnast has a blood volume of 4.9 L. If her stroke volume is 70 mL/minute, what must her
heart rate be in order to pump all of her blood through her heart on one minute?
A person who is hemorrhaging has a very rapid heart rate. Using your knowledge of the formulas governing
cardiac function, explain why. Do you think a rapid heart rate will improve or exacerbate the situation? Why or
why not?
Labeling : Indicate the P wave, the T wave and the QRS complex on the following trace
For each of the following sentences, circle the correct terms to complete the sentence.
Mesothelium is found in (endocardium/epicardium) and endothelium is found in
(endocardium/epicardium).
Pectinate muscles are found in the (atria/ventricles) and trabeculae carneae are found in the
(atria/ventricles)
The (left/right) side of the heart functions as a pulmonary pump and the (left/right) side of the heart
functions as a systemic pump.