MCAT Topic Focus Biochemistry and Biology

Biology Blood Pressure Regulation Passage 1

1. B Colloid is used to increase the osmotic draw of the intravascular space. The large molecules
are unable to diffuse out of the blood vessels, unlike the small, ionic sodium and chloride mol-
ecules which rapidly equilibrate. Choice A is incorrect; if the crystalloid solution had a higher
osmolality than the colloid, it would be more effective at drawing water into the blood vessels
and raising blood pressure. Choices C and D are both false statements; sodium and chloride are
components of blood and colloid molecules do not activate the sympathetic nervous system.

2. C According to the passage, neurogenic shock is caused by an injury to the sympathetic nervous
system. It is safe to assume the injury would lead to malfunction of this system, thus a loss of
sympathetic tone, which results in vasodilation (leading to low blood pressure) and a slow heart
rate (due to overriding parasympathetic tone). Statement III is true. Cardiogenic and hypovole-
mic shock are characterized by low blood pressure along with an increase in heart rate, since loss
of sympathetic function does not occur in these instances. Statements I and II are false.

3. D Hb O2 saturation is only a good measure of hemoglobin O2 saturation. It tells us nothing of

how much O2 is actually reaching the tissues (choice A is wrong). Although knowing the oxy-
gen content of a tissue sample would be useful, it is very invasive and would take a long time to
process (choice C is wrong). CVP is a useful measure of shock, but it is more invasive than sim-
ply measuring blood lactate levels (choice B is wrong). Remember that as cells become hypoxic,
they will switch to anaerobic metabolism and generate more lactic acid.

4. D The parasympathetic system does not innervate blood vessels and thus does not affect SVR (choice
A is wrong). If the heart moved less blood with each beat (i.e., the stroke volume decreased) or if
the heart rate decreased, cardiac output would be reduced, not increased as is described in the
question (choices B and C are wrong). A systemic inflammatory response occurs in septic shock
and causes dilation of almost all blood vessels, leading to very low blood pressures.

5 A This question stumps many a medical resident, “floating the swan” for the first time. It’s really
not that difficult, but the graphs can be confusing, especially in real time. You can answer the
question without Figure 1 if you think it through; the graph is of course in the order that the
catheter passes through the heart! Region A (choice D) is the right atrium. Region B (choice A)
is the right ventricle. Region C (choice C) is the pulmonary artery. Region D (choice B) is the
wedge tracing. Region B is the correct region because systolic pressures are high and diastolic
pressures are equivalent to CVP (right atrial pressure, Region A), as discussed in the passage. In
Region C, note that the diastolic pressure has risen due to elasticity of the pulmonary artery and
the fact that the pulmonic valve has closed. In Region D, the pressures are no longer pulsatile,
and the catheter has equilibrated with the return flow to the left side of the heart.

6. C Equation 1 relates mean arterial pressure to cardiac output and SVR (total peripheral resistance).
The relationship is directly proportional; the equation can be rearranged so that this is more ob-
vious (MAP = CO × SVR). Thus, changes in CO or SVR will result in corresponding changes
in mean arterial pressure. An increase in stroke volume would lead to an increase in cardiac
output (recall that CO = stroke volume × heart rate), and thus an increase in MAP (choice A is
true and eliminated). If this were accompanied by systemic vasoconstriction (in other words, an
increase in SVR) the pressure would rise even higher (choice D is true and eliminated). Simi-
larly, an increase in heart rate would raise CO, and without a corresponding decrease in SVR,
MAP would increase (choice B is true and eliminated). A decrease in heart rate, however, would
decrease cardiac output and blood pressure. If this were accompanied by a proportional increase
in SVR, then MAP would remain unchanged (choice C is false and the correct answer choice).
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