Cardiovascular Physiology Past Paper PDF

1. the 1. the weight weight of of the the column column of of blood blood witin witin the the veins...

1. the 1. the weight weight of of the the column column of of blood blood witin witin the the veins veins B. hydrostatic B. hydrostatic pressure pressure when when standing standing is is called? called? e the the systemic systemic blood blood pressure pressure isis related related to to the the A. systemic A. systemic pressure pressure B. arterial pressures within the body. arterial pressures within the body. B. hydrostatic hydrostatic pressure pressure C. pulmonary pressure e the the pulmonary pulmonary pressure pressure is is related related to to the the C. pulmonary pressure D. pressuer pressuer within within the the pulmonary pulmonary arteries arteries D. transmural transmural pressure pressure 2. 81. 2. 81. Poiseulle's Poiseulle's law law states states that that the the A. vessel A. vessel radius radius has has the the most most significant significant effect effect on on the the blood blood flow flow in in e¢ a small change asmall change in in vessel vessel radius radius causes causes a a a vessel. a vessel. dramatic dramatic change change in in the the blood blood flow flow within within A. A. vessel vessel radius radius b. b. pressrue pressrue gradient gradient c. fluid c. fluid viscosity viscosity d. d. vessel length vessel length 3. 97. 3. 97. which which of of the the following following factors factors are are related related to to D. D. vessel vessel length, length, vessel vessel radius radius and and blood blood potential hemodynamic potential hemodynamic changes changes withinwithin a a viscosity viscosity vessel? vessel? e Changes Changes in in vessel vessel length length A. vessel A. vessel length length and and blood blood viscosity viscosity butbut not not vessel vessel radius e vessel vessel radius radius and and blood blood viscosity viscosity are are related related radius to to potential potential hemodynamic hemodynamic changes changes within within aa B. Blood B. Blood viscosity viscosity and and vessel vessel radius radius but but not not vessel vessel length vessel length c. vessel c. vessel length length and and vessel vessel radius radius but but not not blood blood viscosity viscosity d. d. vessel vessel length, length, vessel vessel radius radius and and blood blood viscosity viscosity  112. Which 4.112. 4. Which of of the the following following describes describes a a A. A. explains explains the the turbulence turbulence and and layers layers of of flow flow cardiovascular cardiovascular application application of of the the Bernoulli Bernoulli separation within the separation within the cartoid cartoid bulb bulb Priniciple? Priniciple? A. ◦© Bernoulli Bernoulli Priniciple Priniciple explains explains the the A. explains explains the the turbulence turbulence andand layers layers of of flow flow separtation turbulence turbulence separtation within within the the carotid carotid bulb bulb B. ◦o and and layers layers of flow separation of flow separation within within B. explains explains the the reason reason for for increased increased resistance resistance toto the the carotid carotid bulb bulb flow at an area of focal stenosis flow at an area of focal stenosis c. c. explains explains the the relationship relationship of of vessel vessel radius radius and and Concept Explanation flow flow volume volume Bernoulli Effect The total fluid energy (gravitational, kinetic, and potential) remains constant when blood flows at a constant velocity. d. d. explains explains thethe reason reason forfor aliasing aliasing of of the the doppler doppler Pressure-Velocity If pressure changes, velocity will adjust to maintain total fluid energy. Relationship signal at high velocities signal at high velocities Blood Flow Slow-moving blood exerts more pressure than faster-moving blood. Dynamics Effect of Stenosis At a stenosis, velocity increases, causing a decrease in pressure. After the stenosis, velocity decreases, and pressure increases. Bernoulli Equation Describes the relationship between pressure and velocity: APressure = 4V?. Clinical Application This equation explains the decrease in pressure with increased blood velocity and describes turbulence and flow separation, especially in areas like the carotid bulb. Concept Explanation Pressure - Highest pressure In the left ventricle, with an average of 120 mmHg. - Pressure during systole Increases with systole and decreases with diastole. - Pressure balance As peripheral pressure meets and exceeds ventricular pressure, diastole occurs. - Average pressures Average pressure in veins: 2 mmHg; Average arterial pressure: 100 mmHg. - Effect of stenosis Arterial stenosis leads to decreased pressure as velocity increases at the stenosis site. Flow Volume - Relationship with Flow volume is always proportional to blood pressure. pressure - Volume effect on Increased flow volume leads to increased blood pressure. pressure NV Concept Explanation 1. Pre-Stenosis Pressure is higher proximal to the stenosis, causing lower velocity. Pressure 2. At Stenosis Pressure drops at the stenosis, creating a large gradient and higher velocity. 3. Post-Stenosis Pressure increases mildly distal to the stenosis, causing a drop in velocity. Multiple Lesions Multiple lesions affect flow more than a single lesion, decreasing flow significantly distal to the lesions. Collateral Collateral pathways can mask disease by rerouting blood to distal locations through Circulation alternate routes, compensating for blockages. Concept Explanation Non-Hemodynamically Volume flow (Q) is preserved through the vessel despite narrowing, explained by Significant Stenosis the Continuity Equation (Q = VA). Pressure drops in the stenotic region as velocity increases (Bernoulli's Principle). Hemodynamically Astenosis that becomes “critical” when there is a 50% diameter reduction, Significant Stenosis (Critical corresponding to a 75% reduction in area. This type of stenosis may not be Stenosis) significant at rest but can become critical during exercise when increased blood flow is needed. Energy Compensation When velocity (kinetic energy) increases, pressure (potential energy) decreases at the stenosis. Distal to the stenosis, velocity decreases, and pressure goes back up. Post-Stenotic Turbulence Turbulence occurs distal to the stenosis as the vessel widens and blood flow becomes disorganized, with regions of laminar and turbulent flow coexisting. Laminar vs. Turbulent Flow In a normal, straight vessel, laminar flow dominates. However, post-stenosis, blood flow becomes turbulent due to the abrupt change in vessel diameter. 5.124. 5. 124. ONCE THE ONCE THE PRESSURE PRESSURE IN IN THE THE DEEP DEEP c. c. perforators perforators will will dialte dialte leading leading to to bi-directional bi-directional VENOUS VENOUS SYSTEM SYSTEM CONSISTENTLY CONSISTENTLY EXCEEDS EXCEEDS flow flow THE PRESSURE IN THE SUPERFICIAL SYSTEM, THE PRESSURE IN THE SUPERFICIAL SYSTEM, e once once the the pressure pressure in in the the deep deep venous venous system system consistently consistently excees excees the the pressure pressure in in a. perforators a. perforators will will constrict constrict forcing flow reversal forcing flow reversal into into the the superficial system, the superficial system, the superficial superficial system system e perforators perforators will will dilate dilate leading leading to to bi- bi- b. perforators will dilate b. perforators will dilate and and allow allow flow flow to to only only move move into directional directional flow flow into the the deep deep system system c. c. perforators perforators will will dialte dialte leading leading toto bi-directional bi-directional flow flow d. d. perforators perforators will will exhibit exhibit stasis stasis of of flow flow and and thrombus formation thrombus formation 6.. 8. 8. exercise exercise causes_____________________which causes which A. Vasodilation, A. Vasodilation, decreased decreased resistance resistance leads leads to to __________ in in the the lower lower extremities. extremities. A. Vasodilation, decreased resistance e vasodilation vasodilation and and resistance resistance drops drops to to A. Vasodilation, decreased resistance B. encourage encourage more more flow flow distally, distally, B. vasoconstriction, vasoconstriction, decreased decreased resistance resistance C. ◦o as as the the muscles muscles require require more more oxygem oxygem C. vasodilation, vasodilation, increased increased resistance resistance D. with with exercise exercise D. vasoconstriction, vasoconstriction, increased increased resistance resistance ▪= an an increase increase inin antegrade antegrade diastolic diastolic flow flow isis anticipated anticipated when the when the peripheral peripheral resistance resistance drops drops Physiological Response 19 increased blood flow, jore blood to reach the muscles. Impact on Blood Flow _ Increased antegrade diastolic flow is expected when peripheral resistance drops. 7.. which of which of the the following following occurs occurs duringduring calf calf muscle muscle A. blood A. blood flows flows through through the the perforators perforators from from the the relaxation? relaxation? superficial superficial to to the the deep deep veins veins A. A. blood blood flows flows through through the the perforators perforators from from the the superficial e when when the the muscle muscle contracts, contracts, superficial toto the the deep deep veins veins b. ▪= flow flow moves moves from from the the deep deep calf calf b. the gastrocnemius veins fill the gastrocnemius veins fill with with blood from the blood from the popliteal veins veins into into the the popliteal popliteal and and popliteal vein vein c. femoral femoral vein vein c. the the blood blood flows flows through through the the perforators perforators from from the the deep ▪= as as the the muscle muscle relaxes, relaxes, deep toto the the superficial superficial veins veins d. the superficial veins fill d. the superficial veins fill with with blood blood ▪= blood blood is is essentially essentially sucked sucked through through the the perforators perforators fromfrom the the superficial superficial system system into into the the deep deep system system to to refill refill the the vessels 8. 8. 28. what 28. what vein vein contains contains blood blood with a very with a very high high b. b. Pulmonary Pulmonary veins veins oxygen oxygen content? content? the the pulmonary pulmonary veins veins are are the the only only veins veins in in A. portal veins A. portal veins B. the the body body that that carry carry highly highly oxygenated oxygenated blood blood B. pulmonary pulmonary veins veins C. these these veins veins drain drain the the blood blood from from the the lungs lungs C. hepatic hepatic veins veins D. into into the the left left atrium atrium for for distribution distribution to to the the body body D. IVC IVC through the left ventricle/aorta through the left ventricle/aorta all other all other veins veins carry carry blood blood that that have have depleted depleted levels levels of of oxygen oxygen because because the the organs organs that that they they are are draining draining require require the the oxygen oxygen to to function Summary: Vein Oxygen Content Function Pulmonary veins Very high oxygen Drain oxygenated blood from the lungs into the left atrium for content systemic circulation Portal veins Low oxygen Carry blood from the gastrointestinal tract and spleen to the liver for content detoxification and metabolism Hepatic veins Low oxygen Drain deoxygenated blood from the liver to the inferior vena cava content IVC (Inferior Vena Low oxygen Carries deoxygenated blood from the lower body to the right atrium Cava) content of the heart 9. 9. 39. which 39. which of of the the following following describes describes a a normal normal D. D. flow flow in in the the femoral femoral vein will stop vein will stop at at onset onset of of the the response response to to the the valsalva valsalva maneuver? maneuver? maneuver maneuver A. A. the femoral vein the femoral vein wull wull demonstrate demonstrate cardiaccardiac pulsality ◦o the the valsalva valsalva maneuver maneuver will will pulsality B. B. flow flow inin the the iliac iliac vein vein will will reverse reverse forfor at at least least 11 significantly decrease significantly decrease oror second ▪= stop flow toward stop flow toward the the heart heart in in second before before normalizing normalizing C. the the deep deep veins. veins. C. flow flow inin the the subclavian subclavian vein vein will will be be augmented augmented toward ▪= upon upon release release of of the the maneuver, maneuver, toward thethe heart heart with with slight slight reversal reversal upon upon release release D. D. flow in the femoral vein will stop at onset of flow in the femoral vein will stop at onset of the the ▪= flow flow will will be be briefly briefly augmented augmented maneuver maneuver toward toward the the heart heart and and then then normalize normalize Aspect Details Maneuver Valsalva maneuver Normal Flow in the femoral vein will stop at the onset of the maneuver Response Mechanism - The Valsalva maneuver increases intra-abdominal and intrathoracic pressure, compressing the veins. - This compression decreases venous return to the heart. Flow Behavior - At the onset: Flow in the femoral vein stops due to increased pressure. - Upon release: Pressure decreases, and blood flow is briefly augmented toward the heart before normalizing. Clinical Use Used to assess the competency of venous valves and other aspects of venous function. Aspect Details Name Femoral Vein (AKA superficial femoral vein, SFV) Nomenclature Recommendations suggest removing the term "superficial" to avoid confusion regarding this deep vein Anatomical Extends from the adductor hiatus to join the profunda femoral vein at the groin Path Relative Courses posterior to the femoral artery Position 10. 62. 10. 62. increased increased pressure pressure in in the the venous venous system system D. EDEMA D. EDEMA results results in: in: e increased increased pressure pressure in in the the venous venous system system A. baker cyst A. baker cyst formation formation B. results results in in edema edema asas fluid fluid is is forced forced into into the the B. decreased decreased arterial arterial pressure pressure C. surrounding surrounding tissues tissues C. an an increased increased risk risk of of stroke stroke D. D. edema edema 11. During 11. During inspiration inspiration the flow in the flow in the the veins veins of of the the upper upper A. A. Increases Increases extremities______________________- extremities - Condition Action Effect During inspiration (chest Pressure within the chest cavity Venous flow from the upper cavity) decreases extremities increases A. A. Increase Increase During expiration (chest cavity) Pressure within the chest cavity increases Venous flow from the upper extremities decreases B. B. decreases decreases Flow from the lower The opposite is true extremities C. C. Remains Remains unchanged unchanged During inspiration (abdominal _ Pressure within the abdominal cavity Venous flow from the lower extremities cavity) increases decreases D. D. Reverse Reverse direction direction During expiration (abdominal Pressure within the abdominal cavity Venous flow from the lower extremities cavity) decreases increases 12. 12. HOW DO HOW DO YOUYOU TESTTEST THE THE CAPILLARY CAPILLARY BLUSH BLUSH Cc. press c. press your your finger finger into into the the fleshy fleshy part part of of the the RESPONSE ON RESPONSE ON THE THE UPPER UPPER EXTREMITY? EXTREMITY? create create pallor, pallor, A. Compress A. Compress the the radial radial and and ulnar ulnar artery artery simulatenously e then then release release to to time time the the return return of of normal normal simulatenously for for 60 60 seconds seconds to to creast creast pallor pallor in in the skin skin coloring coloring the hand and then release to the time the return of hand and then release to the time the return of normal e longer longer times times indicate indicate the the presence presence of of arterial arterial normal coloring coloring in in the the hand hand B. disease disease or or obstruction obstruction B. raise raise the the arm arm above above thethe head head forfor 60 60 seconds seconds to to produce produce pallor pallor and and then then place place thethe armarm inin neutral neutral Aspect Description position position to time the return of the normal coloring in to time the return of the normal coloring in Palpation - General Most arteries are palpated by placing two fingers over the artery the arm the arm - Radial and Ulnar Palpated to evaluate upper extremity pulses Arteries C. press C. press your your finger finger into into the the fleshy fleshy partpart of of the the - Hemodialysis Graft Should be assessed for the presence of a thrill (normal finding) create create pallor, pallor, ~ Loss of Thrill In a dialysis graft usually indicates occlusion then then release to release to time time the the return return of of normal normal skin skin Auscultation coloring coloring - General Use Commonly used to assess hemodialysis grafts - Graft Stenosis Can cause a bruit D. D. apply apply a a blood blood pressure pressure cuff cuff to to the the upper upper arm arm - Pseudoaneurysm Will also cause a bruit and inflate above the systolic pressure for 90 and inflate above the systolic pressure for 90 - Water Hammer Pulse Associated with an occluded graft seconds seconds then then release release the the cuff cuff to to time time the the return return of of Extremity Evaluation normal normal coloring coloring in in the the arm arm - Color Evaluate color of the extremity when elevated and dependent - Skin and Nails Assess the skin and nails Capillary Blush Response - Test Method Press finger on extremity to create an area of pallor, time the delay until color returns - Assessment Use Used to assess ischemia in the distal extremity in patients with hemodialysis graft - Delayed Response Delayed capillary blush response indicates significant ischemic disease is present; a delay of >2 seconds indicates ischemia 13. 13. 7. Hemodynamically 7. Hemodynamically siginifcant siginifcant stenosis stenosis of of the the B. B. 2.0 2.0 m/s m/s celiac celiac axis axis is is diagnosed diagnosed with with the the PSV PSV greater greater e hemodynamically hemodynamically significant significant stenosis stenosis of of the the than ? than ? celiac celiac axis axis is is A. 1.8 A. 1.8 m/s m/s e diagnosed diagnosed with with the the PSV PSV greater greater than than 2.0 2.0 m/ m/ B. 2.0 B. 2.0 m/s m/s C. sSs C. 2.5 2.5 m/s m/s D. 2.75 m/s D. 2.75 m/s 14. 96. 14. 96. how how do do the the microbubbles microbubbles in in an an ultrasound ultrasound b. increase b. increase the the reflectivity reflectivity of of flowing blood flowing blood contrast contrast agent agent change change the the image? image? A. microbubbles e microbubbles microbubbles in in an an ultrasound ultrasound contrast contrast A. microbubbles cannot cannot be be used used to to evaluate evaluate arterial agent agent arterial flow flow due due to to embolism embolism risk risk e increase increase the the reflectivity reflectivity of flowing blood of flowing blood b. increase b. increase the the reflectivity reflectivity ofof flowing flowing blood blood c. c. increase vasodiltion to move the bubbles more increase vasodiltion to move the bubbles more quickly quickly so so theyare theyare visible visible to to ultrasound ultrasound d. d. increase increase the the resistance resistance to to flowing flowing blood blood to to make make itit more more visible visible 15. which 15. which of of the the following following vessels vessels are are evaluated evaluated in in c. c. cavernous cavernous arteries arteries and and dorsal dorsal veins veins doppler doppler evaluation evaluation forfor erectile erectile dysfunction? dysfunction? A. common e doppler doppler evaluation evaluation of of erectile erectile dysfunction dysfunction A. common femoral femoral artery artery B. includes includes assessment assessment ofof the the cavernous cavernous B. internal pudendal artery internal pudendal artery c. arteris arteris and and c. cavernous cavernous arteries arteries and and dorsal dorsal veins veins d. ◦© dorsal dorsal veins veins with with doppler doppler pre pre and and d. cavernous cavernous veins veins and and dorsal dorsal arteries arteries post medication injection: post medication injection: ◦© papaverine papaverine most most common common ¢ normally normally thethe PSV PSV and and EDV EDV ofof the the arteries arteries will will increase post injection but dorsal venous increase post injection but dorsal venous flow will remain flow will remain unchanged unchanged ▪=» PSV PSV >30 >30 cm/s cm/s considered considered normal normal Evaluation Method Description Doppler Evaluation for Erectile | Assesses the cavernous arteries and dorsal veins using Doppler pre- and Dysfunction post-medication injection (e.g., papaverine). Expected Post-Injection - The PSV (Peak Systolic Velocity) and EDV (End Diastolic Velocity) of the Response arteries increase post-injection. - Dorsal venous flow remains unchanged. Normal PSV PSV greater than 30 cm/s is considered normal. 16. 16. 127.Venous perforators with a diameter of or B. B. 4mm 4mm greater will usually demonstrate reflux. Correct Response: ©) 6) Not answered yet B A 2mm ») Instructor Feedback Normal perforator diameter is 2mm. Venous perforators with a diameter of 4mm or greater will usually demonstrate reflux. 127 127 venous venous perforators perforators with with a a diameter diameter of of ◦© normal normal perforator perforator diameter diameter is is 2 2 mm mm ◦© venous venous perforators with a perforators with a diameter diameter of