Week 1

In-Video Quiz Questions

This document contains all of this week's in-video quiz questions. We are providing the questions in this format
because we know that some of you would prefer to have a permanent record of the quiz questions to aid your
study. Also, if you are downloading the lectures to watch off-line, you do not have access to the in-video quiz
questions. Answers to the questions are provided at the end of the quiz. If you miss a question, we encourage you
to consult the lecture outline and watch the video again so that the correct answer makes sense to you.

1.1 Basic Heart Anatomy

1. The heart is located in the ________________ where it is surrounded by a protective membrane sac called the
_________________.
A. abdominal cavity . . . pleurae C. mediastinum . . . pericardium
B. thoracic cavity . . . pleurae D. mediastinum . . . pleurae

2. All of the chambers of the heart have muscular walls. The muscle layer is thickest in the ______________.
A. right atrium C. left atrium
B. right ventricle D. left ventricle

3. Oxygenated blood returns to the left atrium via the _______________. The left ventricle then ejects this
oxygenated blood into the _________________.
A. superior vena cava and inferior vena cava . . . pulmonary trunk
B. pulmonary veins . . . pulmonary trunk
C. pulmonary veins . . aorta
D. superior vena cava and coronary sinus . . . aorta

4. The right ventricular wall is thicker than the left ventricular wall because the right ventricle pumps blood
through the aorta.
A. True
B. False

5. The _______________ carries the blood that supplied the walls of the heart back to the right atrium.
A. superior vena cava C. coronary sinus
B. inferior vena cava D. aorta

6. The pulmonary trunk carries deoxygenated blood toward the lungs.

A. True
B. False

Answers: 1(C), 2(D), 3(C), 4(B), 5(C), 6(A)

1.2a Your Beating Heart

1. The electrical impulse that generates rhythmic and coordinated contraction of the heart is normally initiated in
the __________________.
A. SA node C. AV bundle
B. AV node D. right and left bundle branches

2. The short delay in impulse conduction at the ________________ allows time for the atria to contract before
the ventricles begin contracting.
A. SA node C. AV bundle
B. AV node D. Purkinje fibers

3. The part of the cardiac conduction system that excites contraction of the interventricular septum is the
__________________.
A. SA node C. right and left bundle branches
B. AV bundle D. Purkinje fibers

4. The only electrical connection between the atria and ventricles is the __________________.
A. SA node C. AV bundle
B. AV node D. right and left bundle branches

5. All myocardial cells (i.e., cardiac muscle cells) can generate an electrical signal.
A. True

B. False

Answers: 1(A), 2(B), 3(C), 4(C), 5(A)

1.2b ECG Demonstration

1. On an ECG tracing, isoelectric lines represent time periods when there is no change in the electrical activity of
the heart.
A. True
B. False

2. The ECG waveform that represents ventricular depolarization is the _________________.

A. P wave
B. QRS complex
C. T wave

3. The ECG waveform that represents ventricular repolarization is the __________________.

A. P wave
B. QRS complex
C. T wave

4. The ECG waveform that represents atrial depolarization is the __________________.

A. P wave
B. QRS complex
C. T wave

5. When does the atrium repolarize?

A. before ventricular depolarization
B. after ventricular depolarization
C. during ventricular depolarization
D. The atrium never repolarizes.

Answers: 1(A), 2(B), 3(C), 4(A), 5(C)

1.3a Heart Valves, Part 1

1. When pressure in the ventricles becomes higher than pressure in the atria, the AV valves ___________.
A. open
B. close

2. The left AV valve is called the _________________.

A. aortic valve C. mitral valve
B. pulmonic valve D. tricuspid valve

3. The valve which prevents blood from flowing backward from the right ventricle to the right atrium during
ventricular contraction is the __________________.
A. aortic valve C. mitral valve
B. pulmonic valve D. tricuspid valve

4. What thready structures made of tough collagen help to hold the AV valves in the closed position during
ventricular contraction?
A. chordae tendineae C. AV bundle
B. right and left bundle branches D. papillary muscles

Answers: 1(B), 2(C), 3(D), 4(A)

1.3b Heart Valves, Part 2

1. Which valve prevents the backflow of blood into the left ventricle during ventricular relaxation?
A. aortic valve C. mitral valve
B. pulmonic valve D. tricuspid valve

2. During the ventricular contraction phase, the first change in valve position is _______________.
A. AV valves close C. semilunar valves close
B. AV valves open D. semilunar valves open

3. Closing of the semilunar valves creates the ________ heart sound.

A. first
B. second

4. When pressure in the atrium becomes higher than pressure in the ventricle,
_____________________________.
A. the semilunar valve opens C. the AV valve opens
B. thesemilunar valve closes D. the AV valve closes

5. Which valve prevents the backflow of blood into the left atrium during ventricular contraction?
A. aortic valve C. mitral valve
B. pulmonic valve D. tricuspid valve

Answers: 1(A), 2(A), 3(B), 4(C), 5(C)

1.3c Assessing Heart Rate Demonstration

1. The act of listening to sounds that arise within body organs, usually with a stethoscope, is called
_________________.
A. palpation
B. auscultation

2. The most accurate way to assess heart rate is to ______________.

A. auscultate at the point of maximal impulse
B. palpate at the point of maximal impulse
C. palpate a large artery

3. A heart murmur, which creates a swishing sound, occurs when a heart valve does not close properly.
A. True
B. False

4. The point of maximal impulse is where the apex rests between the 5th and 6th rib.
A. True

B. False

5. S1 occurs when the _____________________.

A. AV valves close C. semilunar valves open
B. AV valves open D. semilunar valves close

Answers: 1(B), 2(A), 3(A), 4(A), 5(A)

1.4a Cardiac Cycle, Part 1
1. Which of the following terms is used to denote the series of events that occur in the heart, each and every time
the heart beats?
A. depolarization C. the cardiac cycle
B. repolarization D. electrocardiogram (ECG)

2. Which of the following cells insures that the heart contracts in a rhythmic sequence?
A. myocardial conducting cells
B. myocardial contracting cells

3. Isoelectric lines on an ECG tracing represent periods when ___________________.

A. all of the myocardial cells are simultaneously depolarizing
B. all of the myocardial cells are simultaneously repolarizing
C. there is no change in the electrical state of the myocardial cells

Answers: 1(C), 2(A), 3(C)

1.4b Cardiac Cycle, Part 2

1. During the cardiac cycle, the ventricles hold their largest volume of blood, called _______________ at the end
of ________________.
A. ESV (end systolic volume) . . . ventricular systole
B. EDV (end diastolic volume). . . . ventricular diastole

2. The onset of ventricular diastole is associated with the closing of the __________ valves, and the onset of
ventricular systole is associated with the closing of the ____________ valves.
A. semilunar. . . .atrioventricular
B. atrioventricular. . . . semilunar

3. The phase of the cardiac cycle in which the myocardium contracts and ejects blood into the larger arteries (i.e.,
the aorta and pulmonary trunk) is called ____________________.
A. atrial diastole C. ventricular diastole
B. atrial systole D. ventricular systole

4. Ventricular systole creates less pressure than atrial systole.

A. True
B. False

5. What ECG event represents the depolarization which triggers ventricular systole?
A. P wave
B. QRS complex
C. T wave

Answers: 1(B), 2(A), 3(D), 4(B), 5(B)

1.4c Assessing Pulse Demonstration

1. In people with healthy cardiovascular function, pulse rate is equal to heart rate.
A. True

B. False

2. Blood is ejected into the aorta during ventricular systole, creating a wave of pressure in the systemic
circulation. This wave creates distension of the blood vessel walls which is called the pulse.
A. True
B. False

3. The pulse may be especially strong in a person whose heart is beating very weakly.
A. True

B. False

4. Where is the radial artery pulse palpated?

A. bend of the hip (i.e., the groin area) C. behind the knee
B. wrist D. on the foot

Answers: 1(A), 2(A), 3(B), 4(B)

1.5 Cardiac Output

1. Use the following information to answer this question. Heart rate = 70 beats per minute (bpm). End diastolic
volume (EDV) = 120 mL. End systolic volume = 50 mL. What is the cardiac output?
A. 3.5 L/min C. 8.4 L/min
B. 4.9 L/min D. 7 L/min

2. What parts of the heart are innervated by the sympathetic nervous system?
A. AV node, SA node
B. AV valves, SL valves
C. SA node, AV valves, AV node
D. SA node, AV node, myocardial contractile cells

3. What parts of the heart are innervated by the parasympathetic nervous system?
A. AV node, SA node
B. SA node, AV valves, AV node
C. AV valves, SL valves
D. SA node, AV node, myocardial contractile cells

4. The parasympathetic division of the autonomic nervous system slows the heart rate by _________________.

A. slowing the rate of blood flow back to the heart during diastole
B. causing the myocardial contractile cells to contract for a longer time
C. slowing the self-excitation rate of the SA node and prolonging impulse delay in the AV node
D. causing the myocardial contractile cells to contract more forcefully

Answers: 1(B), 2(D), 3(A), 4(C)

Week 1 Quiz

1. The tricuspid valve is located:

between the right atrium and right ventricle.
between the left atrium and aorta.
between the left atrium and left ventricle.

2. The first heart sound (S1) is caused by closure of the AV valves and the second heart sound (S2) is
caused by closure of the SL valves.
True
False

3. The two valves located on the right side of the heart are the:
aortic valve and pulmonary valve.
mitral valve and pulmonary valve.
tricuspid valve and pulmonary valve.
aortic valve and mitral valve.

4. Oxygenated blood flows from the pulmonary circulation into the right atrium via the pulmonary veins.
True
False

5. The mitral valve is closed during:

ventricular diastole.
ventricular systole.
both ventricular systole and diastole.
neither ventricular systole or diastole.

6. Blood returns to the heart from the systemic circulation through which blood vessels?
aorta, coronary sinus, pulmonary veins
inferior vena cava, superior vena cava, coronary sinus
pulmonary veins, inferior vena cava, superior vena cava
inferior vena cava, superior vena cava, aorta
7. Tachycardia and bradycardia are respectively defined as heart rate greater than _____ beats per minute
(bpm) and heart rate less than _____ bpm.
80 . . . 60
100 . . . 60
120 . . .50
100 . . . 50

8. Choose the answer that correctly depicts the order of impulse conduction in the cardiac conduction
system.
SA node > AV bundle > AV node > Purkinje fibers > left and right bundle branches
AV node > AV bundle > SA node > Purkinje fibers > left and right bundle branches
SA node > AV node > AV bundle > left and right bundle branches > Purkinje fibers
SA node > AV bundle > AV node > left and right bundle branches > Purkinje fibers

9. The AV node is considered the heart's pacemaker.

True
False

10. On an electrocardiogram the QRS complex results from ____________ and the P wave results from
______________.
ventricular depolarization . . . atrial depolarization
ventricular depolarization . . . ventricular repolarization
ventricular depolarization . . . atrial repolarization
atrial depolarization . . . ventricular depolarization

11. Which of the following factors can increase cardiac output?

Increasing heart rate, increasing the contractility of the heart (i.e., increasing the forcefulness of
contraction), increasing end diastolic volume

decreasing heart rate, decreasing end diastolic volume, decreasing contractility of the heart
increasing stroke volume, decreasing heart rate, decreasing contractility of the heart

12. Case Study #1: Ventricular Septal DefectHere is the case study you will use to answer next set of
questions. I hope you enjoy the case!

Maria and her newborn daughter Isabelle were discharged from the hospital approximately 5 weeks ago.
Maria has noticed that Isabelle is not eating well. Isabelle never seemed to latch well during breast
feeding. Two weeks ago Maria switched to bottle feeding with formula. Maria still feels that Isabelle is
feeding poorly even after switching to bottle feeding. Isabelle does not feed for very long, and drinks only
about 1 ounce at a time. Maria notices that Isabelle seems to breathe heavily all the time, but that her
breathing gets even worse after feeding. Maria decides to see a nurse practitioner (NP) in order to discuss
her concerns about Isabelle’s difficulty feeding and breathing.

After listening to Maria’s concerns, the NP weighs Isabelle and performs a physical exam. When the NP
auscultates Isabelle’s chest, she hears a murmur. The NP is concerned both by the murmur, and because
Isabelle has not gained much weight since birth. The NP decides to order an ECG and an echocardiogram
to evaluate Isabelle’s heart. The ECG will show Isabelle’s heart rate and rhythm. The echocardiogram
(ultrasound of the heart) will provide a picture of Isabelle’s heart structure, and show how blood flows
through Isabelle’s heart. For some of the case study questions you should imagine that blood in the heart is
color-coded according to its oxygenation status (oxygenated blood is red, deoxygenated blood is blue).

The echocardiogram reveal that Isabelle’s murmur is caused by something called a ventricular septal
defect (VSD). A VSD is a hole in the interventricular septum, the wall of muscle that separates the left
ventricle from the right ventricle. The ECG shows sinus rhythm with no conduction abnormalities.

Think about the position of the heart in the chest cavity. Isabelle's VSD is in the interventricular septum
between the mitral and tricuspid valves. At what anatomical location would the NP best hear Isabelle's
murmur?
Between the right lower sternal border and the left lower sternal border
Between the right upper sternal border and the left upper sternal border
At the second intercostal space at the left upper sternal border
At the fifth intercostal space at the left midclavicular line

13. Choose the answer that correctly depicts the order of blood flow through a normal heart and major
blood vessels:
Right atrium > right ventricle > pulmonary trunk > pulmonary veins > left atrium > left ventricle >
aorta
Pulmonary trunk > pulmonary veins > right atrium > right ventricle > left atrium > left ventricle >
aorta
Right atrium > right ventricle > pulmonary veins > pulmonary trunk > left atrium > left ventricle >
aorta
Right ventricle > right atrium > pulmonary trunk > pulmonary veins > left ventricle > left atrium >
aorta

14. In what, if any, manner would you expect a VSD to alter the flow of blood through Isabelle's heart?
I would expect that some blood would flow from the left ventricle to the right ventricle during systole
due to higher pressure in the left ventricle during systole.
I would not expect a VSD to change the direction of blood flow through the heart.
I would expect that some blood would passively flow from the right ventricle to the left ventricle
during diastole due to lower pressure in the left ventricle during diastole.
15. In the heart of a person without a VSD, blood in the right ventricle would be _________, and blood in
the left ventricle would be _________.
oxygenated....deoxygenated
deoxygenated....deoxygenated
oxygenated....oxygenated
deoxygenated....oxygenated

16. Remember to imagine that blood in the heart is color-coded according to its oxygenation status
(oxygenated blood is red, and deoxygenated blood is blue). What color of blood would you expect to see
in Isabelle's left ventricle?
Red
Blue
Both red and blue

17. Remember to imagine that blood in the heart is color-coded according to its oxygenation status
(oxygenated blood is red, deoxygenated blood is blue). What color of blood would you expect to see in
Isabelle's right ventricle?
Red
Blue
Both red and blue

18. Cardiac output is the volume of blood pumped by each ventricle per minute. The cardiac output is the
product of:
Stroke volume and end systolic volume
End diastolic volume and heart rate
End diastolic volume and end systolic volume
Stroke volume and heart rate

19. How would you expect the VSD to affect Isabelle's cardiac output?
Cardiac output would not change.
Cardiac output would decrease because stroke volume would decrease.
Cardiac output would increase because stroke volume would increase.
Cardiac output would decrease because heart rate would decrease.
20. Remember that a VSD is located in the interventricular septum. Based on the location of a VSD, what
part of the cardiac conduction system might be affected?
Sinoatrial node
Atrioventricular bundle (bundle of His)
Bundle branches
Both the atrioventricular bundle and the bundle branches

21. Case Study #2: Pulmonary Valve StenosisPlease use the following case study to answer the remaining
quiz questions. Enjoy the case!

You are taking care of Carl, a one month old with pulmonary valve stenosis. Pulmonary valve stenosis is a
narrowing of the pulmonary valve. You notice Carl is cyanotic (bluish in color), lethargic, and irritable.

When you auscultate Carl's heart with a stethoscope, do you expect to hear a murmur?
Yes, I expect there to be a murmur when either the AV or SL valves do not function normally.
No, I expect there to be a murmur only when the AV valve does not function properly.
No, I expect there to be a murmur only when the SL valve does not function properly.
No, a murmur is never heard when a SL valve is not functioning properly.

22. The wall of a heart chamber thickens, or hypertrophies, when the chamber has to work extra hard to
eject blood. Given Carl's pulmonary valve stenosis, which part of his heart may become hypertrophied?
right atrium
right ventricle
left atrium
left ventricle

23. Why do you think Carl has cyanosis, or a bluish skin color?
Because it is difficult for Carl's heart to pump blood into the pulmonary circulation, deoxygenated
blood will be pumped from the right ventricle into the aorta.
Because it is difficult for Carl's heart to pump blood into the pulmonary circulation, his blood will
contain a higher than normal percentage of deoxygenated blood. Deoxygenated blood has a dark red or
purplish color, which causes Carl's skin to have a bluish tint.
Because it is difficult for Carl's heart to pump blood into the pulmonary circulation, blood will flow
from the superior vena cava into the left ventricle and will be pumped directly back into the systemic
circulation.

Answer:
1a, 2a, 3c, 4b, 5b, 6b, 7b, 8c, 9b, 10a, 11a, 12a, 13a, 14a, 15d, 16a, 17c, 18d, 19b, 20d, 21a, 22b, 23b