PHYSIO 3rd LE Feedback 10.

Which of the following does not cause a negative

chonotropic effect?
1. In this type of arrangement, blood flow changes in one vascular a. Decreased slope of phase 4
bed will other the blood flow of other vascular beds. b. Hyperpolarizing cell
a. In series c. Increased threshold
b. In parallel d. Increased slope of phase 4

2. The Na+/K+ pump and Ca2+ ATPase pumps function to:

c. Prevent depolarization

3. In a patient in surgery, to put patient in heart arrest, what can be

done to alter the resting membrane potential from -90mV to -50mV?
a. Decrease in serum K+
b. Increase in serum K+
c. _
d. Increase in intracellular K+

4. The inactivation of Na+ channels require the closure of

which gate:
a. m
b. h
c. d
d. f
*(positive chronotropy, increase slope of phase 4: negative
5. Slow diastolic depolarization of slow response action chronotropy, decrease slope of phase 4)
potential exhibits:
a. Contractility – not an electrical property 11. Cardiac action potential prevents tetanus by
b. Automaticity a. Resting membrane potential of -90 mV
c. Conductivity b. Automaticity
d. All of the above c. Responsiveness to change in ion concentration
d. Long absolute refractory period
6. Prepotential may be due to:
a. Slow K+ current
*Limits the number of impulses
b. Transient Ca2+ that can be transmitted from
c. Slow Ca2+ atria to the ventricles (230
d. Slow Na+ impulse/min). This protects the
e. Fast Na+ - phase 0 of fast response action potential ventricles from receiving high
* Pre-potential (Phase 0 of slow response action potential or frequency of impulse from the
atria.
spontaneous depolarization or slow diastolic)

7. In contrast to nerve and muscle action potentials, the

cardiac muscle action potential.
a. has shorter duration
b. Requires neuronal stimulation
c. is self-regenerating
d. has transient Ca2+

8. In pacemaker action potential, the depolarizing current is

caused by:
a. Slow Na+
b. Fast Na+ 12. The sympathetic nervous system increases inotropic effect
c. Slow Ca2+ while, the parasympathetic nervous system has
d. Transient Ca2+ a. Negative inotropic effect
b. Positive inotropic effect
9. Ca+ channel blockers affect which phase: c. Little effect on inotropy
a. Resting *(See right column, page 10 of Trans 3.1)
b. Depolarization *Decrease force of contraction, negative inotropy
c. Initial repolarization *Parasympathetics have little effect on inotropy
d. Plateau – Phase 2 (no change in membrane potential
because of entry of Ca+ ions and exit of K+) 13. Which is the most important factor causing AV nodal delay
e. Repolarization a. Diameter of cells in AV node
b. Amplitude of action potential
c. Rate of rise of action potential

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 d. Resistive property of gap junction

18. Appearance in limb leads depends on the patient’s mean

electrical axis
a. P wave
*Junctional fibers of AV node are very small. b. QRS complex
c. ST segment
14. The SA node is the primary pacemaker because of d. T wave
a. AV nodal delay e. U wave
b. Functional syncytium
c. Overdrive suppression
d. Depolarized

15. Synchronized contraction in the heart is due to

a. Transverse tubules
b. Mitochondria
c. Gap junctions
d. Sarcoplasmic reticulum
e. All of the above
* Gap-junction: faster cell-cell signals, instead of synapses;
permit the function of cardiac muscles as if it were a 19. T wave represents
syncytium. a. Atrial depolarization
b. Atrial repolarization
16. The phase 2 of ventricular action potential is c. Ventricular depolarization
represented in the ECG as the: d. Ventricular repolarization
a. P wave e. Repolarization of Purkinje fibers
b. PR segment
c. QRS complex 20. Duration of this interval varies with heart rate
d. ST segment a. PR
e. T wave b. QRS
c. QT
d. ST
e. TT

*Represents total ventricular activity; duration varies with heart rate,

age, sex

21. Contractile strength of myocardial cells depends on

a. Initial length of cardiac muscles
b. Afterload
c. Preload
d. All of the above

*(Repolarization) Contractile strength of myocytes = force of contraction

17. A PR interval value of 0.28s can be interpreted as
a. Normal sinus rhythm 22. Which of the following has positive inotropic effect?
b. Normal physiologic conductance delay a. Presence of acetylcholine
c. Delay of conduction at AV node b. Beta-receptor antagonist
d. Early ventricular repolarization effect c. Ca2+ channel blockers
e. Delay of ventricular repolarization d. Inhibitors of Na+-K+ ATPase pump activity
*An increase in heart rate also stimulates inotropy (Bowditch effect;
treppe; frequency-dependent inotropy). This latter phenomenon is
probably due to an inability of theNa+/K+-ATPase to keep up with the
sodium influx at higher heart rates, which leads to an accumulation of
intracellular calcium via the  sodium-calcium exchanger
23. Sympathetic stimulation will result in the following EXCEPT
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 a. Increase in heart rate d. An important determinant of diastolic pressure
b. Positive dromotropic effect
c. Decrease in lusitropic effect (Lusitropy- rate of relaxation 29. Rapid ventricular filling
or distensibility) a. Occurs immediately after closure of aortic valve
d. Decrease in diastolic filling time b. results to pansystolic murmur
c. –
*Effects of norepinephrine (sympathetic stimulation) include: (+) d. Occurs with opening of AV
chronotropy, (+) dromotropy, (+) inotropy, (+) lusitropy
* ↓in intraventricular pressure → open the AV valves → ventricular
24. Observed in patients with increased parasympathetic nervous filling begins
system activity
a. Decreased cardiac contractility 30. Decreased cardiac output
b. Increased heart rate a. Decreased heart rate
c. Increased end diastolic volume b. Decreased afterload
d. Increased end systolic volume c. Decreased total peripheral resistance
d. None of the above
*Parasympathetic stimulation = no innervation on ventricles =
decreased heart rate – increased filling time – increased end diastolic For numbers 31-35:
volume – stretching of myocytes – greater contractile strength

25. What is stroke volume?

a. Amount of blood ejected per minute
b. Increased when end diastolic volume is increased
c. Rapid ejection phase
d. Rapid filling of ventricles

*Increase in venous return – increase in the filled volume (EDV) of the

ventricle, stretching the muscle fibers - increase in the force of
ventricular contraction and enables the heart to eject the additional
blood that was returned to it - increase in EDV - increase in SV

26. Increased pressure in ventricles exceeding that of the aorta

a. Isovolumetric relaxation
b. Isovolumetric contraction
c. Rapid ejection phase
d. Rapid filling of ventricles
a. Loop X
b. Loop Y
*Increase in ventricular pressure – opening of SL valves – increase in
c. Loop Z
aortic blood flow
d. None of the above
27. Increased ESV may be due to
31. Increased afterload - D
a. Decreased cardiac contractility (inotropy)
32. Increased preload - A
b. Increased chronotropic effect
33. Increased cardiac contractility - B
c. Decreased aortic pressure
34. Normal Pressure-Volume Loop - C
d. Decreased lusitropy
35. Increased heart rate – D

36. Greatest blood pressure drop in both pulmonic and systemic

circulation is at the
a. Arteries
b. Arterioles
c. Capillaries
d. Venules

37. Most important factor in determining resistance to blood

flow
a. Vessel radius
b. Series arrangement of vessels
c. Viscosity
28. What is true of compliance?
d. –
a. 4th heart sound is associated with a very compliant left
ventricle
38. Given the resistance of 3 parallel vessels BV1R= 2 BV2R=4
b. Change in pressure with a change in volume
BV3R=5
c. Right ventricle is less compliant than left
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 a. 1 may have increased
b. 0.95 c. a large volume of albumin may have flowed within the
c. 0.85 capillary  
d. 11 d. the pre capillary sphincter may have contracted
39. What maintains the blood flow in the systemic circulation
during diastole
a. Elastic recoil of arteries For #'s 48-55
b. Resistance of venules A = if X and Y are directly related
c. Pressure difference between systemic and pulmonic vessels B = if X and Y are inversely related
d. Shear pressure on arterial walls C = if the X and Y are NOT related
40. Given a systolic blood pressure  of 170 mmHg and a For numbers 48-50. Consider blood flow in the circulation (Q = (
diastolic blood pressure of 70 mmHg, compute for the mean 48. X = velocity of blood flow               B
arterial pressure Y = apparent blood viscosity
a. 60 mmHg *Resistance by blood: DIRECTLY related to BLOODVISCOSITY
b. 66.6 mmHg ↑ viscosity ↑ resistance
c. 90 mmHg
d. 100 mmHg 49. X = cross-sectional area                  B
Y = blood flow
41. The equilibrium point is seen when
a. Atrial pressure and end diastolic pressure are ___ 50. X = elasticity of the aorta               B
b. – Y = pulse pressure
c. Venous return and cardiac output are equal *PP is directly proportional to heart’s pumping action and inversely
d. – proportional to compliance of aorta

42. Arterioles are very sensitive to 51. In a compliant vessel:

a. Are very sensitive to sympathetic stimulation X = blood flow                               A
b. Have no spontaneous contractions Y = perfusion pressure
c. – *If pressure drops too low, autoregulation fails and organ perfusion
d. – drops. High pressure, excessive flow occurs
e. Only A and C are correct

43. Patient with beta-1 receptors blocker for hypertension

suddenly stood after lying flat for 30 mins
a. Systolic blood pressure increase is greater than diastolic
blood pressure increase
b. Diastolic blood pressure increase is greater than systolic
blood pressure increase
c. No change in systolic blood pressure
d. No change in diastolic blood pressure

44. Severe anaphylaxis (allergy) can lead to shock mainly affects

blood pressure by
52. According to Bernoulli's principle: 
a. Increased stroke volume
X = cross sectional area of vessel     B
b. Decreased blood volume
Y = dynamic pressure of blood
c. Decreased total peripheral resistance
d. Increased venous return
53. X = blood viscosity                        B
Y = Reynold's number
45. What factors will increase venous return
a. Prolonged immobilization in bed
b. Zumba session
c. Straining to lift a heavy barbell
d. Pregnancy at 8 months

46. In the capillary, the exchange of fluid and macromolecules

occurs most prominently at the:
a. arteriolar junction
b. middle of the capillary
c. venular junction
d. whole length of the capillary 54. X = hydrostatic fluid pressure           A
Y = lymphatic drainage of tissue
47. The net filtration pressure in a capillary was (-) 5 mmHg 55. X = total area of the capillary           A
a. the value is within normal limits Y = rate of capillary fluid filtration
b. hydrostatic pressure within the capillary
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*Rationale: Physio Trans 3.5 Blood Vessel Physiology, pg. 13

61. This receives blood during diastole

a. Lungs
b. Heart
c. Liver
d. Kidneys
56. Autoregulation occurs in which of the following
circulations? *Rationale: Physio Trans 3.6 Special Circulatory Circuits, pg 2
a. Cerebral
b. Coronary
c. Renal
d. All of the above
e. Only A and B
*autoregulation – the sustained and constant blood flow to an
organ in spite of varying arterial pressure.

57. In hypoxic conditions, vasoconstriction occurs in which of 62. Which of the following has physical mechanism in
the following special circulations? regulation of blood
a. Pulmonary a. Lungs
b. Renal b. Heart
c. Splanchnic c. Brain
d. Hepatic d. All of the above
e. All of the above
*Rationale: Physio Trans 3.6 Special Circulatory Circuits, pg 5 *the physical mechanism of each organ is discussed in Physio
Trans 3.6 Special Circulatory Circuits

63. Muscarinic receptor affects heart rate by

a. Closing of inward rectifier K+ channel
b. Greater opening of funny current channel
c. Delay in opening of Ca2+ channel
d. All of the above
*read more about this in Physio Trans 3.7 Regulation of the CVS
58. Composition of filtrate affects blood flow in this circulation
64. Produces bradycardia ?
a. Coronary
a. Calcium
b. Cutaneous
b. Epinephrine
c. Muscular
c. Hyperoxia
d. Renal
d. Bainbridge reflex
* Blood flow in the renal circulation is concerned with the
65. Always produces a negative inotropic effect?
filtration of plasma to form urine. –Dr. Bareng
a. Afterload
b. Preload
59. Venous blood is the  major source of blood flow into the
c. Heart rate
a. Brain
d. Contractility
b. Heart
66. Mechanism producing active hyperemia is:
c. Liver
a. Myogenic
d. Kidneys
b. Nitric oxide
* Venous blood does not return directly to the heart, but instead
c. Vasodilator
it flows in the portal vein to the liver before draining into the
d. Oxygen demand
inferior vena cava.
For numbers 67-70,
60. Ambient temperature primarily affect circulation in
A. X > Y
a. Muscles
B. X < Y
b. Skin
C. X = Y
c. Lungs
D. No relationship with X and Y
d. Gastrointestinal tract
67. Sympathetic stimulation:
*Rationale: Dr. Bareng PPT in Special Circulation
X = vessel resistance C
Y=vascular tone
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68. α-receptor activation (sympathetic innervations):
X = arteries A
Y= veins
69. Venoconstriction:
X= cardiac output B
Y=venous return
70. Baroreceptor reflex:
X = hypoxemia D
Y= hypercapnia 76. Congenital Heart Disease is suspected when a child has
a. Cyanosis
b. Clubbing
c. Respiratory distress
d. All of the above
*Rationale: (Found in the 5th page of the 3.8 Pediatric Cardiology
71. Which best explains why pulmonary blood flow to the lungs trans of Section B under ‘A. Basic Tools and Laboratory Exams in
is slow in the fetus? Evaluating CHD: 2. Physical Examination’)
a. Nutritional requirement for lung growth is minimal *Other signs include: Sweat on the forehead, general
b. Pulmonary vascular resistance is high appearance and nutritional state: in distress, well nourished or
c. Ductus Arteriosus is open undernourished, happy or cranky, obesity should be noted, any
d. Right ventricle dominance is … obvious syndrome or chromosomal abnormalities.

72. Vascular remodelling leading to persistent pulmonary 77. Strong pedal pulse with a normal blood pressure on the
hypertension is seen when a subject has: arm will rule out
a. Hypoxia a. Patent ductus arteriosus
b. Metabolic acidosis b. Regurgitation through AV valves
c. Both A and B c. Coarctation of aorta
d. Neither A nor B d. Pulmonary valve constriction

*Rationale: (Found in the 6th page of the 3.8 Pediatric Cardiology

73. This is the most significant event at birth
a. Closure of intracardiac shunts
b. Fall in pulmonary arterial circulation
c. Gas exchange in lungs
d. Increased in left arterial Pressur
74. Patent Ductus Arteriosus
a. Fibrotic changes leads to functional closure
b. Shunts blood from aorta to pulmonary artery
c. A diastolic rumble is significantly heard on the Left
Parasternal Border
d. Manifested as strong bounding pulses
*Rationale: (Found in the 4th page of the 3.8 Pediatric Cardiology
trans of Section B)
trans of Section B under ‘A. Basic Tools and Laboratory Exams in
Evaluating CHD: 2. Physical Examination (Palpation)’)
- If a good pedal pulse is felt, coarctation of the aorta (COA) is
effectively ruled out, especially if the blood pressure in the arm is
normal
- Weak leg pulses and strong arm pulses suggest COA
78. Apical impulse in a five year-old child can be palpated in
a. 2nd ICS RPSB
b. 2nd ICS LPSB
c. 4th ICS LMCL
*Rationale: (Found in the 6th page of the 3.8 Pediatric Cardiology
trans of Section B under ‘A. Basic Tools and Laboratory Exams in
Evaluating CHD: 2. Physical Examination (Palpation’)
-Apical impulse - 5th ICS LMCL only after the age of 7; 4th ICS
LMCL in younger children

79. A widely split S2 indicates

a. Right ventricle ejection time is prolonged
b. Left ventricle ejection
c. Pulmonary hypertension is present

75. Which is true about fetal circulation

a. Cardiac output is relatively low *Rationale: (Found in the 6th page of the 3.8 Pediatric Cardiology
b. Shunts are open trans of Section B under ‘A. Basic Tools and Laboratory Exams in
c. Placenta is a low resistance vessel Evaluating CHD: 2. Physical Examination (Auscultation)’)
d. All are true - Widely split and fixed S2: found in conditions that prolong RV
ejection time or shorten LV ejection; found in ASD or partial
*Rationale: (Found in the 5th page of the 3.8 Pediatric Cardiology anomalous pulmonary venous return (PAPVR) (conditions in
trans of Section B) which the amount of blood ejected by the RV is increased:
volume overload) and PS (the valve stenosis prolongs RV ejection
time: pressure overload)
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 c. Left main coronary artery
80. Which is true about S3 d. Right main coronary artery
a. Best heard at the apex
b. 88. Which is the gold standard in the diagnosis of coronary
c. artery disease?
d. All of the above a. Electrocardiogram
b. Coronary angiogram
*Rationale: (Found in the 6th page of the 3.8 Pediatric Cardiology c. 2D echo
trans of Section B under ‘A. Basic Tools and Laboratory Exams in d. Chest x-ray
Evaluating CHD: 2. Physical Examination (Auscultation)’) 89. An enlargement in the RV can be seen best in the chest
Also true about S3: radiograph in
- Low frequency sound heard in early diastole produced by a. Antero-posterior view
the rapid filling of the ventricles b. Posterior-anterior view
- Common in normal children and young adults c. Lateral view
- Abnormal for patients with dilated and poorly compliant d. Apico-lordotic view
ventricles 90. Which information can be extracted from the ECG?
a. Degree of coronary artery stenosis
81. Which is true about RV dominance in an ECG tracing b. Severity of valvular disease
a. Tall R waves in V1 and V2 c. Presence of high grade heart block
b. Deep S waves V5 and V6 d. Presence of pericardial effusion
c. Right Axis
d. All of the above *Heart block:
First degree: prolongation of PR interval
82. A heart rate of 135/minute in an awake 6 month old child Second degree: Mobitz 1 and 2
is interpreted as: Third Degree: ________
a. Tachypnia
b. Bradycardia
c. Normal LABORATORY
IDENTIFICATION:
1. The placement of the electrodes of Lead I
a. Positive electrode: LEFT ARM
b. Negative electrode: RIGHT ARM
2. The effect of eyeball pressure on the heart rate: DECREASE
HEART RATE
3. Location of the exploring electrode of V2: 4TH INTERCOSTAL
SPACE LEFT PARASTERNAL BORDER

ECG INTERPRETATION: Refer to the ECG tracing provided (NO

83. The axis is: PICTURE. SORRY!)
a. Between 0 o - (+) 90o 1. What is the heart rate (use Lead II)?
b. Between 0 o - (-) 90o 2. What is the PR interval (use Lead II)?
c. Between 90o   - (+/- )180o 3. What is the QT interval (use Lead II)?
84. Therefore, you have: 4. Using the method described in the lab manual, plot the mean
a. Right axis deviation electrical axis. Is it normal?
b. Left axis deviation 5. Is the rhythm sinus? Justify your answer.
c. Normal axis Yes. The HR is within normal range, PR interval is within
85. Is it normal? normal range, P waves are morphologically correct (round,
a. Yes smooth, <0.11 sec. duration), there is a P wave for every QRS,
b. No the rhythm is regular (R-R).
6. Is the ECG tracing normal? Just answer YES or NO. YES.

86. The most anterior portion of the heart is the MULTIPLE CHOICE: Choose the best answer.
a. Left ventricle 1. The first heart sound is due to:
b. Right ventricle a. Atrial contraction
c. Left atrium b. Ventricular relaxation
d. Right atrium c. Opening of the AV valves
d. Closing if the AV valves
87. In 2D echocardiography, in the 5-chamber view of the e. Closing of the semilunar valves
heart, which of the following is considered the fifth heart
chamber? 2. The normal heart rate in man?
a. Pulmonary artery a. 30-60 beats/min
b. Aorta b. 12-20 beats/min
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 c. 60-100 beats/min
d. 15-50 beats/min 1. Result of too loose BP cuff placement A
2. Direct effect of atherosclerotic and non-compliant arteries C
3. The intercostal spaces are located by: 3. What happens when the presence of atherosclerotic arteries
a. Searching for the true ribs are not considered when taking auscultatory BP B
b. Looking for the point of maximal impulse
c. Locating for the junction between the body of the sternum
and manubrium
d. All are true

For the next four questions: Write the word TRUE if the statement is
4. The third heart sound is: correct and FALSE if incorrect.
a. Normal in children 1. Avoiding caffeine intake prior to taking BP measurements is a
b. Due to the tensing of chordae tendinae standard recommendation in order to get accurate results.
c. Observed in atheletes TRUE
d. All are true 2. Prolonged isotonic contraction can lead to vasodilation of
arteries in the skeletal muscle from both autonomic and local
5. In an adult man, the fourth heart sound may be due to a factors.TRUE
decrease in: 3. Immediately after standing from a lying position, venous return
a. Compliance of the ventricles and heart rate is expected to drop suddenly. FALSE
b. Aortic pressure 4. Changes in BP due to positional changes are immediately
c. Cardiac contractility sensed by the baroreceptors in the sternal area. FALSE
d. Heart rate

IDENTIFY THE FOLLOWING:

RADIAL PULSE 1. Palpated in taking the pulse rate and

palpatory BP
2-4 mmHg/sec 2. Recommended rate of deflation of bag when
taking the BP
HAND GRIP _ 3. Instrument used to produce isometric
contraction
COLD PRESSOR TEST 4. Procedure done to check for lability of the BP
using a standard sensory stimulus
CARDIAC OUTPUT, TOTAL PERIPHERAL RESISTANCE 5-6. Physiologic
determinants of BP
AUSCULTATORY GAP 7. Avoided when taking palpatory BP
measurement before auscultatory BP measurement
60 seconds 8. Duration of time that the hand is immersed in
ice cold water
30 seconds 9. Duration of time that the subject should
hyperventilate

For the next of four questions, choose from the following:

a. Increased venous return
b. Decreased venous return
c. Increased heart rate
d. Decreased heart rate
e. Increased total peripheral resistance

1. Most prominent response to hyperventilation A

2. Immediate result of isometric contraction E
3. Compensatory response to change in position from standing to
lying D
4. Direct result of isotonic contraction of muscle A

For the next three questions, choose from the following:

a. Increased systolic BP measurement
b. Decreased systolic BP measurement
c. Increased diastolic BP measurement
d. Decreased diastolic BP measurement
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