Test Bank for Berne and Levy Physiology, 6th Edition: Koeppen

Test Bank for Berne and Levy Physiology, 6th

Edition: Koeppen

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Koeppen: Berne and Levy Physiology, 6th Edition
Chapter 16: Elements of Cardiac Function

Test Bank

Multiple Choice

1. A patient presents for her annual physical examination in seemingly good health.
However, she is concerned about her heart because of family history, and you proceed to
work up an examination of cardiovascular function. She has a blood pressure of 128/83 mm
Hg, and echocardiography indicates that end-diastolic volume is 140 mL and end-systolic
volume is 80 mL. A routine ECG is obtained and is shown below.

The ECG reveals the patient is in normal sinus rhythm with an R-R interval of 0.76 seconds.
This corresponds to a heart rate of:

A. 70 beats/min
B. 74 beats/min
C. 79 beats/min
D. 84 beats/min
E. 88 beats/min

ANS: C

2. A patient presents for her annual physical examination in seemingly good health.
However, she is concerned about her heart because of family history, and you proceed to
work up an examination of cardiovascular function. She has a blood pressure of 128/83 mm
Hg, and echocardiography indicates that end-diastolic volume is 140 mL and end-systolic
volume is 80 mL. A routine ECG is obtained and is shown below.

Inspection of the ECG indicates a PR interval of:

A. 0.08 seconds
B. 0.10 seconds
C. 0.12 seconds
D. 0.16 seconds
E. 0.20 seconds

ANS: D
Copyright © 2008, 2004, 1998, 1993, 1988, 1983 by Mosby, Inc., an affiliate of Elsevier Inc.
Test Bank 16-2

3. A patient presents for her annual physical examination in seemingly good health.
However, she is concerned about her heart because of family history, and you proceed to
work up an examination of cardiovascular function. She has a blood pressure of 128/83 mm
Hg, and echocardiography indicates that end-diastolic volume is 140 mL and end-systolic
volume is 80 mL. A routine ECG is obtained and is shown below.

From the echocardiographic data, the patient’s stroke volume amounts to:

A. 80 mL
B. 70 mL
C. 60 mL
D. 50 mL
E. 45 mL

ANS: C

4. A patient presents for her annual physical examination in seemingly good health.
However, she is concerned about her heart because of family history, and you proceed to
work up an examination of cardiovascular function. She has a blood pressure of 128/83 mm
Hg, and echocardiography indicates that end-diastolic volume is 140 mL and end-systolic
volume is 80 mL. A routine ECG is obtained and is shown below.

You estimate this patient’s cardiac output as:

A. 4.4 L/min
B. 4.7 L/min
C. 5.2 L/min
D. 5.5 L/min
E. 6.3 L/min

ANS: B

Copyright © 2008, 2004, 1998, 1993, 1988, 1983 by Mosby, Inc., an affiliate of Elsevier Inc.
Test Bank 16-3

5. A 63-year-old man was admitted to hospital 1 hour after experiencing substernal chest
pain. He was weak and diaphoretic, and his heart was beating rapidly at 90 beats/min as a
consequence of having a coronary artery occlusion that impaired blood flow to the left
ventricle. From an ECG, it was determined that the tachycardia originated in the SA node.
Before therapy could be started, the man became much weaker and his arterial pulse rate was
about 45 beats/min, yet the ECG revealed an atrial rate of 90 beats/min. A cardiac pacemaker
was inserted because the AV node had been damaged by ischemia. With the implanted
pacemaker set at 75 beats/min, he felt somewhat better and drug therapy was initiated.

Soon after coronary artery occlusion, the interstitial fluid [K+] rose substantially in the flow-
deprived region. In this region, the high extracellular [K+]:

A. increased the propagation velocity of the myocardial action potentials

B. decreased the postrepolarization refractoriness of the myocardial cells
C. depolarized the resting transmembrane potential to a less negative value
D. diminished the automaticity of the myocardial cells
E. decreased the likelihood of reentry dysrhythmias

ANS: C

6. A 63-year-old man was admitted to hospital 1 hour after experiencing substernal chest
pain. He was weak and diaphoretic, and his heart was beating rapidly at 90 beats/min as a
consequence of having a coronary artery occlusion that impaired blood flow to the left
ventricle. From an ECG, it was determined that the tachycardia originated in the SA node.
Before therapy could be started, the man became much weaker and his arterial pulse rate was
about 45 beats/min, yet the ECG revealed an atrial rate of 90 beats/min. A cardiac pacemaker
was inserted because the AV node had been damaged by ischemia. With the implanted
pacemaker set at 75 beats/min, he felt somewhat better and drug therapy was initiated.

The mechanism by which the SA node generated impulses at a rapid rate during the early
stages of the coronary artery occlusion involves an increased:

A. slope of the action potential upstroke (phase 0) of the automatic cells

B. slope of the slow diastolic depolarization of the automatic cells
C. firing threshold (less negative potential) of the automatic cells
D. negativity (hyperpolarization) of the initial portion of the slow diastolic depolarization
E. action potential amplitude of the automatic cells

ANS: B

7. A 63-year-old man was admitted to hospital 1 hour after experiencing substernal chest
pain. He was weak and diaphoretic, and his heart was beating rapidly at 90 beats/min as a
consequence of having a coronary artery occlusion that impaired blood flow to the left
ventricle. From an ECG, it was determined that the tachycardia originated in the SA node.
Before therapy could be started, the man became much weaker and his arterial pulse rate was
about 45 beats/min, yet the ECG revealed an atrial rate of 90 beats/min. A cardiac pacemaker
was inserted because the AV node had been damaged by ischemia. With the implanted
pacemaker set at 75 beats/min, he felt somewhat better and drug therapy was initiated.

Copyright © 2008, 2004, 1998, 1993, 1988, 1983 by Mosby, Inc., an affiliate of Elsevier Inc.
Test Bank for Berne and Levy Physiology, 6th Edition: Koeppen

Test Bank 16-4

The most likely mechanism responsible for the patient’s arterial pulse rate of about 40
beats/min after impulse conduction through the AV junction was blocked is:

A. excitation of the ventricles via an AV bypass tract

B. conversion of ventricular myocardial fibers to automatic cells
C. firing of ventricular ectopic cells that have the same electrophysiolgical characteristics as
SA node cells
D. firing of automatic cells (Purkinje fibers) in the specialized conduction system of the
ventricles
E. excitation of ventricular cells by the rhythmic activity in the autonomic neurons that
innervate the heart

ANS: D

8. A 63-year-old man was admitted to hospital 1 hour after experiencing substernal chest
pain. He was weak and diaphoretic, and his heart was beating rapidly at 90 beats/min as a
consequence of having a coronary artery occlusion that impaired blood flow to the left
ventricle. From an ECG, it was determined that the tachycardia originated in the SA node.
Before therapy could be started, the man became much weaker and his arterial pulse rate was
about 45 beats/min yet the ECG revealed an atrial rate of 90 beats/min. A cardiac pacemaker
was inserted because the AV node had been damaged by ischemia. With the implanted
pacemaker set at 75 beats/min, he felt somewhat better and drug therapy was initiated.

While the heart was being paced, the cardiologist discontinued ventricular pacing
periodically to test the patient’s cardiac status. The cardiologist found that the ventricles did
not begin beating spontaneously until about 5 to 10 sec after cessation of pacing, because the
preceding period of pacing led to:

A. overdrive suppression of the automatic cells in the ventricles

B. release of norepinephrine from the cardiac sympathetic nerves
C. release of neuropeptide Y from the cardiac sympathetic nerves
D. fatigue of the ventricular myocytes
E. release of acetylcholine from the cardiac parasympathetic nerves

ANS: A

Copyright © 2008, 2004, 1998, 1993, 1988, 1983 by Mosby, Inc., an affiliate of Elsevier Inc.

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