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Stage 1 Cohort Quiz Bank Physiology (Physiology of the Cardiovascular & Respiratory Systems) TABLE OF CONTENTS Haematopoiesis\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\..... 3 Initiation of the Heartbeat\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.... 9 The Cardiac Cycle\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.... 17 Control of Cardiac Output\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....25 Control of Blood Pressure\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.... 32 Control of Blood Flow\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.... 38 Regulation of fluid balance in the microcirculation\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\..... 45 Introduction to the Respiratory System: Lung Mechanics I\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\... 50 Lung Mechanics II\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....55 Tutorial 3-Cardiac: question sheet\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\... 60 Gaseous Diffusion and Transport I\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\... 64 Vascular workshop question sheet\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...70 Gaseous Diffusion and Transport II\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\..... 72 Tutorial 4-Hypoxia: question sheet\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\..... 77 Ventilation Workshop Part A\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\..... 83 Ventilation Workshop Part B\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...84 Ventilation Workshop Part C\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...85 Control of Ventilation\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.... 86 Ventilation Perfusion Relationships\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.... 92 1 © Elevating Sisters, Teach Med Updated: March 2024 Coordinated Cardiovascular Responses 1\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....98 Coordinated Cardiovascular Responses 2\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...104 Haemostasis\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....109 Bibliography\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\....114 Details about the creation of the Quiz Bank\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\...\.....115 2 © Elevating Sisters, Teach Med Updated: March 2024 HAEMATOPOIESIS 1\) What is a totipotent stem cell? a\) A stem cell that can divide to produce all cell types of an organism. b\) A stem cell that can divide into endoderm, mesoderm or ectoderm. c\) A stem cell that can divide into multiple, restricted cell types. d\) A stem cell that is restricted to a single lineage. e\) A stem cell that has been generated in a lab directly from a somatic cell. 2\) Which of the following is the correct order of haematopoiesis? a\) Self-renewal, developmental pathway, committed cells, differentiated functional cell b\) Self-renewal, developmental pathway, differentiated functional cell, committed cells c\) Committed cells, self-renewal, differentiated functional cell, developmental pathway d\) Committed cells, developmental pathway, self-renewal, differentiated functional cell e\) Self-renewal, committed cells, developmental pathway, differentiated functional cell 3\) Which of the following statements regarding red blood cells is false? a\) Red blood cells have a biconcave shape b\) Red blood cells are approximately 7 μm in diameter c\) Red blood cells have a nucleus d\) Red blood cells only respire anaerobically e\) Old and damaged red blood cells are removed by the liver and the spleen 4\) Which of the following statements is true regarding the site of haematopoiesis? a\) Haematopoiesis in a foetus occurs exclusively in the spleen throughout intrauterine life b\) Haematopoiesis in an adult occurs in the interstitium between the medullary vascular sinuses of the bone marrow c\) Haematopoiesis in a foetus occurs exclusively in the liver throughout intrauterine life d\) Haematopoiesis in an adult occurs within the radial arteries of the bone marrow e\) Once blood has collected into the central sinus of the bone marrow, it feeds into the nutrient artery 5\) What is the diameter of a normoblast? a\) 8-10μm b\) 6-8nm c\) 0.08- 0.10mm d\) 0.06-0.08mm e\) 6-8μm 3 © Elevating Sisters, Teach Med Updated: March 2024 6\) What is the lifespan of an Eosinophil? a\) Several seconds b\) Several minutes c\) Several hours d\) Several days e\) Several weeks 7\) How long does it take for an Eosinophil to leave circulation once released from bone marrow? a\) Leave circulation within 2-6 h of release from bone marrow b\) Leave circulation within 4-6 h of release from bone marrow c\) Leave circulation within 8-12 h of release from bone marrow d\) Leave circulation within 2-4 h of release from bone marrow e\) Leave circulation within 14-18 h of release from bone marrow 8\) What is the diameter of a platelet? a\) 1-2μm b\) 2-4μm c\) 1-2nm d\) 0.01-0.02mm e\) 0.02-0.04mm 9\) What is the lifespan of a macrophage? a\) Seconds/minutes b\) Days/weeks c\) Months/years d\) 3 weeks e\) 14 days 10\) Which of the following is not a symptom of anaemia? a\) Shortness of breath b\) Dizziness c\) Weakness d\) High blood pressure e\) Yellow eyes 4 © Elevating Sisters, Teach Med Updated: March 2024 11\) Which of the following molecules control red blood cell production? a\) Folic acid b\) Erythropoietin c\) Thyroxine d\) Transferrin e\) Bilirubin 12\) Which of the following statements is true? a\) Folates are cofactors in the synthesis of purines and pyrimidines. b\) Vitamin B12 is given intravenously. c\) Folate is important in reactions that enable vitamin B12 to function in thymidylate synthesis. d\) Folic acid is given to treat pernicious anaemia. e\) Vitamin B12 is stored in the spleen. 13\) Which of the following statements is false? a\) Bilirubin is metabolised to stercobilin by bacteria. b\) Low oxygen levels in blood stimulate kidneys to produce erythropoietin. c\) Aged and damaged erythrocytes are engulfed by macrophages. d\) Iron is stored as ferritin and hemosiderin. e\) The lifespan of an erythrocyte is about 60 days. 14\) What is the diameter of the majority of lymphocytes? a\) 15-18 μm b\) 3-6 μm c\) 6-9 μm d\) 9-15 μm e\) 18-21 μm 15\) What type of anaemia involves a disturbance of proliferation and differentiation of erythroblasts? a\) Maturation defects b\) Increased destruction (haemolytic) c\) Sequestration and mechanical trauma d\) Blood loss e\) Impaired production 5 © Elevating Sisters, Teach Med Updated: March 2024 16\) Which of the following is NOT an example of intrinsic abnormalities leading to anaemia? a\) Hereditary defects of membrane lipids and proteins b\) Enzyme deficiencies in glycolysis c\) Increased oxidative stress d\) Sickle-shaped red blood cells e\) Antibody mediated (rh disease, transfusion reactions) 17\) In terms of treatments for anaemia, which of the following does folic acid treat? a\) Iron deficiency b\) Megaloblastic anaemia c\) Pernicious anaemia d\) Anaemia caused by renal failure e\) Vitamin B12 deficiency 18\) Which of the following is the correct statement regarding red blood cell production? a\) The penultimate precursor is the chondroblast b\) The penultimate precursor is the normoblast, this still has many mitochondria and ribosomes c\) The penultimate precursor is the normoblast, which has a loosely-condensed nucleus, which gets ejected, entering the blood as a reticulocyte d\) The penultimate precursor is the nucleoblast, this contains few Golgi and ribosomes e\) The penultimate precursor is the normoblast, containing a highly condensed nucleus, most of the haemoglobin and few mitochondria and ribosomes 19\) Which of the following blood groups contains A antigen on cells and β antibody in plasma? a\) B b\) AB c\) A d\) O e\) B and O 20\) Which of the following are not complications of blood transfusions? a\) Blood type incompatibility b\) Transmission of infection c\) Fever d\) Iron deficiency e\) Impaired clotting 6 © Elevating Sisters, Teach Med Updated: March 2024 21\) A pregnant woman with Rh- Blood Type is at risk of developing antibodies to the D Antigen, which could lead to Haemolytic Disease in her next child. This sensitisation can occur during various scenarios. Which of the following situations is a potential cause of Rh Sensitisation in an Rh- Individual? a\) Receiving a Blood Transfusion with Rh- Red Cells b\) Giving Birth to an Rh+ Child c\) Having a Diet deficient in Rh+ Antigens d\) Being exposed to Rh+ Agglutinin in the Environment e\) None of the Above 22\) During a scheduled blood transfusion for a patient undergoing major surgery, the medical team carefully monitors for potential complications. Which of the following is NOT a complication that could occur during a blood transfusion? a\) Blood Type Incompatibility b\) Transmission of Infection c\) Iron Overload d\) Impaired Blood Clotting e\) Allergic Reaction 23\) After a serious accident, a patient requires an emergency blood transfusion. Upon examination, the patient's blood type is found to be of Blood Type AB. The Medical Team needs to select the compatible blood type to ensure a successful transfusion. Which blood types can the patient with Blood Type AB safely receive? a\) Only Blood Types A and O b\) Only Blood Types B and O c\) Only Blood Type AB d\) Blood Types A, B, AB, and O e\) Only Blood Types A and B 24\) A patient's blood tests reveal high levels of eosinophil and after further tests, is diagnosed with malaria which is a parasitic infection. Which one of the following statements is incorrect about eosinophils? a\) Leave circulation within 8-12 hours of release from bone marrow. b\) Have a lifespan of several days in tissues. c\) Levels of eosinophils increase during some allergic states such as asthma. d\) Have a horseshoe/ kidney-shaped nucleus. e\) Secrete major basic protein 7 © Elevating Sisters, Teach Med Updated: March 2024 25\) A GP has ordered a FBC for a patient with suspected iron deficiency anaemia. The test comes back with an abnormally low red blood cell count. Which of the following statements is correct about red blood cells? a\) They are biconcave discs which decrease the surface area and allow deformation. b\) Old and damaged red blood cells are removed from circulation by only the spleen. c\) They have a short lifespan, around 12 days circulating in the blood. d\) They have a few enzymes which are needed for anaerobic metabolism of glucose. e\) Their precursor cells are found in the thymus 26\) Jane has survived Stage 3 cancer, and post chemotherapy, she has now fully recovered. At her monthly GP visit it was decided that she would need stem cell transplantation to replace the damaged stem cells in her body. The doctor has recommended the use of a specific type of stem cell, which is able to divide into either the endoderm, mesoderm and ectoderm. From the following options, which is the stem cell used? a\) Totipotent b\) Pluripotent c\) Multipotent d\) Unipotent e\) Progenitor 8 © Elevating Sisters, Teach Med Updated: March 2024 INITIATION OF THE HEARTBEAT 27\) Why does heart rate decrease with increasing heart size? a\) Bigger valves provide larger resistance to blood flow b\) Ventricular conduction takes longer to propagate c\) Bigger ventricles take longer to fill d\) Larger vessels reduce resistance to flow e\) Blood takes longer to circulate a larger body 28\) What is cardiac output essentially proportional to? a\) Body size b\) Respiration rate c\) Brain activity d\) Metabolic demand e\) Digestion 29\) What causes stroke volume to decrease at very high heart rates? a\) Increased blood filtration in kidneys b\) Less time for ventricular filling c\) Greater osmotic pressure d\) To save metabolic energy e\) Baroreceptor reflex 30\) What prognosis is high heart rate associated with in patients with cardiovascular disease? a\) Unclear b\) Good prognosis c\) No association d\) Improving prognosis e\) Poor prognosis 31\) What enables stroke volume to increase from moderate to high heart rates when exercising? a\) Ballooning of cardiac chambers when relaxing b\) Increased afterload c\) Greater thoracic pressure d\) Increased preload and heart contraction strength e\) Tachycardic reflex 9 © Elevating Sisters, Teach Med Updated: March 2024 32\) What did Hermann Stannius use frog hearts for? a\) To demonstrate that there is only one pacemaker in the heart. b\) To demonstrate that frog hearts are better at being pacemakers than human hearts. c\) To demonstrate that the primary pacemaker in the frog heart was the sinus venosus but when that is isolated the atria contains a secondary slower pacemaker. d\) To demonstrate the effect and importance of Purkinje fibres. e\) To show that the primary pacemaker in the frog heart was in the atria but when that is isolated the sinus venosus contains a secondary slower pacemaker. 33\) Which pacemaker in the heart has the fastest intrinsic rate? a\) Sinoatrial node. b\) Atrioventricular node. c\) Bundle of His. d\) Spindle fibres. e\) Ectopic pacemaker. 34\) Where is the sinoatrial node located? a\) Left Atrium b\) Right Atrium c\) Left Ventricle d\) Right Ventricle e\) Apex of Heart 35\) What is not a feature of a P cell? a\) Is poorly differentiated. b\) Has very few mitochondria. c\) Has numerous membrane invaginations called cavaeolae. d\) Is essentially just an empty bag of membrane e\) Is a very large cell. 36\) Which of these is not a type of cell that can be isolated from an SA node? a\) Spindle cell. b\) Elongated spindle cell. c\) Spider cell. d\) Periphery cell e\) All of the above. 10 © Elevating Sisters, Teach Med Updated: March 2024 37\) Why is the funny current (a key player of the membrane clock theory) considered unusual? a\) This inward current is activated when the membrane potential repolarises b\) This inward current brings negative ions into the cell c\) This inward current is activated when the membrane potential hyperpolarises d\) This inward current is activated when the membrane potential becomes more positive. e\) This inward current takes positive ions out of the cell 38\) Which of the following statements is false about cellular regulation of the sinus node? a\) cAMP increases the effect of the funny current b\) Sympathetic stimulation increases heart rate c\) cAMP activates PKA which phosphorylates L type Calcium channels d\) The membrane clock is the dominant pacemaker mechanism e\) Whilst acetylcholine increases cAMP, noradrenaline or adrenaline lower cAMP 39\) Which of the following are the only specific bradycardiac agents licensed for clinical use? a\) Ivabradine b\) Digoxin c\) Zatebradine d\) Alinidine e\) Clonidine 40\) Which transmembrane molecule(s) contain the voltage sensors that confer the voltage-gated properties of the HCN molecule (hyperpolarisation-activated cyclic nucleotide gated cation channel) a\) Transmembrane domains 1 and 4 b\) Transmembrane domain 5 only c\) Transmembrane domain 1 only d\) Transmembrane domain 4 only e\) Transmembrane domain 1 and 5 41\) Which of the following is false about the steady state activation curve? a\) The more positive the cell membrane is, the more channels open b\) -70mV to -45mV is the voltage range for diastolic depolarisation c\) Beta receptor stimulation shifts the curve to the right d\) The steady state curve can be affected by adenosine e\) Shifting the curve to the left reduces the number of channels available 11 © Elevating Sisters, Teach Med Updated: March 2024 42\) What is the effect of a positively chronotropic agent? a\) Increases heart rate b\) Increases stroke volume c\) Decreases heart rate d\) Decreases stroke volume e\) No change in heart rate 43\) What does inotropy describe? a\) Contractility/strength of contraction b\) Rate of relaxation c\) Change in heart rate d\) Change in stroke volume e\) Change in velocity of electrical conduction 44\) What is the purpose of the AV pause? a\) To allow high rates of excitation to be conducted down to the ventricles b\) To allow time for the ventricles to fill c\) To allow time for the atria to fill d\) To ensure the ventricles fully contract e\) To ensure the atria fully contract 45\) What is the approximate length of a ventricular myocyte? a\) 30 micrometres b\) 50 micrometres c\) 70 micrometres d\) 100 micrometres e\) 150 micrometres 46\) What easily passes through the connexons in the intercalated discs between cells? a\) Large molecules only b\) Large molecules and electrical currents c\) Small molecules and electrical currents d\) Small molecules only e\) Electrical currents only 12 © Elevating Sisters, Teach Med Updated: March 2024 47\) Which combination is used for ECG measurements? a\) Right and left shoulders, right leg b\) Right and left shoulders, left leg c\) Right and left legs, upper chest d\) Right shoulder, left leg, upper chest e\) Left shoulder, right leg, upper chest 48\) Limb Lead I is the most common arrangement for ECG recording. Which parts are the reference and recording electrodes? a\) Reference: right leg Recording: left shoulder b\) Reference: left leg Recording: right shoulder c\) Reference: left shoulder Recording: right leg d\) Reference: left leg Recording: upper chest e\) Reference: right shoulder Recording: left leg 49\) What is happening during the R wave? a\) Depolarisation of the septum towards the atria b\) Depolarisation up the free walls of the ventricles towards the atria c\) Depolarisation of the atria towards the apex d\) Depolarisation of the ventricles from the middle of the septum towards the apex of the heart e\) Repolarisation of the ventricles towards the endocardium 50\) Which part of the ECG is most likely to be abnormal during a myocardial infarction? a\) PQ interval b\) Atrial action potential c\) ST segment d\) QT interval e\) QRS duration 13 © Elevating Sisters, Teach Med Updated: March 2024 51\) A patient comes in with an abnormal PR interval. From the information given in this lecture, what has happened? a\) The patient may have an AV block -- the electrical impulse is not passing through the AV node correctly. b\) The patient may have Bundle Branch Block -- there's a delayed wave of excitation in the ventricle, suggesting an issue with conduction down the Hiss Bundle. c\) The patient may have ischaemia -- the ventricle is not firing off potentials as it should. d\) The patient may have a genetic mutation in their ion channels, causing a change in the action potential duration and hence the PR interval. e\) The patient is having a myocardial infarction -- there's a reduced action potential in the ventricles, affecting contraction. 52\) Amy suffers from a very high heart rate and has been prescribed a drug to slow it down by her doctor. Which drug is the doctor most likely to have prescribed? a\) Non-dihydropyridine L-type Ca channel blockers b\) Azithromycin c\) ACE Inhibitors d\) Digoxin e\) Penicillin 53\) Pacemakers are sometimes needed to treat atrial fibrillation. In a healthy heart, what is the hierarchy of pacemakers from the fastest (primary pacemaker) to the slowest? a\) Sinus node, atrioventricular node, Purkinje fibres, His bundle b\) Sinus node, atrioventricular node, His bundle, Purkinje fibres c\) Purkinje fibres,His bundle, atrioventricular node, sinus node d\) Atrioventricular node, Purkinje fibres, sinus node, His bundle e\) Sinus node, His bundle, Purkinje fibres, atrioventricular node 54\) A patient is found to have an abnormally wide and deep Q wave, implying a myocardial infarction. What does the Q wave represent on an ECG? a\) Depolarisation of the atria b\) Excitation wave travelling down the bundle of His c\) Left to right depolarisation of the septum d\) Excitation wave through the Purkinje fibres e\) Depolarisation of ventricular walls 14 © Elevating Sisters, Teach Med Updated: March 2024 55\) A 54-year-old male is admitted to the hospital and complains of shortness of breath when lying down, fatigue and weakness. Upon further analysis, the patient could be seen experiencing a very rapid and irregular heartbeat. A specialist is alerted and decides that a specific bradycardic agent should be administered. Which of these drugs is a specific bradycardic agent that is clinically available? a\) Aspirin b\) Beta-Blockers c\) Alinidine d\) Ivabridine e\) Digoxine 56\) A patient comes in experiencing cardiovascular symptoms. An investigation into the diagnosis is being carried out. Which of the following is true for the Membrane and Calcium Clocks? a\) Membrane Clock modulates the Calcium Clock and both are stimulated and inhibited by neurotransmitters Noradrenaline and GABA b\) Calcium Clock modulates the Membrane Clock and both are stimulated and inhibited by neurotransmitters Noradrenaline and GABA c\) Both modulate each other and both are stimulated and inhibited by neurotransmitters Noradrenaline and ACh d\) Both modulate each other and both are stimulated and inhibited by neurotransmitters Ach and Glutamate e\) They do not modulate each other and both are stimulated and inhibited by neurotransmitters GABA and ACh 57\) Mr Adams, a 43-yr-old patient is experiencing chest pain. The doctor recommends an ECG to be carried out. What does the P wave of the ECG represent? a\) Atrial repolarisation b\) Depolarisation of the ventricles (towards the atria) c\) Atrial depolarisation d\) Depolarisation of the septum (towards the atria) e\) Depolarisation of the ventricles (towards the apex) 15 © Elevating Sisters, Teach Med Updated: March 2024 58\) Beverley suffers with a congenital heart disease, and she is closely monitored on a weekly basis via hospital appointments. Her ejection fraction is measured weekly to ensure its functionality. Which of the following is the correct definition of ejection fraction? a\) The volume of blood pumped out of the ventricle every minute b\) The percentage of blood pumped out of both the ventricles and atria with each contraction c\) The percentage of blood pumped out of the ventricle with each contraction d\) The difference between the end-diastolic volume and end-systolic volume of the ventricle with each contraction e\) The volume of blood pumped out of the ventricle with each contraction 16 © Elevating Sisters, Teach Med Updated: March 2024 THE CARDIAC CYCLE 59\) Which cardiac structure does X correspond to? 1 a\) Mitral Valve b\) Aortic Valve c\) Pulmonary Valve d\) Tricuspid Valve e\) Septic Valve 60\) Which of the following is NOT a feature of atrioventricular valve function? a\) Opening and closing due to pressure differentials b\) Preventing backflow of blood to the atria during ventricular contraction c\) Bulge back into atria during systole d\) Anchored to ventricular walls via chordae tendineae and papillary muscles e\) Opening and closing due to cardiac myocyte contraction 1 Mike Shattock, "The Cardiac Cycle", Physiology of the Cardiovascular and Respiratory Systems 20-21. Accessed March 19, 2021, https://keats.kcl.ac.uk/pluginfile.php/7263270/mod\_resource/content/3/The%20Cardiac%20Cycle-MBBS1-2020-handout.pdf. 17 © Elevating Sisters, Teach Med Updated: March 2024 61\) Which of the following is the correct sequence of events for stage 1 of systole? 2 a\) Left atrial pressure\>Left ventricular pressure; pulmonary valve opens; blood flows into left ventricle b\) Left ventricular pressure\> Left atrial pressure; pulmonary valve opens; blood flows into left ventricle c\) Left atrial pressure\> Left ventricular pressure; mitral valve opens; blood flows into right ventricle d\) Left atrial pressure\> Left ventricular pressure; mitral valve opens; blood flows into left ventricle e\) Left ventricular pressure\> Left atrial pressure; aortic valve opens; blood flows into left ventricle 2 ibid 18 © Elevating Sisters, Teach Med Updated: March 2024 62\) In order to measure pressure and volume changes that occur in a cardiac cycle, in which segment of a heart is a catheter inserted into? a\) Left ventricle b\) Left atrium c\) Right ventricle d\) Right atrium e\) Septum 63\) Which of the following options correctly identifies A, B, C and D in this Pressure-Volume (P-V) loop? 3 a\) A= Mitral valve closes; B= Aortic valve opens; C= Aortic valve closes; D= Mitral valve opens b\) A= Aortic valve opens; B= Aortic valve closes; C= Mitral valve opens; D= Mitral valve closes c\) A= Mitral valve opens; B= Aortic valve opens; C= Mitral valve closes; D= Aortic valve closes d\) A= Mitral valve opens; B= Mitral valve closes; C= Aortic valve opens; D= Aortic valve closes e\) A= Aortic valve closes; B= Mitral valve opens; C= Mitral valve closes; D= Aortic valve opens 3 ibid 19 © Elevating Sisters, Teach Med Updated: March 2024 64\) Pressure-Volume (P-V) loops show the pressure and volume changes that occur in a single cardiac cycle. Which of the following is false? a\) Stroke volume is represented by the width of the graph b\) Stroke work is how much work the heart does moving blood into the peripheral circulation c\) Ejection fraction is the fraction of blood that is in the heart at end diastole that is ejected with each beat d\) If the heart is working harder the loop is smaller e\) Stroke work is calculated by the area of the P-V loop 65\) The effects of hydrostatic pressures mean\... a\) the venous pressures above the heart are high while arterial pressures, and pulse pressures are low. b\) the venous pressures above the heart are low while arterial pressures, and pulse pressures are high. c\) the arterial pressures above the heart are low while venous pressures, and pulse pressures are high. d\) the venous pressures below the heart are low while arterial pressures, and pulse pressures are high. e\) the venous and arterial pressures above the heart are high, while pulse pressures are low. 66\) Venous pulse can be divided into a number of components, these in order are\... a\) A wave, C wave, V wave, X wave, Y wave b\) C wave, V wave, X wave, A wave, Y wave c\) A wave, C wave, X wave, V wave, Y wave d\) Y wave, X wave, A wave, C wave, V wave e\) Y wave , A wave, C wave, X wave, V wave 67\) Venous pulse can be divided into different waves. Which of the following is false? a\) C wave is caused by the transmitted carotid pulse b\) Y is atrial emptying during ventricular diastole and before the atria contract again c\) X wave is related to atrial relaxation d\) A wave is right atrial contraction e\) V wave corresponds to venous filling when the tricuspid valve is open 20 © Elevating Sisters, Teach Med Updated: March 2024 68\) Hydrostatic pressure\... a\) Is relative to heart level b\) Below 0mmHg in the foot when standing c\) Below 0mmHg in the foot when supine d\) Means there is no fall or rise in pressure when standing and lying down e\) Is the same throughout the body 69\) Finish the following statement: The C wave in jugular venous pulse occurs in the: a\) Isometric ventricular contraction b\) Atrial systole phase c\) Isometric ventricular relaxation phase d\) Maximum filling phase e\) Maximum ejecting phase 70\) The "dup" heart sound is due to which of the following? a\) The opening of the semilunar valves at the beginning of diastole b\) The opening of the atrioventricular valves c\) The pressure as blood leaves the aorta d\) The closure of the semilunar valves e\) The closure of the atrioventricular valves 71\) Which of the following factors do NOT influence the shape of the arterial pressure peak? a\) Resonance b\) Resistance c\) Damping d\) Reflected waves e\) Interference 72\) Fill in the following statement correctly. The "lub" heart sound is associated with:- a\) The opening of the atrioventricular valves b\) The closure of the atrioventricular valves c\) The closure of the semilunar valves d\) The rush of blood from the atria into the ventricles (during the rapid filling phase) e\) The opening of the semilunar valves 73\) Due to tricuspid regurgitation, which of the following is caused as a result? a\) A decrease in right atrium pressure b\) An enhancement of the a wave c\) No significant change in the jugular venous pressure d\) An enhancement of the c wave e\) An enhancement of the v wave 21 © Elevating Sisters, Teach Med Updated: March 2024 74\) What is the gallop rhythm? a\) When systolic pressure is raised and S2 and S3 can be heard as a gallop b\) When the EDP is raised and S3 and S4 can be heard as a gallop. c\) When the EDP is lowered and S3 and S4 can be head as a gallop d\) When systolic pressure is raised and S3 and S4 can be heard as a gallop e\) When EDP is raised and S2 and S3 can be heard as a gallop 75\) What are heart murmurs caused by? a\) They are due to a hole in the sternum of the heart b\) It is due to an irregular pacemaker c\) Due to high heart rate d\) It is due to incorrect placement of the stethoscope e\) They are due to turbulence in the blood and they are caused by valve stenosis or valve regurgitation. 76\) Where is the disturbance if a patient has mitral stenosis? a\) Occurs in diastole and the ventricle fills. b\) Occurs in systole and the ventricle empties c\) Occurs in diastole and the ventricle empties d\) Occurs in systole and the ventricle fills e\) Occurs in diastole and the atrium fills 77\) Where is the disturbance if a patient has aortic incompetence? a\) Leads to an early systolic murmur and a softening and prolongation of the 1 st sound b\) Leads to an early diastolic murmur and a softening and prolongation of the 1 st sound c\) Leads to an early systolic murmur and softening and prolongation of the 2 nd sound d\) leads to early diastolic murmur and a softening and prolongation of the 2 nd sound e\) Leads to early systolic murmur and a softening and prolongation of the 2 nd sound 78\) Where is the disturbance if a patient has mitral incompetence? a\) This happens during systole and leads to a lush sound as blood flows back through the tricuspid valve to the atrium b\) This happens during diastole and leads to a lush sound as blood flows back through the mitral valve to the atrium c\) This happens during diastole and leads to a lush sound as blood flows back through the tricuspid valve to the atrium d\) This happens during systole and leads to a lush sound as blood flows back through the aortic valve to the atrium e\) This happens during systole and leads to a lush sound as blood flows back through the mitral valve to the atrium 22 © Elevating Sisters, Teach Med Updated: March 2024 79\) A doctor draws a patient's pressure-volume loop. They notice an abnormality in the 'isovolumic contraction' region of the pressure-volume loop, as it is shorter than what is considered normal. What is isovolumic contraction? a\) When both ventricles contract simultaneously b\) When pressure in the right ventricle does not change but volume decreases c\) When pressure in the right ventricle falls but volume does not change d\) When pressure in the left ventricle rises but volume does not change e\) When pressure in the left ventricle is smaller than the pressure in the left atrium so the mitral valve opens 80\) Angelie comes into hospital for her ECG and Echo scan. Whilst the physiologist is observing her echo, a murmur could be heard as her ventricles were filling. What would the name of this condition be? a\) Mitral Stenosis b\) Aortic Incompetence c\) Aortic stenosis d\) Mitral Incompetence e\) None of the Above 81\) A patient has been having arrhythmias and was recently diagnosed with tricuspid regurgitation. Which wave of the jugular venous pressure is enhanced to show this? a\) A wave b\) C wave c\) X wave d\) V wave e\) Y wave 82\) Isra has a heart disease where one of her valves doesn't function appropriately affecting the expected atrial and ventricle pressure. During the diastolic phase of the contractile cycle, which is true for atrial and ventricle pressure: a\) Left atrial pressure is lower than left ventricular pressure. b\) Left atrial pressure is higher than aortic pressure. c\) Left ventricular pressure is higher than aortic pressure. d\) The aortic pressure remains constant. e\) The left ventricular volume is at its lowest point. 23 © Elevating Sisters, Teach Med Updated: March 2024 83\) When listening to a patient's heart, you notice extra sounds in between S1 and S2 and diagnose the patient with a heart murmur. What is a heart murmur caused by? a\) Faulty valves b\) A turbulence in the blood by valvular stenosis only c\) A turbulence in the blood by valvular regurgitation only d\) A turbulence in the blood by valvular stenosis or valvular regurgitation e\) A raised end diastolic pressure 84\) A 78-year-old man has left ventricular hypertrophy resulting in an increased QRS voltage. Which phase of the cardiac cycle occurs at the same time as the R wave of ECG? a\) The arterial contraction and rapid filling phase b\) The iso-volumetric relaxation phase c\) The rapid ejection phase d\) The iso-volumetric contraction phase e\) The reduced ejection phase 24 © Elevating Sisters, Teach Med Updated: March 2024 CONTROL OF CARDIAC OUTPUT 85\) There are 4 factors that can directly affect cardiac output, what are they? a\) Preload, afterload, contractility and the renin-angiotensin-aldosterone-system b\) Heart strength, contractility, heart rate, calcium concentration c\) Preload, contractility, calcium concentration and heart rate d\) Contractility, afterload, heart rate and preload e\) Heart rate, preload, afterload, renin-angiotensin-aldosterone-system 86\) What is preload? a\) The power with which the heart contracts b\) The degree of stretch of a ventricle immediately before it contracts at the end of systole c\) The degree of stretch of a ventricle immediately before it contracts at the end of diastole d\) The degree of stretch of an atrium immediately before it contracts at the end of diastole e\) The degree of stretch of a ventricle after it contracts at the end of diastole 87\) How are preload, end-diastolic volume and filling pressure related? a\) As filling pressure of ventricles increases, this increases the preload. This then increases the end-diastolic volume. b\) As the end-diastolic volume of the ventricles increases, this increases the preload which ultimately causes an increase in filling pressure. c\) As the preload increases, the end-diastolic volume increases as a result. The filling pressure is not involved. d\) An increase in end-diastolic volume is followed by an increase in filling pressure. This increases the preload. e\) As filling pressure of ventricles increases, this increases the end-diastolic volume. This then increases the preload. 88\) What is afterload? a\) The force against which an atrium pumps to eject blood b\) The velocity of blood flow in the aorta after being ejected from the left ventricle c\) The increased stretch in the outflow tracts which provide a resistance to ejection of blood from the ventricles d\) The force against which a ventricle pumps to eject blood e\) The force which causes aortic regurgitation 25 © Elevating Sisters, Teach Med Updated: March 2024 89\) What is the Frank-Starling Law of the heart? a\) The total energy liberated at each heartbeat is determined by the systolic volume of the heart and therefore by the muscle fibre length at the beginning of contraction b\) The total energy liberated at each heartbeat is determined by the diastolic volume of the heart and therefore by the muscle fibre length at the beginning of relaxation c\) The total energy liberated at each heartbeat is determined by the diastolic volume of the heart and therefore by the muscle fibre length at the beginning of contraction d\) The total energy liberated at each heartbeat is determined by the diastolic volume of the heart and therefore by the muscle fibre length at the beginning of relaxation e\) The total energy liberated at each heartbeat is determined by the diastolic volume of the heart and therefore by the muscle fibre length at the end of contraction 90\) What are the 3 components of troponin? a\) TnC, TnT and TnI b\) TnA, TnI and TnT c\) TnA, TnI and TnC d\) TnC, TnT and TnO e\) TnA, TnO and TnI 91\) Length dependant activation: a\) Is identical in skeletal and cardiac muscle b\) Is the process by which increased contraction causes an increased stretch in cardiac muscle c\) In skeletal muscle, length dependant activation is mainly down to the degree of overlap between the actin and myosin filaments d\) Occurs in cardiac muscle only e\) In cardiac muscle, length dependant activation is also contributed to by separation of myofilaments 92\) Which of these statements pertaining to calcium sensitivity is true? a\) An increase in calcium binding sites leads to no change in contractility b\) An increase in calcium binding sites leads to increased contractility c\) The shorter the sarcomere the larger the force development d\) During diastole, there's an increase in calcium concentration e\) Calcium binds to troponin at higher concentrations as the sarcomere is stretched 26 © Elevating Sisters, Teach Med Updated: March 2024 93\) Which of these is a consequence of the frank-starling law? a\) Stroke volumes of the L and R ventricles aren't matched b\) CO is determined by CVP at specific rates and at a single functional state of the heart c\) Throws CO off balance during periods of increase afterload d\) CO is maintained during decreased contractility e\) Stroke volumes of the L and R ventricles are matched at specific times and at specific physiological moments 94\) Which of the following statements about titin during length dependent activation is incorrect? a\) Titin interacts with both myosin and actin b\) Thought to be responsible for increased sensitivity of TnC to calcium c\) Increased sarcomere length pulls on titin, drawing the actin and myosin closer together d\) Increases force by increasing access of actin headgroups to myosin, which favours formation of cross bridges e\) Titin acts on myosin binding protein C 95\) It takes less pressure to fill the right ventricle than the left ventricle. This is because: a\) The left ventricular wall is thinner, and so it's more compliant b\) The right ventricular wall is thinner, and so it's less compliant c\) The left ventricular wall is thicker, and so it's more compliant d\) The right ventricular wall is thinner, and so it's more compliant e\) The right ventricle is receiving a higher volume of blood 96\) An increase in the end diastolic pressure (EDP) increases the stroke volume by increasing the force of contraction by the cardiac muscle, however this is not considered an increase in contractility, as: a\) An increase in EDP is an increase in preload, which should be constant when increasing contractility. b\) An increase in EDP is a decrease in preload, which should be constant when increasing contractility. c\) An increase in contractility requires a decrease in afterload. d\) An increase in contractility requires both an increase in preload and a decrease in afterload e\) Contractility can only be affected by the sympathetic nervous system 27 © Elevating Sisters, Teach Med Updated: March 2024 97\) Which of the following is not a compensatory mechanism in response to heart failure? a\) Increased cardiac contractility b\) Increased heart rate c\) Venoconstriction d\) Renin-angiotensin-aldosterone system activation e\) Fall in cardiac output reduces renal excretion of fluid, activating the parasympathetic nervous system 98\) Which of the following is most suitable to describe the effects of afterload on cardiac output? a\) An increase in afterload will result in a significantly lower stroke volume at any blood pressure b\) A decrease in afterload will result in a significantly lower stroke volume at any blood pressure c\) Afterload has little effect on the cardiac output in the normal range of blood pressures d\) Afterload has little effect on the cardiac output at very high blood pressures e\) Afterload has no effect on the cardiac output at any range of blood pressures 99\) Which of the following best describes the effects of aortic valve stenosis (narrowing of the aortic valve) on cardiac output? a\) Aortic valve stenosis decreases afterload enough to reduce stroke volume and cardiac output b\) Aortic valve stenosis increases afterload enough to reduce stroke volume and cardiac output c\) Aortic valve stenosis decreases afterload enough to increase stroke volume and cardiac output d\) Aortic valve stenosis increases afterload enough to increase stroke volume and cardiac output e\) Aortic valve stenosis has no effect on cardiac output 28 © Elevating Sisters, Teach Med Updated: March 2024 100\) Which one of the following is true for normal ranges of right atrial pressure and mean arterial blood pressure? a\) They are very close to each other. b\) The ranges are very wide for both. c\) In the normal ranges of RAP and mABP, CO is controlled by both RAP and mABP/afterload. d\) In the normal ranges of RAP and mABP, CO is controlled by RAP but not mABP/afterload. e\) In the normal ranges of RAP and mABP CO is controlled by mABP/afterload but not RAP. 101\) At what levels of mABP does an increase in afterload cause a decrease in CO? a\) Very high b\) Sort of high c\) Moderate d\) Low e\) Extremely low 102\) Which of the following provides the best list of reasons as to why a small pressure gradient can still cause venous return? a\) Cohesion-tension of red blood cells to vein walls, low density of blood, low viscosity of blood b\) Wide lumen of vein, thick walls of vein, low vein resistance c\) Low vein resistance, skeletal muscle pump action, respiratory pump action d\) Gravity, skeletal muscle pump action, low vein resistance e\) Valve action, rapid contraction of vein smooth muscle, respiratory pump action 103\) Preload for the right side of the heart is equivalent to? a\) Mean arterial blood pressure b\) Central venous pressure c\) Pulmonary venous pressure d\) Afterload e\) None of the above 104\) Which of the following increases Central Venous pressure? a\) Venodilation b\) Stenosis of mitral valve c\) Venoconstriction d\) Hemorrhage e\) Orthostasis 29 © Elevating Sisters, Teach Med Updated: March 2024 105\) During heart failure, cardiac output may decrease to a level which is insufficient to provide enough blood for the body's metabolic needs. In such circumstances, what compensatory mechanisms may be activated? a\) Activation of the SNS to decrease heart rate and cardiac contractility b\) Activation of RAAS to increase fluid excretion c\) Activation of the PSNS to increase heart rate and cardiac contractility d\) Activation of SNS to cause venoconstriction e\) Inactivation of the SNS to increase heart rate and cardiac contractility 106\) A patient comes into the hospital, complaining of dizziness and blurred vision. The doctor finds that she has low cardiac output syndrome \[LCOS\]. What could be a possible explanation for her lowered cardiac output? a\) The filling pressure of the right ventricle has increased b\) The force which the ventricles have to pump against to eject blood is lower, hence less blood is pumped out of the heart c\) The heart is beating faster, so blood has less time to reach the ventricles before ventricular systole occurs d\) The heart is contracting less powerfully as the stretch of the ventricle walls is greater e\) The afterload on the heart is higher, hence less blood is pumped out of the heart 107\) A 68-year-old man presents to the emergency room with fatigue, oedema of the ankles, and breathlessness. He is diagnosed with congestive heart failure. Which of these statements of cardiac function is true? a\) Left ventricular preload is directly related to Pulmonary venous pressure b\) Left ventricular preload is mainly due to aortic blood pressure c\) Right ventricular preload is directly related to Pulmonary venous pressure d\) Left ventricular afterload is mainly due to main pulmonary artery pressure e\) Right ventricular afterload is directly related to Central venous pressure 30 © Elevating Sisters, Teach Med Updated: March 2024 108\) A biopsy was taken of a muscle to be used in a laboratory study, the length of two sarcomeres was compared. One was measured to be 1.9 microns whilst the other was 2.1 microns. What would be the likely consequence of the difference observed on the activation of cardiac muscle? a\) The shorter sarcomere will show a much higher force development at very low calcium ion concentrations. b\) The longer sarcomere will show the same force development at peak concentration of the calcium ion signal. c\) The longer sarcomere will show a lower force development at higher calcium ion concentrations. d\) The shorter sarcomere will show a higher force development at low calcium ion concentrations. e\) The longer sarcomere will show a greater increase in force development as the calcium ion concentration increases. 109\) Venous blood flow can be accomplished with a small pressure gradient. Why is this? a\) very low resistance of the veins b\) the skeletal muscle pump c\) the respiratory pump d\) A and C e\) A, B and C 110\) A 40-year old woman is undergoing chronic heart failure. Which of the following compensatory mechanisms can be activated by heart failure? a\) Increase in cardiac output increasing the renal excretion of fluid hence increasing the blood volume b\) Decreased venous blood volume c\) Increased blood pressure activates the sympathetic nervous system to increase heart rate and contractility d\) Increase venoconstriction increases central venous pressure e\) Decreasing afterload to increase stroke volume 111\) A patient admitted into the ward is exhibiting fatigue and shortness of breath even when at rest and says that he can feel a very rapid and irregular heartbeat. Monitoring his heart rate and blood pressure, heart failure is likely to be the cause of his symptoms. What is likely to be the compensatory mechanism activated by heart failure? a\) Increase in renal excretion of fluid b\) Decrease in the venous blood volume c\) Venodilation and suppress fluid retention d\) Decrease in heart rate e\) Activation of renin-angiotensin-aldosterone system 31 © Elevating Sisters, Teach Med Updated: March 2024 CONTROL OF BLOOD PRESSURE 112\) How is the mean blood pressure calculated? a\) The mean blood pressure is calculated as the time weighted average of the systolic and diastolic blood pressures or 2/3 x DBP plus 1/3 x SBP b\) The mean blood pressure is calculated as the average of the systolic and diastolic blood pressures or 1/3 x DBP plus 2/3 x SBP c\) The mean blood pressure is calculated as the average of the systolic and diastolic blood pressures or 2/3 x DBP plus 1/3 x SBP d\) The mean blood pressure is calculated as the time weighted average of the systolic and diastolic blood pressures or 1/2 x DBP plus 2/3 x SBP e\) The mean blood pressure is calculated as the time weighted average of the systolic and diastolic blood pressures or 2/3 x DBP plus 1/4 x SBP 113\) Where are the baroreceptor reflexes found? a\) Carotid sinuses and aortic arch b\) Medulla and nucleus tractus solitarius c\) Medulla and carotid sinuses d\) Carotid sinuses e\) Aortic arch 114\) What is the equation which relates cardiac output to blood pressure? a\) Cardiac output x total peripheral resistance b\) Cardiac output x stroke volume c\) Cardiac output x heart rate d\) Cardiac output x heart rate x total peripheral resistance e\) Cardiac output x end diastolic volume 115\) What is the neurogenic model of control of blood pressure? a\) The SNS can contribute to the long term control of blood pressure as well as the kidneys b\) The kidneys are the sole long term control of blood pressure c\) The SNS can not contribute to the long term control of blood pressure along with the kidneys d\) Pressure natriuresis is the sole long term control of blood control e\) None of the above 32 © Elevating Sisters, Teach Med Updated: March 2024 116\) What is Guyton's hypothesis? a\) The stabilisation of blood pressure over the long term is due to there being a constant extracellular fluid volume which requires there to be a constant sodium content in the body b\) The stabilisation of blood pressure over the long term is due to there being a variable extracellular fluid volume which requires there to be a constant sodium content in the body c\) The stabilisation of blood pressure over the long term is due to there being a variable extracellular fluid volume which requires there to be a variable sodium content in the body d\) The stabilisation of blood pressure over the long term is due to there being a constant extracellular fluid volume which requires there to be a variable sodium content in the body e\) The stabilisation of blood pressure over the long term is due to there being a constant extracellular fluid volume which requires there to be a constant potassium concentration in the body 117\) Which artery is generally used to measure blood pressure? a\) Radial artery b\) Brachial artery c\) Ulnar artery d\) Cephalic artery e\) Median artery 118\) Why does the pressure wave become larger as it moves down the arterial tree? a\) Arterial stiffness b\) Pleural effusion c\) Loss of elasticity d\) Increase in force e\) Decreased total peripheral resistance 119\) What is the speed in which blood cells move at? a\) 10cm/s b\) 8cm/s c\) 32cm/s d\) 48cm/s e\) 19cm/s 33 © Elevating Sisters, Teach Med Updated: March 2024 120\) Define BP a\) The average diastolic and pulse pressure b\) The time-weighted average of the systolic and pulse pressure c\) The volume-weighted average of the systolic and diastolic pressure d\) The time-weighted average of the systolic and diastolic pressure e\) The mean pressure of systole and diastole 121\) Which one of the following is a major contributor to the total peripheral resistance? a\) Arteries b\) Veins c\) Capillaries d\) Arterioles e\) Venules 122\) Which of the following occurs as a long term response to a low Blood pressure a\) Increase preload b\) Increase stroke volume c\) Decrease Na reabsorption d\) Increase Na reabsorption e\) Increase Cardiac contractility 123\) Stabilisation of blood pressure in the long term due to a\) Maintenance of a constant internal K conc b\) Maintenance of a constant ICF volume c\) Maintenance of a constant internal Ca conc d\) Maintenance of a constant ECF volume e\) Maintenance of a constant internal Cl conc 124\) Which of the following is responsible for the long term regulation of blood pressure a\) Heart b\) Lungs c\) Blood vessels d\) Brain e\) Kidneys 125\) Which of the following is the main result of ingesting too much salt? a\) Increase in blood volume b\) Decrease in blood pressure c\) Increase in Na reabsorption d\) Increase in pressure natriuresis e\) Increase in blood pressure 34 © Elevating Sisters, Teach Med Updated: March 2024 126\) Which of the following occurs because of pressure natriuresis? a\) Decrease in blood pressure b\) Increase in blood pressure c\) Na excretion d\) Na reabsorption e\) Decrease in blood volume 127\) A 35-year-old man came into Kings College Hospital after a falling accident. The patient was losing blood and the signs showed that his BP is decreasing, and HR is increasing. What factor is causing this increase in Heart Rate? a\) Increase in the parasympathetic drive through M2 receptor. b\) Decrease in the parasympathetic drive through ß1 receptor. c\) Increase in the sympathetic drive through α1 receptor. d\) Decrease in the sympathetic drive through α1 receptor. e\) Increase in the sympathetic drive through ß1 receptor. 128\) Sarah Thomas is a 29-year-old woman who has been recently diagnosed with hypertension. She has been advised to maintain a balanced diet to reduce the sodium levels in her blood. How can the reduction of sodium levels contribute to a long-term stabilisation of her blood pressure? a\) Sodium directly contributes to transcellular fluid in the blood which stabilises blood pressure b\) Sodium directly reduces interstitial fluid in the blood which stabilises blood pressure c\) Sodium stabilises the albumin levels in the blood which impacts blood volume and hence stabilises blood pressure d\) Sodium stabilises intracellular fluid which impacts blood volume and hence stabilises blood pressure e\) Sodium stabilises the ECF which impacts blood volume and hence stabilises blood pressure. 129\) A 45-year-old man has hypotension. The systolic pressure was 90 mm Hg and the diastolic pressure was 40 mm Hg. His heart rate is 80 beats per minute and the pressure waves are moving at 5 m/s. What is the mean arterial pressure of the man approximately? a\) Insufficient information b\) 65 mm Hg c\) 50 mm Hg d\) 56 mm Hg e\) 60 mm Hg 35 © Elevating Sisters, Teach Med Updated: March 2024 130\) A 45-year-old man is at high risk of developing hypertension. His increased blood pressure is detected by baroreceptors in the aortic arch and carotid sinuses. The carotid sinuses relay the signal to the brain through which cranial nerve? a\) Glossopharyngeal Nerve b\) Vagus Nerve c\) Olfactory Nerve d\) Accessory Nerve e\) Hypoglossal Nerve 131\) A 45 year old patient has a reading of 85/65 mmHg and therefore has low blood pressure. What is the correct internal response to increase blood pressure? a\) Increase in angiotensin 2-\> vasodilation b\) Increase in angiotensin 2-\>decrease ADH release c\) Decrease in angiotensin 2 -\>vasoconstriction d\) Decrease in angiotensin 2 -\>increase renal Na+ absorption e\) Increase in angiotensin 2 -\> increase ADH release 132\) A 65-year old woman went to the GP and was diagnosed with hypertension. Hypertension is high blood pressure. Which of the following does not cause vasodilatation? a\) Atrial natriuretic peptide (ANP) b\) Adrenaline acting on β2 receptor c\) Oxidative stress d\) Increase in muscle metabolite production e\) Bradykinin 133\) Dr Mohammed, a GP, sees a patient with hypertension. The patient's mean blood pressure above their heart is higher than their mean blood pressure below the heart. How is mean blood pressure calculated? a\) 1/2 Diastolic Blood pressure + 2/3 Systolic Blood Pressure b\) (Diastolic Blood Pressure multiplied by Systolic Blood Pressure) / 3 c\) 2/3 Diastolic Blood Pressure + 1/3 Systolic Blood Pressure d\) Diastolic Blood Pressure + 1/4 Systolic Blood Pressure e\) (Diastolic Blood Pressure multiplied by Systolic Blood Pressure) / 4 134\) Lucy has been informed that she has hypertension, and is at high risk of heart disease, aortic aneurysms and vascular dementia. She asks the GP what diastolic blood 36 © Elevating Sisters, Teach Med Updated: March 2024 pressure is. Which one of the following options best describes what diastolic blood pressure is? a\) Pressure in the left ventricle when aortic valve is open b\) Pressure created in the aorta by the rebound of its elastic wall c\) Minimum pressure reached when the rebounding process is finished and stored pressure in large elastic arteries fall d\) Maximum pressure reached when the rebounding process is finished and stored pressure in the large elastic arteries fall e\) Minimum pressure reached when the rebounding process is finished, stored pressure in large elastic arteries fall and aortic valve close CONTROL OF BLOOD FLOW 37 © Elevating Sisters, Teach Med Updated: March 2024 135\) The following statements are correct, EXCEPT a\) Coronary arteries dilate during exercise to supply the heart with more blood b\) The arterial BP creates a pressure a head to drive the blood through all the organs c\) Tubulo-glomerular feedback in the kidney adjusts efferent arteriolar resistance to stabilise glomerular pressure d\) Veins and arteries in the lower extremities constrict to maintain central BP during orthostasis e\) Most vascular beds constrict during haemorrhage to maintain blood flow to the brain and heart 136\) Sympathetic nerve firings cause constriction in the following structures: a\) Salivary glands b\) Renal vascular beds c\) Pancreas d\) Intestinal mucosa e\) Penis 137\) Which of the following is true: a\) Parasympathetic activation increases total peripheral resistance b\) Angiotensin 2 causes vasodilation during intrarenal haemodynamics c\) Muscarinic receptors are sympathetic receptors d\) Sympathetic nerve firing raises total peripheral resistance e\) Alpha-1 receptors are parasympathetic receptors 138\) Which of the following is NOT true: a\) Noradrenaline acts on Beta-1 receptors b\) Noradrenaline acts on Beta-2 receptors c\) Adrenaline acts on Beta-2 receptors d\) Adrenaline acts on Beta-1 receptors e\) Adrenaline acts on Alpha-1 receptors 139\) The following statements are true, EXCEPT: a\) Alpha-1 receptors cause vasoconstriction in renal vascular beds b\) Beta-1 decrease cardiac contractility c\) Beta-1 increase heart rate d\) Vasopressin contributes to regional vasoconstriction during haemorrhage e\) Vascular tone is the result of a balance between various constricting and dilating influences 140\) What is the substance that the endothelium releases which relaxes the surrounding muscle and is also referred to as the endothelium derived relaxing factor (EDRF)? 38 © Elevating Sisters, Teach Med Updated: March 2024 a\) Nitric Dioxide b\) Hydrogen Chloride c\) Nitric Oxide d\) Methane e\) Sulphur Hydride 141\) Nitric Oxide is produced by an enzyme called ENOS. What is endothelial nitric oxide synthase stimulated by? a\) a rise in L-arginine concentration b\) a rise in Calcium concentration c\) a decrease in L-arginine concentration d\) a decrease in Calcium concentration e\) a rise in Nitrate levels 142\) Nitric Oxide causes the relaxation of vascular smooth muscle cells. On these cells what does the opening of potassium cells cause? a\) A drop in potassium concentration leading to a rise in calcium levels leading to desensitisation of calcium ions b\) PMCA-(plasma membrane calcium ATPase) to be released and exit smooth muscle cells c\) Leads to depolarisation and the voltage gated sodium channels open leading to a relaxation of smooth muscle d\) A release in superoxide which reacts with nitric oxide creating peroxynitrate. e\) They cause the cells to hyperpolarise and lead to closure of voltage gated sodium channels causing contraction of smooth muscle 143\) What does introducing L-MNNA to your system mean? a\) It releases of Arginine reducing nitric oxide synthesis and leads to a fall in blood flow b\) It releases NAPH oxidase which releases ENOS causing a fall in blood pressure c\) It's a blocker of ENOS reducing nitric oxide synthesis and leads to a fall in blood flow d\) It causes a release of adenine reducing nitric oxide synthesis and leads to a fall in blood flow e\) It's a blocker of cGMP reducing nitric oxide synthesis leading to a fall in blood pressure 144\) Which substance(s) can cause Endothelium-derived hyperpolarisation? 39 © Elevating Sisters, Teach Med Updated: March 2024 a\) hydrogen peroxide and epoxy accosted trienoic acid b\) Nitric oxide and NADPH oxidase c\) L arginine d\) PMCA and Nitric Oxide e\) Calcium 145\) What is the effect of 'Rho kinase' in smooth muscle contraction? a\) Ca2+ desensitisation b\) Ca2+ sensitisation c\) K+ desensitisation d\) K+ sensitisation e\) Depolarisation 146\) What is the myogenic response to an increase in flow within arterioles? a\) Slow relaxation b\) Fast relaxation c\) No response d\) Slow constriction e\) Fast constriction 147\) What is the effect of increasing metabolism on smooth muscle cells? a\) No effect b\) Vasoconstriction c\) Vasodilatation d\) Lose function e\) Cells are broken down 148\) How are excess metabolites dealt with after blood supply to the area is temporarily cut off? a\) Broken down via white blood cells b\) Blood flow returns below normal levels and washes them out c\) Blood flow returns to normal levels and washes them out d\) Blood flow returns above normal levels and washes them out e\) Not removed and used in the area over time 149\) What % of cardiac output does the brain use at rest. 40 © Elevating Sisters, Teach Med Updated: March 2024 a\) 15% b\) 30% c\) 1% d\) 5% e\) 50% 150\) How does the heart compensate when an atherosclerotic plaque forms in the coronary arteries? a\) Increasing the force of contraction b\) Development of intra-arterial collaterals between coronary arteries c\) Decreasing cardiac output d\) Diverting blood flow through other existing coronary artery branches e\) Increasing heart rate 151\) Why does the capillary density in the endocardium differ to that of the epicardium in the region of the left ventricle? a\) Diameter of the capillaries in the endocardium is less than that of the epicardium b\) The need for a rich blood supply is greater in the endocardium than in the epicardium c\) To allow ventricular contraction to be more efficient d\) Increase in wall tension during ventricular contraction causes compressive forces reducing flow greatly to the endocardium e\) To decrease the chances of developing ischaemia 152\) What does the heart do to enable it to work harder for example during exercise? a\) Releases vasodilating metabolites b\) Initiate release of calcium ions c\) Release vasoconstricting metabolites d\) Increase cardiac output e\) Activate baroreceptors 153\) What is the purpose of autoregulation in the heart? a\) Acts only when there is an increase in heart rate b\) Allows the same volume of blood to enter the heart despite changes in pressure c\) Keeps coronary blood flow constant d\) Initiates a mechanism to recover a fall in coronary blood flow e\) Prevents fall in coronary blood flow at low pressures 154\) What is the role of the sympathetic nervous system in the coronary arteries? 41 © Elevating Sisters, Teach Med Updated: March 2024 a\) Stimulates beta-1 and beta-2 receptors by noradrenaline and adrenaline at the onset of exercise, causing vasodilation b\) Stimulates beta-1 and beta-2 receptors by noradrenaline and acetylcholine at the onset of exercise, causing vasodilation c\) Stimulates muscarinic receptors by noradrenaline and adrenaline at the onset of exercise, causing vasodilation d\) Stimulates muscarinic by noradrenaline and acetylcholine at the onset of exercise, causing vasodilation e\) Stimulates beta-1 and beta-2 receptors by adrenaline alone at the onset of exercise, causing vasodilation 155\) Whilst taking the history of a patient, the doctor sees that he is vulnerable to ischemia. This can occur when coronary blood flow is reduced. Which of the following is a correct reason for reduced coronary blood flow? a\) Heart rate is increased b\) Heart rate is decreased c\) Coronary arteries are widened by stenosis d\) Diastolic pressure rises e\) Adrenaline is stimulated by the sympathetic nervous system 156\) A patient diagnosed with cardiogenic shock has been prescribed a nitric oxide synthase, eNOS, inhibitor. What effect would this drug have on blood flow within vessels? a\) blood flow would reduce due to a lack of arterial smooth muscle relaxation. b\) blood flow would reduce due to increased arterial smooth muscle relaxation. c\) blood flow would increase due to arterial smooth muscle constriction. d\) blood flow would increase due to increased arterial smooth muscle relaxation. e\) blood flow would increase due to a lack of arterial smooth muscle relaxation. 157\) A 30-year-old man comes into A&E with blurred vision and confusion. The doctor discovers that he is a cyclist. Which statement is correct? 42 © Elevating Sisters, Teach Med Updated: March 2024 a\) Aldosterone secretion by the adrenal medulla is increased by exercise, fight-fright, hypotension and hyperglycaemia. b\) Cortisol secretion by the adrenal medulla is decreased by exercise, fight-fright, hypertension and hypoglycaemia. c\) Adrenaline secretion by the adrenal medulla is decreased by exercise, fight-fright, hypotension and hypoglycaemia. d\) Noradrenaline secretion by the Zona glomerulosa is increased by exercise, fight-fright, hypotension and hyperglycaemia. e\) Adrenaline secretion by the adrenal medulla is increased by exercise, fight-fright, hypotension and hypoglycaemia. 158\) A 60-year-old patient has come in with severe hypotension, which is when blood vessels become relaxed. Blood Vessel relaxation involves endothelium derived hyperpolarisation. How does this hyperpolarisation of the smooth muscle cells lead to relaxation of blood vessels? a\) opening Calcium ion channels on membrane of the smooth muscle cell b\) opening of Na+ Channels on membrane of the smooth muscle cell c\) leads to a decrease in calcium ions concentrations in the smooth muscle cell d\) closes the Na+ channels on membrane of the smooth muscle cell e\) sends action potentials across the smooth muscle cells which causes it to contract 159\) A patient presents to the Emergency Department in a confused and disorientated state, with clammy skin and shortness of breath. Further assessment reveals that they are hypotensive and tachycardic. They are suspected to have haemorrhaging. Which of the following does not describe the mechanisms in their body taking place in an attempt to help regulate their blood flow? a\) SNS activation causes constriction in splanchnic, renal and muscle vascular beds therefore raising total peripheral resistance. b\) Angiotensin II contributes to regional vasoconstriction. c\) PNS nerve firing causes vasoconstriction in the pancreas, salivary glands and reduces TPR. d\) Adrenaline acts on β1, β2 receptors and dilates coronary and skeletal muscle beds and constricts most other vascular beds via α1 receptors. e\) Vasopressin contributes to regional vasoconstriction. 160\) Mr Ali has presented to the hospital following an ischemic injury. This involves his organs failing to keep the blood flow fairly constant over a wide range of pressures. Which physiological regulatory system has failed? a\) Transduction 43 © Elevating Sisters, Teach Med Updated: March 2024 b\) Automission c\) Transmission d\) Autoregulation e\) Modulation REGULATION OF FLUID BALANCE IN THE MICROCIRCULATION 161\) The microcirculation is\... 44 © Elevating Sisters, Teach Med Updated: March 2024 a\) The part of the vascular system comprising terminal arterioles which are blind ended tubes that take up and transport microorganisms to lymph glands b\) The part of the vascular system comprising capillaries and post-capillary venules that are covered by smooth muscle and controlled by local factors c\) The part of the vascular system comprising lymphatic capillaries that are covered by smooth muscle and controlled by local factors d\) Where gases, water, nutrients, waste materials and other substances are exchanged between the blood and body tissues, via the interstitial compartment e\) A 3D meshwork of blood vessels which are 50 -- 100 μm in diameter 162\) What type of capillary allows large molecules, such as proteins, to diffuse readily across the capillary wall? a\) Lymphatic b\) Sinusoidal c\) Continuous d\) Terminal e\) Fenestrated 163\) Small lipophobic molecules, such as water and ions, cannot diffuse across the lipid bilayer. They can cross between cells (intercellular clefts) in continuous capillaries but have to diffuse across what to be able to get into the clefts? a\) Glucitol -- A glycoprotein layer on the basolateral surface of the endothelium b\) Glycocalyx -- A glycoprotein layer on the basolateral surface of the endothelium c\) Glucitol -- A glycolipid layer on the luminal surface of the endothelium d\) Transferrin -- A glycoprotein embedded in the endothelium e\) Glycocalyx - A glycoprotein layer covering the luminal surface of the endothelium 164\) Diffusion = a\) Diffusion constant × diffusion distance × concentration area b\) Diffusion constant × area × concentrationDiffusion distance c\) area × concentrationDiffusion distance d\) area × concentrationDiffusion distance × diffusion constant e\) Diffusion distance ×area × concentration 165\) Filtration and absorption of fluid are almost perfectly balanced (net volume \~ 4-8 L filtered each day). Fluid filtration is driven by 2 pressure gradients, one of which is a 45 © Elevating Sisters, Teach Med Updated: March 2024 hydrostatic pressure gradient. The hydrostatic pressure gradient drives water in which direction? a\) From the capillaries into the interstitium b\) From the interstitium into the capillaries c\) From the capillaries into the interstitium as there is higher hydrostatic pressure at the venous than arteriolar end of capillaries d\) From the interstitium into the capillaries as there is higher hydrostatic pressure at the venous than arteriolar end of capillaries e\) From the interstitium into the capillaries as there is a higher hydrostatic pressure at the arteriolar than venous end of the capillaries 166\) What creates an osmotic pressure gradient across capillary walls? a\) The high protein concentration in the interstitium b\) The low permeability of the capillary wall to proteins c\) The low permeability of the capillary wall to glucose d\) The gradient of protein concentration e\) The gradient of glucose concentration 167\) The osmotic pressure gradient \... a\) Draws water into the capillaries b\) Draws water into the interstitium c\) Forces glucose out of the blood d\) Forces proteins into the blood e\) Maintains blood pressure 168\) Oedema occurs when \... a\) Filtration \> absorption b\) Filtration \> absorption + lymphatic flow c\) Excretion \> absorption d\) Excretion \> absorption + lymphatic flow e\) Filtration + Excretion \> absorption + lymphatic flow 169\) Lymphangions function to\... a\) Pump lymph towards lymphatic capillaries b\) Pump lymph away from lymphatic capillaries c\) Pump lymph away from lymph glands d\) Pump blood around the body e\) Pump lymph fluid towards lymph glands 170\) The net movement of fluid across an exchange vessel is \... a\) Driven by the hydrostatic pressure gradient acting on the fluid 46 © Elevating Sisters, Teach Med Updated: March 2024 b\) Driven by the osmotic pressure gradient acting on the fluid c\) Driven by an overall pressure gradient acting on the fluid d\) Caused by the difference in solute concentration e\) Caused by the difference in protein concentration 171\) A 73-year-old woman presents to her GP complaining of swollen ankles, aching joints and difficulty in walking. After performing a physical exam, the GP concludes that the patient is suffering from peripheral oedema. Oedema is promoted by increased net filtration. Which of the following is a contributing factor to this? a\) Decreased capillary hydrostatic pressure b\) Lymphatic obstruction which reduces lymphatic flow c\) Decreased capillary/venular permeability d\) Increased plasma oncotic pressure e\) Increased reabsorption of fluid from interstitial compartment 172\) A patient is diagnosed with oedema which is visible from their swollen ankles. Oedema occurs when filtration is greater than both absorption and lymphatic flow. Which of the following are not a factor that causes oedema? a\) Increased capillary or venular permeability b\) Decreased plasma oncotic pressure c\) Increased plasma oncotic pressure d\) Lymphatic obstruction reduces lymphatic flow e\) Increased capillary hydrostatic pressure 173\) A 45-year-old woman is brought to A&E presenting with chest pain with exertion, shortness of breath and lower-extremity oedema for the past 2 days. After a chest x-ray 47 © Elevating Sisters, Teach Med Updated: March 2024 the patient is diagnosed with chronic heart failure. Which of the following explains how the patient's heart failure caused the symptom of lower-extremity oedema? a\) Accumulation of fluid in the tissue interstitium caused by elevation of the venous pressure resulting in the increase in osmotic pressure in the microcirculation causing an increase in absorption. b\) Accumulation of fluid in the tissue interstitium caused by elevation of the venous pressure resulting in the increase in hydrostatic pressure in the microcirculation causing an increase in filtration. c\) Accumulation of fluid in the tissue interstitium caused by elevation of the arterial pressure resulting in the increase in hydrostatic pressure in the microcirculation causing a decrease in filtration. d\) Accumulation of fluid in the capillaries caused by elevation of the venous pressure resulting in the increase in osmotic pressure in the microcirculation causing an decrease in filtration. e\) Accumulation of fluid in the capillaries caused by elevation of the arterial pressure resulting in the increase in hydrostatic pressure in the microcirculation causing an increase in filtration. 174\) A patient presents with swelling in their legs, this could indicate lymphatic dysfunction. Which of the following is not a function of the lymphatic system in the human body? a\) Transporting excess interstitial fluid back to the bloodstream b\) Absorbing dietary fats and fat-soluble vitamins from the digestive system c\) Removing waste products from the body d\) Maintaining blood pressure and fluid balance e\) Defending the body against infection and disease 175\) A patient presents with swelling in their ankle, which could be a sign of oedema. In a clinical context, it is important to identify the underlying cause of the oedema to provide appropriate treatment. Which of the following can cause oedema in patients? a\) Decreased capillary hydrostatic pressure b\) Increased lymphatic flow c\) Increased plasma oncotic pressure d\) Decreased capillary permeability e\) None of the above 176\) A patient has been diagnosed with hypertension and is at risk of developing heart failure. It is important to understand factors regulating fluid balance in the body to treat 48 © Elevating Sisters, Teach Med Updated: March 2024 patients. Which of the following factors regulate filtration and reabsorption in capillaries of a patient\'s body? a\) Downstream arterioles b\) Upstream arterioles c\) Lymphatic vessels d\) Interstitial fluid e\) None of the above 177\) A patient has been bitten by a venomous snake and is at risk of developing systemic toxicity. How do lymphatics prevent pumping in the event of envenomation in a patient\'s body? a\) By increasing pacemaker cell activity b\) By decreasing lymphatic vessel diameter c\) By increasing interstitial pressure d\) By increasing lymphatic vessel pressure e\) None of the above 178\) Mr John Ramsey has some swelling in his lower legs, ankles and feet. This is important as it could be an early sign of a heart issue. Which of the following could not be a cause of this oedema? a\) A lymph node has become inflamed/damaged therefore damaging the lymphatic system and its drainage. b\) A diet which is very low in protein and overall low in the sufficient nutrients for a man of his age and weight. c\) An increased capillary hydrostatic pressure due to a thromboembolism. d\) An increase in the permeability of his capillaries and veins leading to a higher net filtration. e\) His new medication which has a vasodilatory effect by increasing peripheral resistance. 179\) A patient has been diagnosed with lymphedema, a condition where there is abnormal accumulation of lymphatic fluid in the tissues. What is the function of the intercellular clefts in lymphatic capillaries of a patient\'s body? a\) To allow one-way entry of fluid b\) To allow two-way exchange of fluid c\) To prevent fluid exchange d\) To allow lymphocytes to enter and exit e\) None of the above INTRODUCTION TO THE RESPIRATORY SYSTEM: LUNG MECHANICS I 49 © Elevating Sisters, Teach Med Updated: March 2024 180\) Which of these is not part of the inspiratory muscles? a\) Diaphragm b\) Internal intercostal muscles c\) Scalenes d\) Sternocleidomastoids e\) Parasternal intercostal muscles 181\) During normal expiration: a\) There is lower pressure in the chest wall relative to atmospheric pressure b\) Intercostal muscles contract c\) There is a decrease in lung volume d\) There is a decrease in alveolar pressure e\) The chest wall expands 182\) Boyles Law (1662) is defined as: a\) The pressure of a fixed number of molecules in a space (at a constant temperature) is related to the volume of a container in which they are placed. b\) The volume occupied by a fixed amount of gas is directly proportional to its absolute temperature, if the pressure remains constant c\) The pressure exerted by a mixture of gases in a fixed volume is equal to the sum of the pressures that would be exerted by each gas alone in the same volume. d\) The mass of a dissolved gas in a given volume of solvent at equilibrium is proportional to the partial pressure of the gas. e\) Equal volumes of all gases, at the same temperature and pressure, have the same number of molecules. For a given mass of an ideal gas, the volume and amount (moles) of the gas are directly proportional if the temperature and pressure are constant. 183\) During normal inspiration: a\) Internal intercostal muscles contract b\) As soon as pressure in the airways becomes more positive than the atmospheric pressure, the pressure gradient drives airflow into the lungs c\) The volume in the thoracic cavity decreases to allow airflow into the lungs d\) Diaphragm relaxes e\) The pressure gradient draws air into the lungs 184\) Lung distending pressure\... a\) Is also known as intrapleural pressure 50 © Elevating Sisters, Teach Med Updated: March 2024 b\) Is the pressure difference between atmospheric and alveolar pressure c\) Is the pressure difference between intrapleural and atmospheric pressure d\) Is also known as alveolar pressure e\) Is the pressure difference between intrapleural and alveolar pressure 185\) The inspiratory process involves\... a\) Air flowing into the lung when the atmospheric pressure becomes lower than the alveolar pressure. b\) A positive intrapleural pressure c\) A negative intrapleural pressure d\) A decreasing transpulmonary pressure e\) Increasing dimensions of the thoracic cavity which increase intrapleural pressure and airway pressure. 186\) Which of the following is true? a\) Anatomic dead space includes all of the lung, but not the alveoli or respiratory bronchioles and has a typical volume of 175ml. b\) Anatomic dead space includes respiratory bronchioles and alveoli only but not the rest of the lung and has a typical volume of 150ml. c\) Anatomic dead space includes physiologic dead space and has a typical volume of 150ml. d\) Anatomic dead space includes all of the lung, but not the alveoli or respiratory bronchioles and has a typical volume of 150ml. e\) Anatomic dead space includes physiologic dead space and has a typical volume of 175ml. 187\) In an average healthy adult male tidal volume is roughly\... a\) 500ml b\) 50ml c\) 5L d\) 0.5ml e\) 550ml 188\) During the expiratory process\... a\) Inspiratory muscles contract b\) Alveolar pressure \> mouth pressure c\) Intrapleural pressure becomes more negative d\) Transpulmonary pressure increases e\) Alveolar pressure \< mouth pressure 189\) What is internal respiration? 51 © Elevating Sisters, Teach Med Updated: March 2024 a\) The exchange of gases between blood, interstitial fluid & cells. b\) The exchange of gases between the capillaries surrounding the alveoli and air within the lungs. c\) The exchange of gases between the internal environment of the lungs and the external environment. d\) The exchange of gases (oxygen and carbon dioxide) between blood and the external environment. e\) The transport of oxygen and carbon dioxide around the body. 190\) How does air move into the alveoli during inspiration? a\) Air moves down a concentration gradient as the atmospheric pressure is less than the alveolar pressure. b\) Air moves up a pressure gradient as the atmospheric pressure is greater than the alveolar pressure. c\) Air moves down a pressure gradient as the atmospheric pressure is less than the alveolar pressure. d\) Air moves down a pressure gradient as the alveolar pressure is less than the atmospheric pressure. e\) Air moves down a concentration gradient as the alveolar concentration is less than the atmospheric concentration. 191\) Define flow through a tube in terms of pressure and resistance. a\) The pressure divided by resistance. b\) The diameter of the tube divided by the length of the tube. c\) The difference in pressure divided by the resistance through the tube. d\) The pressure is divided by the difference in resistance at two points along the tube. e\) The resistance along the tube is divided by the pressure. 192\) According to Boyles Law, compression of a space containing a fixed number of molecules, will have what effect? a\) the pressure and volume of the container to remain the same. b\) an increase in pressure and the volume of the container remains the same. c\) an increase in pressure, and the volume of the container decreases. d\) the volume of the container increasing, and the pressure decreasing. e\) the volume of the container decreases, but the pressure remains the same. 52 © Elevating Sisters, Teach Med Updated: March 2024 193\) What is the natural state of the lungs and chest wall? a\) The lungs will naturally recoil inwards, and the chest wall will naturally recoil outwards. b\) The lungs and wall are fixed in place due to a natural positive intrapleural pressure. c\) The lungs and chest wall naturally recoil inwards due to a negative intrapleural pressure. d\) The lungs naturally recoil inwards while the chest wall is fixed. e\) The lungs and chest wall naturally recoil outwards due to a negative intrapleural pressure. 194\) A patient comes in complaining of shortness of breath. You decide to check their lung function using a spirometer. Which of the following cannot be measured directly by spirometry? a\) Tidal volume b\) Inspiratory reserve volume c\) Inspiratory capacity d\) Total lung capacity e\) Vital capacity 195\) A patient has come into the respiratory clinic to get their lung volumes measured through spirometry. What is the average expiratory reserve volume (ERV), assuming that the patient is a 70kg young man? a\) 1500ml b\) 1700ml c\) 1800ml d\) 2000ml e\) 3300ml 196\) A 27 year old man is brought to A&E following a knife wound to the chest. The patient's chest wall collapsed inwardly. What muscle could have been damaged? a\) External intercostal muscles b\) Parasternal intercostal muscles c\) Internal intercostal muscles d\) Rectus abdominis e\) Internal oblique 53 © Elevating Sisters, Teach Med Updated: March 2024 197\) Patient X comes into the hospital with breathing problems and is then subsequently diagnosed with pulmonary fibrosis. Pulmonary fibrosis is a type of restrictive lung disease which stops the lungs from fully expanding. This limits the volume of air and oxygen that a person inhales during inspiration. Which of the following is the correct description of the pressure gradient required for inspiration? a\) PB \< Pm b\) PA \< Pm c\) PB \> Pm d\) PA \> Pm e\) PB \< PA 54 © Elevating Sisters, Teach Med Updated: March 2024 LUNG MECHANICS II 198\) What is elastic resistance? a\) Resistance to the stretch of the lung tissues and the air-liquid interface lining the alveoli. b\) Resistance due to the friction between layers of flowing air and between the air and airway walls. c\) Resistance between the elastic fibres of the bronchi and alveoli when they are filled with air during respiration. d\) Resistance between the stretch of the elastic tissue in the alveoli capillary walls. e\) Resistance between the air entering the alveoli during inspiration and the surfactant lining the alveoli. 199\) When laminar flow hits a sharp edge or branch point what can happen? a\) The air becomes turbulent, which increases the resistance and causes vibrations. b\) The air causes oscillation of walls of the airways. c\) The air that hits the branch points becomes turbulent, increasing the resistance while the air that does not continues in laminar flow. d\) The air becomes turbulent, which causes the resistance to decrease and vibrations to occur along the airways. e\) The air continues in laminar flow, with slight vibrations occurring down the airways. 200\) Wheezes are generated specifically by what? a\) Oscillations in the walls of the airways near an airway obstruction. b\) Oscillations when there is a high velocity air flow in narrowed severely obstructed airways. c\) When the airways become completely obstructed and oscillations occur down the closed airways. d\) Oscillations at the bronchi when a positive intrapleural pressure causes the collapse of airways. e\) Vibrations when the elastic resistance in the airways is too high. 201\) Which of the following is equal to lung compliance? a\) Change in lung volume / Change in intrapleural pressure gradient b\) Change in lung volume/ Change in transmural pressure gradient c\) Change in lung volume/ Change in alveolar pressure gradient d\) Change in lung surface area/ Change in transmural pressure gradient e\) Change in transmural pressure gradient/ Change in lung volume 55 © Elevating Sisters, Teach Med Updated: March 2024 202\) In forced expiration high intrapleural pressures can cause a\) Dynamic compression of airways b\) Slow decompression of airways c\) Dynamic extension of airways d\) Slow extension of airways e\) Slow compression of airways 203\) Which of the following is equal to the Transmural pressure gradient? a\) Intrapleural pressure -- Atmospheric pressure b\) Atmospheric pressure -- Alveolar pressure c\) Atmospheric pressure -- Intrapleural pressure d\) Alveolar pressure -- Intrapleural pressure e\) Intrapleural pressure -- Alveolar pressure 204\) The typical value of lung compliance in an adult male is a\) 11.4 L.kPa-1 b\) 2.1 L.kPa-1 c\) 1.5 L.kPa-1 d\) 1.6 L.Pa-1 e\) 8.0 L.kPa-1 205\) In lung fibrosis there is: a\) No elastic resistance and no compliance b\) High elastic resistance and high compliance c\) High elastic resistance and low compliance d\) Low elastic resistance and high compliance e\) Low elastic resistance and low compliance 206\) An example of an obstructive lung disease is a\) lung fibrosis b\) asbestosis c\) chronic bronchitis d\) respiratory muscle weakness e\) sarcoidosis 207\) Peak flow metres record a\) forced vital capacity b\) the minimum rate of air expelled from the lungs through an open mouth c\) tidal volume d\) the maximum rate of air expelled from the lungs through an open mouth e\) forced expiratory volume 56 © Elevating Sisters, Teach Med Updated: March 2024 208\) A normal FEV1/FVC ratio is around a\) 50% b\) 60% c\) 75% d\) 30% e\) 85% 209\) Considering a restrictive lung disease, which of the following statements are TRUE a\) A high FEV1 is recorded b\) a low FVC is recorded c\) readings are not affected by age, sex or height d\) The FEV1/FVC ratio is low e\) The recording for FEV1 and FVC are the same for an obstructive lung disease 210\) Emphysema leads to an increased functional residual capacity due to reduced lung recoil. What lung shape is caused as a result? a\) Barrel chest b\) Funnel chest c\) Pigeon chest d\) Traumatic Flail chest e\) Thoracic Kyphoscoliosis 211\) A 57-year-old woman is diagnosed with emphysema. She came into A&E with chest pain. What are the clinical manifestations of emphysema? a\) Shortness of breath as airways are poorly supported and alveoli are destroyed. b\) Shortness of breath as airways walls are damaged but the alveoli are normal. c\) Shortness of breath as airways are narrowed d\) A cough that produces a lot of mucus e\) Wheezing when exhaling 212\) Mr Burrich comes into A&E with persistent wheezing, increasing breathlessness and tightness in his chest. After x-rays, blood tests and lung function tests, Dr.Vestrit believes he has emphysema. Which of the following statements about this disease is incorrect? a\) It causes a decrease in FEV1/FVC (forced expiratory ratio) b\) Emphysema causes high lung compliance c\) It causes decreased FRC (Functional Residual Capacity) d\) It is an obstructive lung disease e\) It results in a concave appearance of forced expiratory curve 57 © Elevating Sisters, Teach Med Updated: March 2024 213\) A 45-year-old woman presents in A&E with trouble breathing. The doctors decide to measure her lung compliance. She inhales 2L of air and holds her breath. At the beginning of inspiration her lung transmural pressure is 0.2kPa, and whilst holding her breath it is measured as 1.8kPa. What is her lung compliance? a\) L.kPa-1 b\) 1.25 L.kPa-1 c\) 1.50 L.kPa-1 d\) 1.75 L.kPa-1 e\) 2.00 L.kPa-1 214\) A GP fails to hear sounds coming from a patient's chest upon pressing a stethoscope to the patient's chest using the correct technique. What does this indicate? a\) Mild asthma b\) Bradycardia c\) The stethoscope is broken d\) Severe asthma e\) Tachycardia 215\) There are two types of lung disease- obstructive and restrictive. A patient diagnosed with an obstructive lung disease has their lung function tested with a forced expiratory spirogram. How would the patient's FEV1 (forced expiratory volume in 1 second), and FVC (forced vital capacity) compare to that of a healthy individual (of the same age, size and sex etc) who took the same test? a\) The patient's FEV1 and FVC would be slightly decreased b\) The patient's FEV1 and FVC would be significantly decreased c\) The patient's FEV1 would be slightly decreased and their FVC would significantly be decreased d\) The patient's FEV1 would be significantly decreased and their FVC would be slightly decreased e\) The patient's FEV1/FVC would be increased 216\) A GP is seeing a teenager who has come in as their asthma has been worsening their breathing. Which of the following factors contributes to increased airway resistance that can make breathing more difficult in asthma? a\) Smooth laminar flow b\) Negative intrapleural pressure during normal breathing c\) Constriction of bronchial smooth muscles d\) Reduced inflammation of the airway epithelium e\) Strong Thoracic muscles 58 © Elevating Sisters, Teach Med Updated: March 2024 217\) A patient presents with respiratory distress. Suspecting a potential lung disease, you decide to measure the forced expiratory volume of the patient over time to obtain the FEV1/FVC ratio. How can the findings of FEV1 , FVC, and FEV1/FVC ratio allow you to distinguish between an obstructive and a restrictive lung disease? a\) Obstructive: FEV1 decreased, FVC decreased or normal, and FEV1/FVC ratio decreased; Restrictive: FEV1 decreased, FVC decreased, and FEV1/FVC ratio decreased or normal b\) Obstructive: FEV1 decreased, FVC decreased or normal, and FEV1/FVC ratio decreased; Restrictive: FEV1 decreased or normal, FVC decreased, and FEV1/FVC ratio normal or increased c\) Obstructive: FEV1 decreased, FVC decreased or normal, and FEV1/FVC ratio decreased; Restrictive: FEV1 decreased, FVC decreased, and FEV1/FVC ratio normal or increased d\) Obstructive: FEV1 decreased, FVC decreased or normal, and FEV1/FVC ratio decreased; Restrictive: FEV1 decreased or normal, FVC decreased, and FEV1/FVC ratio decreased or normal e\) Obstructive: FEV1 decreased, FVC decreased or normal, and FEV1/FVC ratio normal or increased; Restrictive: FEV1 decreased, FVC decreased, and FEV1/FVC ratio decreased 218\) A baby is diagnosed with 'Newborn Respiratory distress syndrome' - a disorder where the baby's lungs have not produced enough surfactant. What is the role of surfactant as alveoli shrink? a\) Surface surfactant concentration decreases so surface tension falls. b\) Surface surfactant concentration increases so pressure increases. c\) Type 2 alveolar cells stop producing surfactant. d\) Surface surfactant concentration increases so there is a higher tendency for alveoli to collapse. e\) Surface surfactant concentration increases so surface tension falls. 59 © Elevating Sisters, Teach Med Updated: March 2024 TUTORIAL 3-CARDIAC: QUESTION SHEET 219\) According to the diagram of a ventricular action potential displayed below, what does the phase marked '2' refer to? 4 a\) Voltage gated K \+ (out) and Ca2+ (in) channels open b\) Voltage-gated Na+ channels close c\) Slow voltage gated Ca2+ (in) channels closing d\) Slow/leaky Na+ channels e\) Voltage-gated K \+ (out) channels closing 220\) Why has the ventricular action potential evolved over a long duration? a\) To cause tetany b\) Shorter durations protect against reentrant arrhythmias c\) To prevent tetany d\) The heart should not relax between beats e\) So that the action potential can get longer as rates increase 4 "Ventricular action potential", Wikipedia. Accessed March 1, 2021, https://en.wikipedia.org/wiki/Ventricular\_action\_potential 60 © Elevating Sisters, Teach Med Updated: March 2024 221\) Typically, the cells in the centre of the sino-atrial (SA) node have higher resting membrane potentials. Slow diastolic depolarisation accelerates to a threshold before firing an action potential in which the upstroke is dominated by: a\) Funny current (If) b\) L-type Ca current c\) Na/Ca exchanger current d\) Na+ current e\) T-type Ca current 222\) The funny current (If) is funny because\... a\) It is an inward current that activates when the cell membrane gets more negative b\) It is an inward current that activates when the cell membrane gets more positive c\) It is an outward current that activates when the cell membrane gets more positive d\) It is an outward current that activates when the cell membrane gets more negative e\) It is a voltage-gated Na channel that is activated when the membrane gets more positive 223\) The absolute refractory period is: a\) The period of time where another action potential is possible, regardless of the size of the stimulus. b\) The period of time when the Na channels are open. c\) The period of time where the initiation of an action potential is inhibited but not impossible. d\) The period of time before the ventricular action potential occurs. e\) The period of time where another action potential is impossible, regardless of the size of the stimulus. 224\) Beta-1 adrenoreceptors principally activate which kinase? a\) Protein Kinase A b\) Creatine Kinase c\) Protein Kinase B d\) Troponin e\) Myosin 225\) The principle mechanism which triggers Ca release from cardiac muscle sarcoplasmic reticulum is: a\) Voltage-induced Ca release b\) Na/Ca exchange c\) Ca-induced Ca release d\) Na/K exchange e\) IP3-induced Ca release 61 © Elevating Sisters, Teach Med Updated: March 2024 226\) The principle mechanism triggering Ca release from skeletal muscle sarcoplasmic reticulum is: a\) Voltage-induced Ca release b\) Na/Ca exchange c\) Ca-induced Ca release d\) Na/K exchange e\) IP3-induced Ca release 227\) This is a question regarding the electrocardiogram (ECG). What does the P-Q interval tell us? 5 a\) Ventricular conduction velocity b\) Presence of ischaemia c\) Ventricular action potential duration d\) Atrial conduction and AV nodal delay e\) Long QT syndrome 228\) What type of drug changes the force of heart contractions? a\) Chronotropic agent. b\) Bathmotropic. c\) Lusitropic agent. d\) Dromotropic agent. e\) Inotropic agents. 5 "Tutorial 3-Initiation of the Heartbeat-Answers", King's College London. Accessed March 1, 2021, https://keats.kcl.ac.uk/pluginfile.php/6827483/mod\_resource/content/1/Tutorial%20Initiation%20of%20the%20heart%20beat%202021% 20student%20answers.pdf 62 © Elevating Sisters, Teach Med Updated: March 2024 229\) Rita is prescribed Iamrinone. Iamrinone has positive lusitropic effects. What is the effect of a positively lusitropic drug on the heart? a\) An increase in heart rate b\) An increase in the rate of relaxation c\) A strengthening of contraction of the heart d\) A decrease in heart rate e\) A decrease in the rate of relaxation 230\) A patient has been referred to the cardiologist for an ECG after they reported shortness of breath during exercise and a significantly higher blood pressure - signs of an irregular heartbeat. An ECG tracks the electrical impulses emitted from the heart. Which of the following is true of an ECG? a\) The P-Q interval represents atrial conduction and SA nodal delay b\) An AV block can affect the QRS duration c\) The S-T segment is not affected by myocardial infarction d\) The Q-T interval represents ventricular action potential duration e\) In a healthy person, QRS duration is longer than P-R du

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