A 15-year-old boy presents for a sports physical.

His vital signs include blood pressure

110/70 mm Hg, temperature 36.5°C (97.7°F), and heart rate 100/min. On cardiac
auscultation, an early diastolic heart sound is heard over the cardiac apex while the patient
is in the left lateral decubitus position. A transthoracic echocardiogram is performed which
shows an ejection fraction of 60% without any other abnormalities. Which of the following
is the end-systolic volume in this patient if his cardiac output is 6 L/min?

A. 50 mL

B. 60 mL

C. 100 mL

D. 40 mL

E. 120 mL

A 75-year-old woman presents to her physician with a cough and shortness of breath. She says
that cough gets worse at night and her shortness of breath occurs with moderate exertion or
when lying flat. She says these symptoms have been getting worse over the last 6 months. She
mentions that she has to use 3 pillows while sleeping in order to relieve her symptoms. She denies
any chest pain, chest tightness, or palpitations. Past medical history is significant for hypertension
and diabetes mellitus type 2. Her medications are amiloride, glyburide, and metformin. Family
history is significant for her father who also suffered diabetes mellitus type 2 before his death at
90 years old. The patient says she drinks alcohol occasionally but denies any smoking history. Her
blood pressure is 130/95 mm Hg, temperature is 36.5°C (97.7°F), and heart rate is 100/min. On
physical examination, she has a sustained apical impulse, a normal S1 and S2, and a loud S4
without murmurs. There are bilateral crackles present bilaterally. A chest radiograph is
unremarkable. A transesophageal echocardiogram is performed and shows a normal left
ventricular ejection fraction. Which of the following myocardial changes is most likely present in
this patient?

A. Ventricular hypertrophy with sarcomeres duplicated in series

B. Macrophages with hemosiderin

C. Ventricular hypertrophy with sarcomeres duplicated in parallel

D. Asymmetric hypertrophy of the interventricular septum

E. Granuloma consisting of lymphocytes, plasma cells and macrophages surrounding necrotic

A 56-year-old man presents to his general practitioner with frequent episodes of facial flushing for
the past 2 weeks. He says these episodes are associated with mild headaches and a sensation of
fullness in his head and neck. In addition, he has developed recurrent, often severe, itching after
taking a hot shower. The patient denies any smoking history but says he drinks alcohol socially. His
blood pressure is 160/90 mm Hg and his temperature is 37°C (98.6°F). On physical examination, his
face and neck appear red. Cardiac examination reveals a regular rate and rhythm. Lungs are clear
to auscultation bilaterally. The spleen is noted to be palpable just below the costal margin. A
complete blood count shows a hemoglobin level of 19.5 g/dL, a total leukocyte count of
12,000/mm3, and a platelet count of 450,000/mm3. Which of the following set of abnormalities
are most likely present in this patient?

A. ↑ Blood viscosity, ↓ blood flow with blast cells

B. ↑ Blood viscosity, ↓ blood flow with an M-spike of immunoglobulin G

C. ↓ Blood viscosity, ↑ blood flow, ↓erythropoietin, ↑ferritin

D. ↑ Blood viscosity, ↓ blood flow with an M-spike of immunoglobulin M

E. ↑ Blood viscosity, ↓ blood flow, ↓ erythropoietin

A 52-year-old man with stage 5 chronic kidney disease receives hemodialysis 3 times daily. Past
medical history is significant for type 1 diabetes mellitus diagnosed 25 years ago, hypertension
diagnosed for 19 years ago, and diabetic retinopathy diagnosed 3 years ago. Current medications
are lisinopril, simvastatin, ezetimibe and epoetin alfa. After finding a matched living donor, renal
transplantation surgery is scheduled. Which of the following changes in total peripheral resistance
will most likely occur in the donor after this surgery?

A. The total peripheral resistance will decrease as systemic circulation is considered a parallel
circuit

B. The total peripheral resistance will not be changed

C. The total peripheral resistance will increase as systemic circulation is considered a parallel
circuit

D. The total peripheral resistance will increase as systemic circulation is considered a series circuit
A 33-year-old woman visits an outpatient clinic for the first time after moving to the US from Peru
a few months ago. She complains of easy fatigability and shortness of breath with minimal
exertion for the past 6 months. She further adds that her breathlessness is worse when she goes
to bed at night. She is also concerned about swelling of both her legs. As a kid, she says she always
had sore throats. She does not smoke or drink alcohol. Past medical records are unavailable but
the patient says that she has always been healthy apart from her sore throats. Her blood pressure
is 114/90 mm Hg, pulse is 109/min, respirations are 26/min and temperature is 36.7°C (98°F). On
examination, she is icteric with distended jugular veins. Bilateral basal crepitations are audible on
auscultation of the lungs. Also, a high-pitched apical holosystolic murmur is audible that radiates
to the left axilla. A transthoracic echocardiogram reveals mitral regurgitation with an ejection
fraction of 25%. Which of the following is the principle of treatment of this patient’s condition?

A. Decrease total peripheral resistance

B. Increase inotropy of cardiac muscle

C. Increase left ventricular end diastolic pressure

D. Increase the rate of SA node discharge

E. Increase coronary blood Flow

An experiment to determine the effects of gravity on blood pressure is conducted on 3 individuals

with equal heights and blood pressures oriented in different positions in space. Participant A is
strapped in a supine position on a bed turned upside down in a vertical orientation with his head
towards the floor and his feet towards the ceiling. Participant B is strapped in a supine position on
a bed turned downwards in a vertical orientation with his head towards the ceiling and his feet
just about touching the floor. Participant C is strapped to a supine position on a bed in a horizontal
orientation. Blood pressure readings are then taken at the level of the head, heart, and feet of all 3
participants. Which of these positions will have the lowest recorded blood pressure reading?

A. Participant A: at the level of the head

B. Participant B: at the level of the feet

C. Participant C: at the level of the heart

D. Participant A: at the level of the feet

E. Participant B: at the level of the head

A 47-year-old busy executive visits his physician for a routine medical check-up. He currently has
no complaints and claims to be ‘as fit as a fiddle’. Physical examination findings are unremarkable
except for a mid-systolic murmur heard in the 2nd left intercostal space that radiates to the
carotids on auscultation. The physician decides to perform a maneuver to confirm his suspicion
instructing the patient to stand from a supine position with the stethoscope still placed on his
chest. Which of the following changes would be seen in the patient following commencement of
this maneuver?

A. An increase in right atrial pressure.

B. An increase in left ventricular end-diastolic pressure.

C. An increase in pulmonary capillary wedge pressure.

D. A reduction in the slope of the pacemaker potential.

E. A reduction in diastolic filling time.

A 19-year-old male presents to the clinic with a complaint of increasing breathlessness for the past
2 years. His shortness of breath is associated with mild chest pain and occasional syncopal attacks
during strenuous activity. There is no history of significant illness in the past, however, one of his
uncles had similar symptoms when he was his age and died while playing basketball a few years
later. He denies alcohol use, tobacco consumption, and the use of recreational drugs. On
examination, pulse rate is 76/min regular, high volume, and blood pressure is 130/70. A triple
apical impulse is observed on the precordium and a systolic ejection crescendo-decrescendo
murmur is audible between the apex and the left sternal border along with a prominent fourth
heart sound. The physician then asks the patient to take a deep breath, close his mouth and pinch
his nose and try to breathe out without allowing his cheeks to bulge out. In doing so, the intensity
of the murmur increases. Which of the following changes would be observed on the
commencement of this maneuver?

A. ↓ Mean Arterial Pressure, ↑ Heart rate, ↑ Baroreceptor activity, ↓ Parasympathetic Outflow

B. ↑ Mean Arterial Pressure, ↓ Heart rate, ↓ Baroreceptor activity, ↑ Parasympathetic Outflow

C. ↑ Mean Arterial Pressure, ↑ Heart rate, ↓ Baroreceptor activity, ↓ Parasympathetic Outflow

D. ↓ Mean Arterial Pressure, ↑ Heart rate, ↓ Baroreceptor activity, ↓ Parasympathetic Outflow

E. ↑ Mean Arterial Pressure, ↓ Heart rate, ↑ Baroreceptor activity, ↑ Parasympathetic Outflow

A 25-year-old male presents to the emergency department complaining of palpitations,

lightheadedness, and sweating. He just started working at an investment firm and has been
staying late at night to make a good impression. Today, he had a dozen cups of espresso to keep
himself awake and working. He has never had such an episode before. His past medical history is
unremarkable. His pulse is 150/min, blood pressure is 134/88 mm Hg, respirations are 12/min, and
temperature is 36.7°C (98.0°F). ECG shows supraventricular tachycardia with sinus rhythm. Which
of the following is the next best step in the management of this patient?
A. Adenosine infusion

B. Drinking coffee

C. Dipping his face in warm water

D. Synchronized cardioversion

E. Valsalva maneuver

A 25-year-old male presents to the emergency department complaining of palpitations,

lightheadedness, and sweating. He just started working at an investment firm and has been
staying late at night to make a good impression. Today, he had a dozen cups of espresso to keep
himself awake and working. He has never had such an episode before. His past medical history is
unremarkable. His pulse is 150/min, blood pressure is 134/88 mm Hg, respirations are 12/min, and
temperature is 36.7°C (98.0°F). ECG shows supraventricular tachycardia with sinus rhythm. Which
of the following is the next best step in the management of this patient?

A. Adenosine infusion

B. Drinking coffee

C. Dipping his face in warm water

D. Synchronized cardioversion

E. Valsalva maneuver

A 25-year-old male presents to the clinic with a complaint of lightheadedness when standing up
from his bed in the morning and then from his chair at work. He has had similar complaints for
many months and despite drinking lots of fluids, eating regular meals, and taking a multivitamin,
he has not improved. His daily routine is disturbed as he finds himself getting up very slowly to
avoid the problem. This has created some awkward situations at his workplace and in social
settings. His blood pressure while seated is 120/80 mm Hg and upon standing it falls to 100/68
mm Hg. The physical examination is unremarkable except for a strong odor suggestive of
marijuana use. The patient denies drug use and insists the odor is due to his roommate who
smokes marijuana for medical purposes. No pallor or signs of dehydration are seen. Lab work
shows:

Serum Glucose 90 mg/dL

Serum Electrolytes

Sodium 140 mEq/L

Potassium 4.1 mEq/L

Chloride 100 mEq/L

Serum Creatinine 0.8 mg/dL

Blood Urea Nitrogen 9 mg/dL

Hemoglobin (Hb) Concentration 15.3 g/dL

Mean Corpuscular Volume (MCV) 83 fl

Reticulocyte count 0.5%

Erythrocyte count 5.3 million/mm3

Platelet count 00,000/mm3

ECG shows no abnormal finding. Which of the following could alleviate this patient’s symptoms?

A. Alpha 1 receptor activation

B. Carotid massage

C. Increased parasympathetic stimulation

D. Inhibition of the baroreceptor response

E. Sodium chloride infusion

A 40-year-old female volunteers for an invasive study on normal cardiac function. She has no
previous cardiovascular concerns and takes no medications. With the test subject at rest, the
following data is collected using blood tests, intravascular probes, and a closed rebreathing circuit:

Blood hemoglobin concentration 14 g/dL

Arterial oxygen content 0.22 mL O2/mL

Arterial oxygen saturation 98%

Venous oxygen content 0.17 mL O2/mL

Venous oxygen saturation 78%

Oxygen consumption 250 mL/min

During measurement, the patient's vitals were pulse of 75/min, respirations: 14/ min, and blood
pressure: 125/70 mm Hg. What is the cardiac output of this volunteer?

A. 250 mL/min
B. 5.0L/min

C. 50 L/min

D. Stroke volume is required to calculate cardiac output

E. Body surface area is required to calculate cardiac output

A 35-year-old male presents to the physician's clinic due to episodic chest pain during the last
couple of months. He is currently pain-free. His chest pain occurs soon after he starts to exercise
and is rapidly relieved by rest. He recently started training for a marathon after a decade of a fairly
sedentary lifestyle. He was a competitive runner during his college years but has only had
occasional exercise since then. He is concerned that he might be developing some heart disease.
He has no prior medical issues and takes no medications. Family history is significant for
hypertension and myocardial infarction in his father. His vitals are pulse: 74/min, respirations:
10/min, and blood pressure: 120/74 mm Hg. ECG is normal. The physician orders an exercise
tolerance test that has to be stopped after 5 minutes due to the onset of chest pain. Which of the
following is the greatest physiological contributor to this patient's chest pain?

A. Coronary vasoconstriction

B. Diastolic aortic pressure

C. Duration of diastole

D. Force of myocardial contraction

E. Ventricular blood volumen

A 22-year-old woman presents to the physician due to lightheadedness. Earlier in the day, she had
her first job interview since graduating from college 3 months ago. While waiting outside the
interviewer's office, she began to feel nervous and started breathing really fast. She then felt as if
she was going to faint, so she excused herself from the interview and had a friend drive her to the
clinic. Which of the following is responsible for her symptoms?

A. Decreased arterial pCO2

B. Increased arterial pO2

C. Decreased arterial pH

D. Increased plasma lactic acid

E. Vagus nerve stimulation

A medical student volunteers for an experiment in the physiology laboratory. Before she does
anything, oral temperature is recorded as 36.9°C (98.4°F). She is then made to dip both her hands
in a bowl containing ice cold water. She withdraws her hands out of the water and finds that they
look pale and feel very cold. Her oral temperature is recorded once more and is found to be 36.9°C
(98.4°F) even though her hands are found to be 4.5°C (40.0°F). Which of the following mechanisms
is responsible for the maintenance of her temperature throughout the experiment?

A. Cutaneous vasoconstriction

B. Diving reflex

C. Endogenous pyrogen release

D. Muscular contraction

E. Shivering

A 20-year-old healthy male is running on a treadmill for the last 30 minutes. He is in good shape
and exercises 3 times per week. He takes no medications and denies smoking cigarettes, drinking
alcohol, and illicit drug use. Immediately after stopping his run, his heart rate is 130/min and blood
pressure is 145/75 mm Hg. Prior to starting his run, his heart rate was 70/min and blood pressure
was 114/74 mm Hg. Which of the following is most likely responsible for the change in his heart
rate and blood pressure?

A. Baroreceptor reflex

B. Increased activation of the vagal nuclei

C. Increased aldosterone production

D. Sympathetic nervous system activation

E. Vasopressin release from the pituitary

A 48-year-old male is brought to the emergency department for sudden onset of difficulty
breathing 6 hours ago. For the past several months, he has had shortness of breath on exertion
and lying down on the bed, frequent headaches, and swelling of his feet. He does not take any
medications despite being diagnosed with hypertension 10 years ago. His pulse is 90/min,
respirations are 20/min, blood pressure is 150/110 mm Hg, and temperature is 37°C (98.6°F).
Physical examination shows an overweight male in acute distress and audible wheezes.
Crepitations are heard bilaterally and loudest at the lung base. Which of the following findings on
cardiac auscultation will most likely be present in this patient?

A. Fixed split S2
B. Loud P2

C. S3 Gallop

D. Absent S4

E. A loud S1

A 54-year-old male presents to the emergency department complaining of shortness of breath and
fatigue for 1 day. He reports feeling increasingly tired. His medical records show a long history of
intravenous drug abuse and a past hospitalization for infective endocarditis 2 years ago.
Echocardiography performed at that time showed vegetations on the tricuspid valve. The patient
has not regularly attended his follow-up appointments. Visual inspection of the neck is shown in
the image. What finding would you expect to see on this patient's jugular venous pulse tracing?

A. Absent a waves

B. Prominent y descent

C. Obliterated x wave

D. Augmented v waves

E. Large a waves
A 32-year-old woman makes an appointment at her physician’s office for a regular health check-
up. She does not have any complaints and mentions that she has started to train for an upcoming
marathon and hydrates with an electrolyte solution. She has been trying unsuccessfully to quit
smoking for a few years now. She has hypercholesterolemia, which is controlled with a low-
cholesterol diet. The family history is significant for hypertension in both of her parents. Her father
died of myocardial infarction a few years ago. Her vital signs are as follows: heart rate 55/min;
respiratory rate 16/min; temperature 37.6 °C (99.68 °F); and blood pressure 120/88 mm Hg. The
physical exam findings are within normal limits. A routine ECG is done and is shown below. The
abnormal wave seen on the ECG tracing represents which of the following mechanical events?

A. Ventricular depolarization

B. Period between ventricular depolarization and repolarization

C. Ventricular repolarization

D. Atrial depolarization

E. Atrial repolarization

A 78-year-old man visits his primary care provider complaining of a 2-week history of fatigue and
cough. His cough gets worse at night with shortness of breath. He was diagnosed with congestive
heart failure 2 months ago. He also suffers from diabetes mellitus and hypertension. His current
medication regimen includes captopril, carvedilol, metformin, and furosemide. His blood pressure
is 140/90 mm Hg, temperature is 36.7°C (90.1°F), pulse is 125/min, and respiratory rate is 30/min.
Bilateral basilar crackles are present. A chest X-ray shows cardiomegaly and transesophageal
echocardiography shows an ejection fraction of 20%. The treating physician decides to add a drug
to increase cardiac contractility and improve the patient’s symptoms. Which of the following
figures best represents the effect of this drug on cardiac and vascular function curves?

A. Image 1

B. Image 2

C. Image 3

D. Image 4

A molecular biologist is studying the roles of different types of ion channels underlying cardiac
excitation. He identifies a voltage-gated calcium channel in the sinoatrial node, which is also
present throughout the myocardium. The channel is activated at ~ -40 mV of membrane potential,
undergoes voltage-dependent inactivation and is highly sensitive to nifedipine. Which of the
following phases of the action potential in the sinoatrial node is primarily mediated by ion currents
through the channel that the molecular biologist is studying?

A. Phase 0

B. Phase 1

C. Phase 2

D. Phase 3

E. Phase 4

A 24-year-old woman presents to a physician with recurrent episodes of palpitation, shortness of

breath, and perspiration. The episodes are self-limited and are usually preceded by specific social
circumstances to which she has a significant dislike. There is no significant past medical history.
After a complete history and physical examination, the physician diagnoses an anxiety disorder. He
explains that anxiety is associated with the stimulation of the sympathetic nervous system which
produces several symptoms related to anxiety such as tachycardia. Which of the following cellular
mechanisms best explains the effects of stimulation of sympathetic cardiac nerves on the
pacemaker cells in the sinoatrial node?

A. Decreased intracellular cyclic adenosine monophosphate (cAMP) level in the sinoatrial node

B. Inactivation of L-type voltage-gated calcium channels

C. Facilitation of If currents through HCN-channels

D. Decreased slope of prepotentials

E. Opening of G-protein activated potassium channels

A 45-year-old man presents to a physician with recurrent episodes of palpitation over the last 3
months. The episodes are self-limiting but cause significant distress and discomfort to the patient.
After a detailed electrophysiological workup, the physician concludes that the symptoms occur
mainly due to abnormal function of the cardiac ion channels, which primarily produce the plateau
phase of the action potential in cardiac myocytes in healthy patients. Which of the following ion
channels shows disordered function in this patient?

A. HCN-channels

B. Fast sodium channels

C. L-type voltage-gated calcium channels

D. T-type voltage-gated calcium channels

E. Inward rectifier IK1 channels

A 43-year-old woman presents to a physician with weakness and fatigue for a week. She mentions
that she has been taking oral fluconazole for the last 4 weeks for the treatment of tinea capitis.
She also says that she loves coffee and usually consumes 4–6 cups of coffee every day. On physical
examination, her vital signs are stable and examination of all systems, including nervous system, is
normal. Her laboratory evaluation reveals that her serum potassium level is 3.1 mmol/L (3.1
mEq/L). The physician orders an electrocardiogram. Which of the following findings is most likely
to be present?

A. Widening of QRS complexes

B. Tall peaked T waves

C. Disappearing P waves
D. Depression of ST segment

E. Shortened QT Interval

A 68-year-old man presents to the emergency department with palpitations. He also feels that his
exercise tolerance has reduced over the previous week. His past history is positive for ischemic
heart disease and he has been on multiple medications for a long time. On physical examination,
his temperature is 36.9ºC (98.4ºF), pulse rate is 152/min and is regular, blood pressure is 114/80
mm Hg, and respiratory rate is 18/min. Auscultation of the precordial region confirms tachycardia,
but there is no murmur or extra heart sounds. His electrocardiogram is obtained, which suggests a
diagnosis of atrial flutter. Which of the following findings is most likely to be present on his
electrocardiogram?

A. Atrial rate above 400 beats per minute

B. Slurred upstroke of R wave

C. Atrioventricular block

D. No discernible P waves

E. Wenckebach phenomenon

A 21-year-old man presents to a physician with repeated episodes of syncope and dizziness over
the last month. On physical examination, his pulse rate is 64/min while all other vital signs are
normal. His 24-hour electrocardiographic monitoring suggests a diagnosis of sinus node
dysfunction. His detailed genetic evaluation shows that he carries a copy of a mutated gene “X”
that codes for an ion channel, which is the most important ion channel underlying the
automaticity of the sinoatrial node. This is the first ion channel to be activated immediately after
hyperpolarization. Which of the following ion channels does the gene “X” code for?

A. HCN-channels

B. L-type voltage-dependent calcium channels

C. T-type voltage-dependent calcium channels

D. Fast delayed rectifier (IKr) voltage-dependent K+ channels

E. Stretch-activated cationic channels

While explaining the effects of hypokalemia and hyperkalemia on the cardiac rhythm, a
cardiologist explains that the electrophysiology of cardiac tissue is unique. He mentions that
potassium ions play an important role in the electrophysiology of the heart and that the resting
membrane potential of the cardiac myocytes is close to the equilibrium potential of K+ ions. This is
because of the high resting potassium conductance of the ventricular myocytes, which is
contributed by specific potassium channels. These are open at rest and are closed when there is
depolarization. Which of the following potassium channels is the cardiologist talking about?

A. Inward rectifier IK1 potassium channels

B. Inward rectifier IKACh potassium channels

C. Fast delayed rectifier IKr potassium channels

D. Slow delayed rectifier IKs potassium channels

E. Transient outward current Ito potassium channels

An elderly male presents to his physician with complaints of difficulty breathing, easy fatigability,
and bilateral leg swelling which began 2 months ago. His breathlessness worsens while walking,
climbing the stairs, and lying flat on his back. He also finds it difficult to sleep well at night as he
often wakes up to catch his breath. His pulse is 98/min and blood pressure is 114/90 mm Hg. On
examination, he has mild respiratory distress, distended neck veins, and bilateral pitting edema is
evident on the lower third of his legs. His respiratory rate is 33/min, SpO2 is 93% in room air and
coarse crepitations are heard over the lung bases. On auscultation, the P2 component of his
second heart sound is heard loud at the second left intercostal space and an S3 gallop rhythm is
heard at the apex. A medication is prescribed for his symptoms which changes his cardiac
physiology as depicted with the dashed line recorded post-medication. What is the mechanism of
action of the prescribed medication?

A. Decrease in the slope of the pacemaker potential

B. Decrease in transmembrane sodium gradient

C. Preferential dilatation of capacitance vessels

D. Inhibition of aldosterone-mediated sodium reabsorption

E. Reduction in myocardial contractility

A 72-year-old man is brought to the emergency room by his daughter with complaints of a
productive cough, rust-colored sputum, and fever for 1 week. He denies any breathlessness or
chest pain. The past medical history is unremarkable. The vital signs include a pulse rate of
103/min, respiratory rate of 34/min, and blood pressure of 136/94 mm Hg, with an axillary
temperature of 38.9°C (102.0°F). The SaO2 is 86% on room air. The chest examination revealed a
dull percussion note and coarse crepitations over the left mid-chest. The patient was admitted to
the medical unit and intravenous antibiotics were started. He responded well, but after 2 days an
elevated temperature was noted. The patient deteriorated and he was transferred to the intensive
care unit. A few days later, his temperature was 39.0°C (103.2°F), the respiratory rate was 23/min,
the blood pressure was 78/56 mm Hg, and the SaO2 was 78%. He also had a delayed capillary refill
time with a pulse of 141/min. Blood was drawn for the white cell count, which revealed a total
count of 17,000/µL. The attending physician decides to begin therapy for the low blood pressure,
which brings about a change in the cardiovascular physiology, as shown in the graph with the post-
medication represented by a dashed line. Which of the following medications was most likely
administered to the patient?

A. Captopril

B. Phenoxybenzamine

C. Low-dose dopamine

D. Isoproterenol

E. Norepinephrine

Un hijo de 72 años de edad es llevado a la sala de emergencias por su hija con quejas de tos
productiva, esputo de color óxido y fiebre durante 1 semana. Él niega cualquier dificultad
respiratoria o dolor en el pecho. La historia médica pasada no es destacable. Los signos vitales
incluyen una frecuencia del pulso de 103 / min, una frecuencia respiratoria de 34 / min y una
presión arterial de 136/94 mm Hg, con una temperatura axilar de 38.9 ° C (102.0 ° F). La SaO2 es
del 86% en aire ambiente. El examen de tórax reveló una nota de percusión opaca y gruesas
crepitaciones sobre la parte media del pecho izquierdo. El paciente ingresó en la unidad médica y
se iniciaron antibióticos intravenosos. Respondió bien, pero después de 2 días se notó una
temperatura elevada. El paciente se deterioró y fue trasladado a la unidad de cuidados intensivos.
Unos días más tarde, su temperatura era de 39.0 ° C (103.2 ° F), la frecuencia respiratoria era de
23 / min, La presión arterial fue de 78/56 mm Hg y la SaO2 fue de 78%. También tuvo un tiempo
de relleno capilar retrasado con un pulso de 141 / min. Se extrajo sangre para el recuento de
glóbulos blancos, que reveló un recuento total de 17,000 / µL. El médico de cabecera decide
comenzar la terapia para la presión arterial baja, lo que provoca un cambio en la fisiología
cardiovascular, como se muestra en el gráfico con la medicación posterior representada por una
línea discontinua. ¿Cuál de los siguientes medicamentos fue probablemente administrado al
paciente? como se muestra en el gráfico con la medicación posterior representada por una línea
discontinua. ¿Cuál de los siguientes medicamentos fue probablemente administrado al paciente?
como se muestra en el gráfico con la medicación posterior representada por una línea discontinua.
¿Cuál de los siguientes medicamentos fue probablemente administrado al paciente?

A. Captopril

SEGUNDO. Fenoxibenzamina
DO. Dosis bajas de dopamina

RE. Isoproterenol

MI. Norepinefrina

A 50-year-old woman presents to the emergency department with mild chest pressure that does
not radiate several times over the last 24 hours. Her troponin level is elevated and her heart rate
waivers around 47/min. Note this patient’s EKG in the exhibit. Which pacemaker is likely in use in
this patient?

A. SA node

B. AV node

C. Atrial myocardium

D. Purkinje fibers

E. Ventricular myocardium

Una mujer de 50 años se presenta en el servicio de urgencias con una leve presión en el pecho que
no se irradia varias veces en las últimas 24 horas. Su nivel de troponina está elevado y su
frecuencia cardíaca se reduce a 47 / min. Tenga en cuenta el ECG de este paciente en la
exposición. ¿Qué marcapasos es probable que se use en este paciente?

A. Nodo SA

SEGUNDO. Nodo AV

DO. Miocardio atrial

RE. fibras de Purkinje

MI. Miocardio ventricular

A 60-year-old obese man comes to the emergency department with tightness in his chest and
lower extremity edema. He has a history of heart failure that has gotten worse over the last
several years. He takes finasteride, lisinopril, and albuterol. He does not use oxygen at home. He
has mildly elevated blood pressure and he is tachycardic and tachypneic. Physical examination
shows an overweight man having difficulty speaking with 2+ pitting edema on his lower
extremities up to his thighs. The attending asks you to chart out the patient's theoretical cardiac
function curve from where it was 5 years ago when he was healthy to where it is right now. What
changes occurred in the last several years without compensation?

A. Cardiac output went up and right atrial pressure went down

B. Cardiac output went down and right atrial pressure went up

C. Cardiac output went down and right atrial pressure went down

D. Cardiac output went up and right atrial pressure went up

E. Neither cardiac output nor right atrial pressure changed

A 66-year-old male presents to the emergency room with symptoms of breathlessness during a
change in position and at rest for the past 5 days. His breathlessness is mostly at night and he is
also concerned about bilateral leg swelling. He is a heart failure patient who is being managed
with oral medication and has been compliant with his drugs. Physical examination reveals an
elderly man in respiratory distress with abdominal distention and bilateral pitting ankle edema.
Respiratory rate is 32/minute, SpO2 is 93% in room air and coarse crepitations are heard on both
lung bases. Pulse rate is 73/min and barely palpable. His blood pressure is 79/54 mm Hg. On
auscultation, a blowing holosystolic murmur is heard at the apex radiating to the left axilla. An
echocardiography shows an ejection fraction of 18%. The physician decides to include an inotropic
agent in his current medication. What would likely result from this intervention?

A. A decrease in the systemic vascular resistance

B. A decrease in the interval between the heart sounds S1 and S2

C. An increase in the left ventricular end-systolic volume

D. A decrease in the interval between the heart sounds S2 and S1

E. A decrease in the left ventricular end-diastolic pressure

Un hombre obeso de 60 años de edad acude al servicio de urgencias con opresión en el pecho y
edema en las extremidades inferiores. Tiene un historial de insuficiencia cardíaca que ha
empeorado en los últimos años. Toma finasterida, lisinopril y albuterol. No usa oxígeno en casa.
Tiene una presión arterial ligeramente elevada y es taquicárdico y taquipneico. El examen físico
muestra a un hombre con sobrepeso que tiene dificultad para hablar con más de 2 edemas con
picaduras en las extremidades inferiores hasta los muslos. El asistente le pide que trace la curva de
la función cardíaca teórica del paciente desde donde estaba hace 5 años cuando estaba sano hasta
donde está ahora. ¿Qué cambios ocurrieron en los últimos años sin compensación?

A. El gasto cardíaco aumentó y la presión auricular derecha disminuyó.

SEGUNDO. El gasto cardíaco bajó y la presión auricular derecha aumentó.

DO. El gasto cardíaco bajó y la presión auricular derecha bajó

RE. El gasto cardíaco aumentó y la presión auricular derecha aumentó.

MI. Ni el gasto cardíaco ni la presión auricular derecha cambiaron

Un hombre de 66 años de edad se presenta en la sala de emergencias con síntomas de falta de

aliento durante un cambio de posición y descanso durante los últimos 5 días. Su falta de aliento es
mayormente en la noche y también le preocupa la hinchazón bilateral de las piernas. Es un
paciente con insuficiencia cardíaca que está siendo administrado con medicamentos orales y ha
cumplido con sus medicamentos. El examen físico revela a un anciano con dificultad respiratoria
con distensión abdominal y edema bilateral en el tobillo. La frecuencia respiratoria es de 32 /
minuto, SpO 2es del 93% en el aire de la habitación y se escuchan crepitaciones gruesas en ambas
bases pulmonares. La frecuencia del pulso es de 73 / min y apenas palpable. Su presión arterial es
de 79/54 mm Hg. En la auscultación, se escucha un soplo holosistólico en el vértice que irradia a la
axila izquierda. Una ecocardiografía muestra una fracción de eyección del 18%. El médico decide
incluir un agente inotrópico en su medicación actual. ¿Qué es probable que resultaría de esta
intervención?

A. Una disminución de la resistencia vascular sistémica.

SEGUNDO. Una disminución en el intervalo entre los sonidos del corazón S1 y S2

DO. Aumento del volumen sistólico final ventricular izquierdo.

RE. Una disminución en el intervalo entre los sonidos del corazón S2 y S1

MI. Una disminución en la presión diastólica final del ventrículo izquierdo.

A 45-year-old man is rushed to the emergency department by his wife after complaining of a
sudden onset excruciating headache that started about an hour ago. On further questioning, the
patient’s wife gives a prior history of loin pain, hematuria, and hypertension in the patient, and
recalls that similar symptoms were present in his uncle. On examination, his GCS is 12/15 and
when his hip joint and knee are flexed, he resists subsequent extension of the knee. When the
neck is flexed there is severe neck stiffness and it causes a patient's hips and knees to flex. During
the examination, he lapses into unconsciousness. Which of the following mechanisms best
explains the development of the sudden onset headache in this patient?

A. Embolic occlusion of a cerebral vessel

B. Increased wall tension within an aneurysm

C. Intracerebral hemorrhage due to vascular malformations

D. Meningeal irritation from a space occupying lesion

E. Uremic encephalopathy from chronic renal disease

Un hombre de 45 años de edad es llevado al departamento de emergencias por su esposa luego

de quejarse de un dolor de cabeza insoportable de inicio repentino que comenzó hace
aproximadamente una hora. Al realizar preguntas adicionales, la esposa del paciente presenta una
historia previa de dolor en el lomo, hematuria e hipertensión en el paciente, y recuerda que en su
tío había síntomas similares. En el examen, su GCS es 12/15 y cuando la articulación de la cadera y
la rodilla están flexionadas, resiste la extensión posterior de la rodilla. Cuando se flexiona el cuello,
hay una rigidez severa en el cuello que hace que las caderas y las rodillas de un paciente se
flexionen. Durante el examen, él cae en la inconsciencia. ¿Cuál de los siguientes mecanismos
explica mejor el desarrollo del dolor de cabeza repentino en este paciente?

A. Oclusión embólica de un vaso cerebral.

SEGUNDO. Aumento de la tensión de la pared dentro de un aneurisma.

DO. Hemorragia intracerebral por malformaciones vasculares.

RE. Irritación meníngea por una lesión que ocupa el espacio.

MI. Encefalopatía urémica por enfermedad renal crónica.

A 52-year-old business executive presents to his physician with complaints of an on and off chest
pain which started 2 months ago. He describes his pain as crushing, centrally located, and typically
lasting about 5 minutes but never more than 10 minutes. The pain radiates to his left arm and jaw
and occurs only when he climbs the stairs or runs on a treadmill and is relieved by rest. He has
been hypertensive and diabetic for the last 10 years and has been compliant with his medications.
His physical exam findings are insignificant. Lab tests are within normal limits except for a
significantly elevated LDL-cholesterol level. A stress EKG shows ST-segment depression in the chest
leads when his heart rate and blood pressure increase to over 40% from their baseline values. The
physician decides to commence him on a medication to relieve his symptoms. Which of the
following changes best describes the direct effect of the prescribed medication on his
cardiovascular physiology in the cardiac output/venous return versus right atrial graph below?

A. i

B. ii

C. iii

D. iv

E. v

F. vi

Un ejecutivo de negocios de 52 años presenta a su médico las quejas de un dolor en el pecho

dentro y fuera del cuerpo que comenzó hace 2 meses. Describe su dolor como aplastante, ubicado
en el centro y, por lo general, dura unos 5 minutos, pero nunca más de 10 minutos. El dolor se
irradia a su brazo y mandíbula izquierdos y aparece solo cuando sube las escaleras o corre en una
cinta de correr y se alivia con el descanso. Ha sido hipertenso y diabético durante los últimos 10
años y ha cumplido con sus medicamentos. Los hallazgos de su examen físico son insignificantes.
Las pruebas de laboratorio están dentro de los límites normales, excepto por un nivel de colesterol
LDL significativamente elevado. Un EKG de estrés muestra que la depresión del segmento ST en el
pecho aumenta cuando la frecuencia cardíaca y la presión arterial aumentan a más del 40% de sus
valores iniciales. El médico decide comenzar con un medicamento para aliviar sus síntomas.

A. yo

SEGUNDO. ii

DO. iii

RE. iv

MI. v

F. vi
A 70-year-old female presents to the emergency department with crushing chest pain and
diaphoresis. Her symptoms suddenly started 30 minutes ago and the pain is radiating to her left
shoulder. In the diagrams, below, both blue and green curves are the normal cardiac and vascular
function curves, respectively; the pink curves, however, represent the shifts induced on the
function curves, under pathological conditions. Which of the following best represents this
patient’s current cardiovascular state?

A. Chart A

B. Chart B

C. Chart C

D. Chart D

E. Chart E

Una mujer de 70 años se presenta al servicio de urgencias con dolor de pecho aplastante y
diaforesis. Sus síntomas comenzaron repentinamente hace 30 minutos y el dolor se irradia a su
hombro izquierdo. En los diagramas, a continuación, las curvas azul y verde son las curvas de
función cardíaca y vascular normales, respectivamente; Las curvas rosadas, sin embargo,
representan los cambios inducidos en las curvas de función, en condiciones patológicas. ¿Cuál de
las siguientes opciones representa mejor el estado cardiovascular actual de este paciente?

A. Gráfico A

SEGUNDO. Tabla b

DO. Gráfico C

RE. Gráfico d

MI. Gráfico e
A 27-year-old woman G2P1 at 34 weeks estimated gestational age presents with bouts of
sweating, weakness, and dizziness lasting a few minutes after lying down on the bed. She says
symptoms resolve if she rolls on her side.. She reports that these episodes have occurred several
times over the last 3 weeks. On lying down, her blood pressure is 90/50 mm Hg and her pulse is
50/min. When she rolls on her side, her blood pressure slowly increases to 120/65 mm Hg, and
pulse increases to 72/min. Which of the following best describes the mechanism which underlies
this patient’s most likely condition?

A. Aortocaval compression

B. Progesterone surge

C. Increase in plasma volume

D. Peripheral vasodilation

E. Renin-angiotensin system activation

Una mujer G2P1 de 27 años a las 34 semanas de edad gestacional estimada presenta episodios de
sudoración, debilidad y mareos que duran unos minutos después de acostarse en la cama. Ella dice
que los síntomas se resuelven si ella rueda de lado. Informa que estos episodios han ocurrido
varias veces en las últimas 3 semanas. Al acostarse, su presión arterial es de 90/50 mm Hg y su
pulso es de 50 / min. Cuando rueda de lado, su presión arterial aumenta lentamente a 120/65 mm
Hg y el pulso aumenta a 72 / min. ¿Cuál de las siguientes opciones describe mejor el mecanismo
que subyace a la condición más probable de este paciente?

A. Compresion aortocava

SEGUNDO. Oleada de progesterona

DO. Aumento del volumen plasmático.

RE. Vasodilatación periférica

MI. Activación del sistema renina-angiotensina

A physiologist is studying various mediators that modulate coronary circulation. He is particularly

looking at mediators that are activated via the clotting cascade, primarily activated factor XII. He
finds that when the clotting cascade starts, it leads to the activation of factor XII, which in turn
activates the enzyme kallikrein. This enzyme activates high- and low-molecular-weight precursors
of certain mediators, which work by contracting the visceral smooth muscle while relaxing the
vascular smooth muscle. They are primarily associated with hypersensitivity and can cause an
increase in capillary permeability, pain, and also mobilize leukocytes. Which of the following is the
precursor protein for the mediators the physiologist is studying?

A. L-Arginine

B. Arachidonic acid

C. Hydroxytryptophan

D. Kininogen

E. Prothrombin

Un fisiólogo está estudiando varios mediadores que modulan la circulación coronaria. En

particular, observa a los mediadores que se activan a través de la cascada de coagulación,
principalmente el factor XII activado. Encuentra que cuando comienza la cascada de la
coagulación, conduce a la activación del factor XII, que a su vez activa la enzima calicreína. Esta
enzima activa los precursores de alto y bajo peso molecular de ciertos mediadores, que funcionan
al contraer el músculo liso visceral mientras relaja el músculo liso vascular. Se asocian
principalmente con hipersensibilidad y pueden causar un aumento de la permeabilidad capilar, el
dolor y también movilizar a los leucocitos. ¿Cuál de las siguientes es la proteína precursora para
los mediadores que estudia el fisiólogo?
A. L-Arginina

SEGUNDO. Ácido araquidónico

DO. Hidroxitriptófano

RE. Cininógeno

MI. Protrombina

A 21-year-old man comes to his physician for a routine checkup. His doctor asks him if he has had
any particular concerns since his last visit and also if he has taken any medications. He says that he
has not been ill over the past year, except for occasional flu. He did take his flu shot at the end of
the year and does not have anything significant to report. He has been training excessively for his
intercollege football tournament which is supposed to be a huge event. His blood pressure is
110/70 mm Hg, pulse is 69/min, and respirations are 17/min. He has a heart sound coinciding with
the rapid filling of the ventricles and no murmurs. He does not have any other significant physical
findings. Which of the following best describes the heart sound heard in this patient?

A. Opening snap

B. Fourth heart sound (S4)

C. Mid-systolic click

D. Second heart sound (S2)

E. Third heart sound (S3)

Un hombre de 21 años acude a su médico para un chequeo de rutina. Su médico le pregunta si ha

tenido alguna preocupación particular desde su última visita y también si ha tomado algún
medicamento. Él dice que no ha estado enfermo durante el año pasado, excepto por una gripe
ocasional. Tomó su vacuna contra la gripe a fin de año y no tiene nada significativo que informar.
Ha estado entrenando excesivamente para su torneo de fútbol intercolegio, que se supone que es
un gran evento. Su presión arterial es de 110/70 mm Hg, el pulso es de 69 / min y las respiraciones
son de 17 / min. Tiene un sonido cardíaco que coincide con el rápido llenado de los ventrículos y
no soplos. No tiene otros hallazgos físicos significativos. ¿Cuál de las siguientes opciones describe
mejor el sonido del corazón que se escucha en este paciente?

A. Cierre de apertura

SEGUNDO. Cuarto sonido del corazón (S4)

DO. Clic medio-sistólico

RE. Segundo sonido del corazón (S2)

MI. Tercer sonido del corazón (S3)

A student is experimenting with the effects of nitric oxide in the body. He used a variety of amino
acid isolates and measured the resulting nitric oxide levels in the body and the physiological
effects on the body. The amino acids function as substrates for nitric oxide synthase. After
supplement administration, blood vessels dilated and the systemic blood pressure decreased.
Which of the following amino acids was used in this study?

A. Histidine

B. Arginine

C. Methionine

D. Leucine

E. Tyrosine

Un estudiante está experimentando con los efectos del óxido nítrico en el cuerpo. Utilizó una
variedad de aislados de aminoácidos y midió los niveles de óxido nítrico resultantes en el cuerpo y
los efectos fisiológicos en el cuerpo. Los aminoácidos funcionan como sustratos para la sintasa de
óxido nítrico. Después de la administración de suplementos, los vasos sanguíneos se dilatan y la
presión arterial sistémica disminuye. ¿Cuál de los siguientes aminoácidos se usó en este estudio?

A. Histidina

SEGUNDO. Arginina

DO. Metionina

RE. Leucina

MI. Tirosina

A 55-year-old man comes to the emergency department complaining of mild vision changes,
dizziness, and severe pain in the chest for the past hour. He has also been experiencing nausea
since this morning and already vomited twice. Past medical history includes poorly controlled type
2 diabetes and end-stage renal disease requiring dialysis. His blood pressure is 210/100 mm Hg,
pulse is 110/min, and respirations are 18/min. Ophthalmic examination of his eyes show
papilledema and flame-shaped hemorrhages and he is diagnosed with hypertensive emergency.
Treatment involves rapidly lowering his blood pressure and he is started on intravenous sodium
nitroprusside while emergent dialysis is arranged. Which of the following cardiac pressure-volume
loops closely represents the action of the drug he has been administered, where blue represents
before administration and red represents after administration?

A. Diagram A
B. Diagram B

C. Diagram C

D. Diagram D

E. Diagram E

Un hombre de 55 años de edad acude al departamento de emergencias quejándose de cambios

leves en la visión, mareos y dolor intenso en el pecho durante la última hora. También ha estado
sintiendo náuseas desde esta mañana y ya ha vomitado dos veces. La historia médica pasada
incluye diabetes tipo 2 mal controlada y enfermedad renal en etapa terminal que requiere diálisis.
Su presión arterial es de 210/100 mm Hg, el pulso es de 110 / min y las respiraciones son de 18 /
min. El examen oftalmológico de sus ojos muestra papiledema y hemorragias en forma de llama y
se le diagnostica una emergencia hipertensiva. El tratamiento consiste en bajar rápidamente su
presión arterial y se inicia con nitroprusiato de sodio por vía intravenosa mientras se organiza una
diálisis de emergencia. ¿Cuál de los siguientes ciclos de presión-volumen cardíaco representa de
cerca la acción del fármaco que se le administró?

A. Diagrama A
B. SEGUNDO. Diagrama b
C. DO. Diagrama c
D. RE. Diagrama d
E. MI. Diagrama e

In an experiment, a certain gene product is known to stimulate the production of a particular

hormone synthesized in the liver. This hormone, when present in increased amounts,
downregulates the expression of a divalent cation transmembrane transporter located on the
basolateral membranes of enterocytes. Mutations in the gene product have been linked to certain
abnormalities in affected patients. Such individuals may present with darkening of the skin, cold
intolerance, excessive urination, and weight loss. Patients may also present with symptoms of a
cardiovascular disease as a result of this disease. Which of the following would be a likely finding
in affected patients?

A. Preload: increased, cardiac contractility: decreased, afterload: increased

B. Preload: decreased, cardiac contractility: decreased, afterload: decreased

C. Preload: increased, cardiac contractility: increased, afterload: increased

D. Preload: decreased, cardiac contractility: unchanged, afterload: increased

E. Preload: increased, cardiac contractility: increased, afterload: decreased

En un experimento, se sabe que un determinado producto génico estimula la producción de una

hormona particular sintetizada en el hígado. Esta hormona, cuando está presente en cantidades
aumentadas, regula a la baja la expresión de un transportador transmembrana de catión divalente
ubicado en las membranas basolaterales de los enterocitos. Las mutaciones en el producto génico
se han relacionado con ciertas anomalías en los pacientes afectados. Estas personas pueden
presentar oscurecimiento de la piel, intolerancia al frío, micción excesiva y pérdida de peso. Los
pacientes también pueden presentar síntomas de una enfermedad cardiovascular como resultado
de esta enfermedad. ¿Cuál de los siguientes sería un hallazgo probable en los pacientes afectados?

A. Precarga: aumentada, contractilidad cardíaca: disminuida, poscarga: incrementada

SEGUNDO. Precarga: disminuida, contractilidad cardíaca: disminuida, poscarga: disminuida

DO. Precarga: aumentada, contractilidad cardíaca: incrementada, poscarga: incrementada

RE. Precarga: disminuida, contractilidad cardíaca: sin cambios, poscarga: incrementada

MI. Precarga: aumentada, contractilidad cardíaca: aumentada, poscarga: disminuida

Un hombre de 56 años se presenta a su médico general con episodios frecuentes de

enrojecimiento facial durante las últimas 2 semanas. Él dice que estos episodios están
asociados con leves dolores de cabeza y una sensación de plenitud en la cabeza y el
cuello. Además, ha desarrollado una picazón recurrente, a menudo severa, después de
tomar una ducha caliente. El paciente niega cualquier historial de tabaquismo, pero dice
que bebe alcohol socialmente. Su presión arterial es de 160/90 mm Hg y su temperatura
es de 37 ° C (98.6 ° F). En el examen físico, su cara y cuello aparecen rojos. El examen
cardíaco revela una frecuencia y un ritmo regulares. Los pulmones son claros para la
auscultación bilateral. Se observa que el bazo es palpable justo debajo del margen
costal. Un hemograma completo muestra un nivel de hemoglobina de 19,5 g / dL, un
recuento total de leucocitos de 12,000 / mm   y un recuento de plaquetas de 450,000 /
3

mm.  . ¿Cuál de las siguientes anomalías es más probable que esté presente en este
3

paciente?

A. ↑ Viscosidad sanguínea, flow Flujo sanguíneo con células blásticas.

B. ↑ Viscosidad sanguínea, flow flujo sanguíneo con un pico M de inmunoglobulina G
C. Viscos Viscosidad sanguínea, ↑ Flujo sanguíneo, Eritropoyetina, Ferritina.
D. ↑ Viscosidad sanguínea, flow flujo sanguíneo con un pico M de inmunoglobulina M
E. ↑ Viscosidad de la sangre, flow flujo sanguíneo, ↓ eritropoyetina

A. ↑ Blood viscosity, ↓ blood flow with blast cells

B. ↑ Blood viscosity, ↓ blood flow with an M-spike of immunoglobulin G

C. ↓ Blood viscosity, ↑ blood flow, ↓erythropoietin, ↑ferritin

D. ↑ Blood viscosity, ↓ blood flow with an M-spike of immunoglobulin M

E. ↑ Blood viscosity, ↓ blood flow, ↓ erythropoietin

Un hombre de 52 años con enfermedad renal crónica en etapa 5 recibe hemodiálisis 3
veces al día. La historia clínica pasada es significativa para la diabetes mellitus tipo 1
diagnosticada hace 25 años, la hipertensión diagnosticada hace 19 años y la retinopatía
diabética diagnosticada hace 3 años. Los medicamentos actuales son lisinopril,
simvastatina, ezetimiba y epoetina alfa. Después de encontrar un donante vivo
compatible, se programa la cirugía de trasplante renal. ¿Cuál de los siguientes cambios
en la resistencia periférica total probablemente ocurrirá en el donante después de esta
cirugía?

A. La resistencia periférica total disminuirá a medida que la circulación sistémica se considere

un circuito paralelo.
B. SEGUNDO. La resistencia periférica total no será cambiada.
C. DO. La resistencia periférica total aumentará a medida que la circulación sistémica se
considere un circuito paralelo.
D. RE. La resistencia periférica total aumentará a medida que la circulación sistémica se
considere un circuito en serie.

Una mujer de 33 años visita una clínica ambulatoria por primera vez después de mudarse
a los EE. UU. Desde Perú hace unos meses. Se queja de la fatiga fácil y la falta de aliento
con un esfuerzo mínimo durante los últimos 6 meses. Además, agrega que su falta de
aliento es peor cuando se acuesta por la noche. A ella también le preocupa la hinchazón
de ambas piernas. Cuando era niña, ella dice que siempre tuvo dolores de garganta. Ella
no fuma ni bebe alcohol. Los registros médicos anteriores no están disponibles, pero la
paciente dice que siempre ha estado sana, aparte de sus dolores de garganta. Su presión
arterial es de 114/90 mm Hg, el pulso es de 109 / min, las respiraciones son de 26 / min y
la temperatura es de 36.7 ° C (98 ° F). En el examen, es ictérica con venas yugulares
distendidas. Las crepitaciones basales bilaterales son audibles en la auscultación de los
pulmones. También, Se escucha un soplo holosistólico apical agudo que se irradia hacia
la axila izquierda. Un ecocardiograma transtorácico revela regurgitación mitral con una
fracción de eyección del 25%. ¿Cuál de los siguientes es el principio de tratamiento de la
condición de este paciente?

A. Disminuir la resistencia periférica total.

SEGUNDO. Aumento de la inotropía del músculo cardíaco.

DO. Aumentar la presión diastólica final del ventrículo izquierdo.

RE. Aumentar la tasa de descarga del nodo SA

MI. Aumentar el flujo sanguíneo coronario.

1. Un hombre de 72 años llega al departamento de emergencias 30 minutos después

de desarrollar una debilidad en el lado derecho de inicio rápido y disminución de la
sensación en el lado derecho de su cuerpo. La esposa del paciente también
informa que ha tenido dificultades para formar oraciones. Su esposa agrega que
estos síntomas estaban al máximo a los pocos minutos del incidente y
comenzaron a resolverse casi instantáneamente. El paciente dice que tuvo un
 episodio relacionado de pérdida visual indolora en su ojo izquierdo que se resolvió
después de unos 10 a 20 minutos, aproximadamente 3 meses atrás. El historial
médico anterior incluye diabetes mellitus tipo 2 e hipertensión esencial. El paciente
reporta un historial de tabaquismo de 50 paquetes al año. Su presión arterial es de
140/60 mm Hg y su temperatura es de 36.5 ° C (97.7 ° F). El examen neurológico
es significativo para una sutil debilidad de la mano derecha. Una tomografía
computarizada sin contraste de la cabeza es normal, y una ecografía Doppler
carotídea muestra un 40% de estenosis de la arteria carótida interna derecha y un
50% de estenosis de la arteria carótida interna izquierda. ¿Cuál de los siguientes
es el cambio esperado en la resistencia al flujo sanguíneo a través de la arteria
estenótica que probablemente sea el responsable de los síntomas actuales de
este paciente?

A. Se duplicará
B. Será 4 veces mayor.
C. Será 8 veces mayor
D. Será 16 veces mayor
E. Ningún cambio

Un experimento para determinar los efectos de la gravedad sobre la presión arterial se

lleva a cabo en 3 individuos con alturas iguales y presiones sanguíneas orientadas en
diferentes posiciones en el espacio. El participante A está atado en posición supina en
una cama boca abajo en una orientación vertical, con la cabeza hacia el suelo y los pies
hacia el techo. El participante B está atado en una posición supina en una cama girada
hacia abajo en una orientación vertical con su cabeza hacia el techo y sus pies casi
tocando el piso. El participante C está atado a una posición supina en una cama en una
orientación horizontal. Luego se toman las lecturas de presión arterial al nivel de la
cabeza, el corazón y los pies de los 3 participantes. ¿Cuál de estas posiciones tendrá la
lectura de presión arterial más baja registrada?

A. Participante A: a nivel de la cabeza.

SEGUNDO. Participante B: a nivel de los pies.

DO. Participante C: a nivel del corazón.

RE. Participante A: a nivel de los pies.

MI. Participante B: a nivel de la cabeza.

Un hombre de 19 años se presenta a la clínica con una queja de aumento de la disnea en

los últimos 2 años. Su falta de aliento se asocia con dolor leve en el pecho y ataques
sincopales ocasionales durante la actividad vigorosa. No hay antecedentes de
enfermedad significativa en el pasado, sin embargo, uno de sus tíos tuvo síntomas
similares cuando tenía su edad y murió jugando al baloncesto unos años más
tarde. Niega el consumo de alcohol, el consumo de tabaco y el uso de drogas
recreativas. En el examen, la frecuencia del pulso es 76 / min regular, volumen alto y la
presión arterial es 130/70. Se observa un impulso apical triple en el precordio y se
escucha un soplo sistólico de crescendo-decrescendo de eyección sistólica entre el ápice
y el borde esternal izquierdo junto con un cuarto ruido cardíaco prominente. El médico le
pide al paciente que respire profundamente. cierra la boca y pellizca la nariz e intenta
exhalar sin permitir que sus mejillas se abulten. Al hacerlo, aumenta la intensidad del
soplo. ¿Cuál de los siguientes cambios se observaría al comienzo de esta maniobra?

A. Pressure Presión arterial media, ↑ Frecuencia cardíaca, ↑ Actividad de barorreceptores, ↓

Salida parasimpática

SEGUNDO. ↑ Presión Arterial Media, rate Frecuencia Cardíaca, or Actividad de Baroreceptor, ↑

Salida Parasimpática

DO. ↑ Presión Arterial Media, ↑ Frecuencia Cardíaca, or Actividad de Baroreceptor, Salida

Parasimpática

RE. Pressure Presión arterial media, ↑ Frecuencia cardíaca, activity Actividad de los
barorreceptores,, Salida parasimpática

MI. ↑ Presión Arterial Media, rate Frecuencia Cardíaca, ↑ Actividad de Baroreceptor, ↑ Salida
Parasimpática

1. Un varón de 25 años se presenta en Urgencias quejándose de palpitaciones,

aturdimiento y sudoración. Acaba de empezar a trabajar en una empresa de
inversiones y se ha quedado hasta tarde en la noche para causar una buena
impresión. Hoy bebió una docena de tazas de café para mantenerse despierto y
trabajando. Nunca antes había tenido un episodio así. Su pasado historial médico no
tiene nada de especial. Su pulso es de 150 / min, la presión arterial es de 134/88 mm
Hg, las respiraciones son de 12 / min y la temperatura es de 36.7 ° C. El ECG muestra
taquicardia supraventricular con ritmo sinusal. ¿Cuál de los siguientes es el siguiente
mejor paso en el manejo de este paciente?

A. Infusión de adenosina

SEGUNDO. Bebiendo café

DO. Sumergiendo su rostro en agua tibia.

RE. Cardioversion sincronizada

MI. maniobra de Valsalva

1. Una voluntaria de 40 años de edad, para un estudio invasivo sobre la función cardíaca
normal. Ella no tiene problemas cardiovasculares anteriores y no toma
medicamentos. Con el sujeto de prueba en reposo, los siguientes datos se recolectan
mediante análisis de sangre, sondas intravasculares y un circuito cerrado de Re
inspiración:

Concentración de hemoglobina en la sangre. 14 g / dL

Contenido de oxigeno arterial 0.22 mL O 2 / mL

Saturación arterial de oxígeno 98%

Contenido de oxigeno venoso 0.17 mL O 2 / mL

Saturacion venosa de oxigeno 78%

Consumo de oxigeno 250 ml / min

Durante la medición, los signos vitales del paciente fueron de pulso de 75 / min,
respiraciones: 14 / min y presión arterial: 125/70 mm Hg. ¿Cuál es el gasto cardíaco de
este voluntario?

A. 250 ml / min
SEGUNDO. 5.0L / min
DO. 50 l / min
RE. Se requiere un volumen sistólico para calcular el gasto cardíaco.
MI. Se requiere área de superficie corporal para calcular el gasto cardíaco.

roducto cardíaco = oxígeno consumido / gradiente de oxígeno arteriovenoso

Rendimiento cardíaco = (250 mL / min) / (0.22 mL O   / mL de sangre - 0.17 mL
2

O   / mL de sangre)
2

Rendimiento cardíaco = 5,000 ml / min o 5 l / min.

1. Un varón de 25 años se presenta en la clínica con una queja de mareo al levantarse
de la cama por la mañana y luego de su silla en el trabajo. Él ha tenido quejas
similares durante muchos meses y, a pesar de beber muchos líquidos, comer comidas
regulares y tomar multivitaminas, no ha mejorado. Su rutina diaria se ve perturbada
cuando se levanta muy lentamente para evitar el problema. Esto ha creado algunas
situaciones incómodas en su lugar de trabajo y en entornos sociales. Su presión
arterial mientras está sentado es de 120/80 mm Hg y al pararse cae a 100/68 mm
Hg. El examen físico es normal, excepto por un fuerte olor que sugiere el uso de
marihuana. El paciente niega el uso de drogas e insiste en que el olor se debe a su
compañero de cuarto que fuma marihuana con fines médicos. No se ven palidez ni
signos de deshidratación. Trabajos de laboratorio muestran:

Glucosa en suero 90 mg / Dl
Electrolitos en suero
Sodio140 mEq / L
Potasio4.1 mEq / L
Cloruro100 mEq / L
Suero de creatinina 0.8 mg / dL
Nitrógeno ureico en sangre 9 mg / dL
Concentración de hemoglobina (Hb)15.3 g / dL
Volumen corpuscular medio (MCV) 83 fl
Recuento de reticulocitos0.5%
Recuento de eritrocitos5,3 millones / mm 3

Recuento de plaquetas00,000 / mm  3

El ECG no muestra hallazgos anormales. ¿Cuál de los siguientes podría aliviar los
síntomas de este paciente?

A. Activación del receptor alfa 1

SEGUNDO. Masaje carotideo
DO. Aumento de la estimulación parasimpática.
RE. Inhibición de la respuesta barorreceptora.
MI. Infusión de cloruro de sodio.
2. Un ejecutivo ocupado de 47 años de edad visita a su médico para un chequeo médico
de rutina. Actualmente no tiene quejas y afirma ser "tan adecuado como un
violín". Hallazgos del examen físico son normales excepto por un murmullo mesosistólico
oído en el 2   dejó espacio intercostal que se irradia a las carótidas en la auscultación. El
nd

médico decide realizar una maniobra para confirmar su sospecha e instruir al paciente
para que se pare desde una posición supina con el estetoscopio todavía colocado sobre
su pecho. ¿Cuál de los siguientes cambios se vería en el paciente después del comienzo
de esta maniobra?

A. Un aumento de la presión auricular derecha.

SEGUNDO. Aumento de la presión diastólica final del ventrículo izquierdo.

DO. Aumento de la presión de enclavamiento capilar pulmonar.

RE. Una reducción en la pendiente del potencial del marcapasos.

MI. Una reducción en el tiempo de llenado diastólico.

Gasto Cardiaco
Gasto cardiaco o Retorno venoso
(L/min)

Retorno Venoso

Presion arterial media

Presión de la aurícula derecha (mmHg)

o volumen de fin de diástole (L)