Review Test

1. A 53-year-old woman is found, by (D) pulse pressure

arteriography, to have 50% narrowing of (E) stroke volume
her left renal artery. What is the expected (F) systolic pressure
change in blood flow through the stenotic
artery? Questions 6 and 7
(A) Decrease to ⁄2
1 An electrocardiogram (ECG) on a person
(B) Decrease to 1⁄4 shows ventricular extrasystoles.
(C) Decrease to 1⁄8
(D) Decrease to 1⁄16 6. The extrasystolic beat would produce
(E) No change (A) increased pulse pressure because con-
tractility is increased
2. When a person moves from a supine (B) increased pulse pressure because heart
position to a standing position, which of the rate is increased
following compensatory changes occurs? (C) decreased pulse pressure because ven-
(A) Decreased heart rate tricular filling time is increased
(B) Increased contractility (D) decreased pulse pressure because stroke
(C) Decreased total peripheral resistance volume is decreased
(TPR) (E) decreased pulse pressure because the
(D) Decreased cardiac output PR interval is increased
(E) Increased PR intervals
7. After an extrasystole, the next “normal”
ventricular contraction produces
3. At which site is systolic blood pressure the
highest? (A) increased pulse pressure because
the contractility of the ventricle is
(A) Aorta
increased
(B) Central vein
(B) increased pulse pressure because
(C) Pulmonary artery
total peripheral resistance (TPR) is
(D) Right atrium
decreased
(E) Renal artery
(C) increased pulse pressure because
(F) Renal vein
compliance of the veins is decreased
(D) decreased pulse pressure because
4. A person’s electrocardiogram (ECG) has
the contractility of the ventricle is
no P wave, but has a normal QRS complex
increased
and a normal T wave. Therefore, his pace-
(E) decreased pulse pressure because TPR
maker is located in the
is decreased
(A) sinoatrial (SA) node
(B) atrioventricular (AV) node 8. An increase in contractility is demonstrat-
(C) bundle of His ed on a Frank–Starling diagram by
(D) Purkinje system (A) increased cardiac output for a given
(E) ventricular muscle end-diastolic volume
(B) increased cardiac output for a given
5. If the ejection fraction increases, there end-systolic volume
will be a decrease in (C) decreased cardiac output for a given
(A) cardiac output end-diastolic volume
(B) end-systolic volume (D) decreased cardiac output for a given
(C) heart rate end-systolic volume

100
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Chapter 3 Cardiovascular Physiology 101

Questions 9–12 (C) Filtration; 6 mm Hg

(D) Filtration; 9 mm Hg
Left ventricular pressure
(E) There is no net fluid movement
150
3
14. If Kf is 0.5 mL/min/mm Hg, what is
(mm Hg)

the rate of water flow across the capillary

2 wall?
75
(A) 0.06 mL/min
(B) 0.45 mL/min
4 1 (C) 4.50 mL/min
0
0 50 100 150
(D) 9.00 mL/min
(E) 18.00 mL/min
Left ventricular volume (mL)

9. On the graph showing left ventricular vol- 15. The tendency for blood flow to be turbu-
ume and pressure, isovolumetric contraction lent is increased by
occurs from point (A) increased viscosity
(A) 4→1 (B) increased hematocrit
(B) 1→2 (C) partial occlusion of a blood vessel
(C) 2→3 (D) decreased velocity of blood flow
(D) 3→4
16. Following a sympathectomy, a 66-year-
10. The aortic valve closes at point old man experiences orthostatic hypoten-
sion. The explanation for this occurrence is
(A) 1
(B) 2 (A) an exaggerated response of the
(C) 3 renin–angiotensin–aldosterone system
(D) 4 (B) a suppressed response of the
renin–angiotensin–aldosterone system
11. The first heart sound corresponds to (C) an exaggerated response of the barore-
point ceptor mechanism
(D) a suppressed response of the barorecep-
(A) 1
tor mechanism
(B) 2
(C) 3 17. The ventricles are completely depolar-
(D) 4 ized during which isoelectric portion of the
electrocardiogram (ECG)?
12. If the heart rate is 70 beats/min, then the
cardiac output of this ventricle is closest to (A) PR interval
(B) QRS complex
(A) 3.45 L/min (C) QT interval
(B) 4.55 L/min (D) ST segment
(C) 5.25 L/min (E) T wave
(D) 8.00 L/min
(E) 9.85 L/min 18. In which of the following situations is
pulmonary blood flow greater than aortic
Questions 13 and 14
blood flow?
In a capillary, Pc is 30 mm Hg, Pi is –2 mm
(A) Normal adult
Hg, πc is 25 mm Hg, and πi is 2 mm Hg.
(B) Fetus
(C) Left-to-right ventricular shunt
13. What is the direction of fluid movement (D) Right-to-left ventricular shunt
and the net driving force? (E) Right ventricular failure
(A) Absorption; 6 mm Hg (F) Administration of a positive inotropic
(B) Absorption; 9 mm Hg agent
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102 Board Review Series: Physiology

19. The change indicated by the dashed (C) increased plasma protein concentration
lines on the cardiac output/venous return (D) muscular activity
curves shows
23. Inspiration “splits” the second heart
sound because

Cardiac output
(A) the aortic valve closes before the pul-
monic valve
venous return (L/min)

(B) the pulmonic valve closes before the

Cardiac output

aortic valve
(C) the mitral valve closes before the tricus-
or

Ve pid valve
no
us (D) the tricuspid valve closes before the
re
tu mitral valve
rn
(E) filling of the ventricles has fast and slow
components
24. During exercise, total peripheral resist-
Right atrial pressure (mm Hg)
or ance (TPR) decreases because of the effect of
end-diastolic volume (L) (A) the sympathetic nervous system on
splanchnic arterioles
(A) decreased cardiac output in the “new”
(B) the parasympathetic nervous system on
steady state
skeletal muscle arterioles
(B) decreased venous return in the “new”
(C) local metabolites on skeletal muscle
steady state
arterioles
(C) increased mean systemic pressure
(D) local metabolites on cerebral arterioles
(D) decreased blood volume
(E) histamine on skeletal muscle arterioles
(E) increased myocardial contractility
Questions 25 and 26
20. A 30-year-old female patient’s electrocar-
diogram (ECG) shows two P waves preced-
ing each QRS complex. The interpretation of
this pattern is Curve A
Volume or pressure

(A) decreased firing rate of the pacemaker

in the sinoatrial (SA) node Curve B
(B) decreased firing rate of the pacemaker
in the atrioventricular (AV) node
(C) increased firing rate of the pacemaker in
the SA node
(D) decreased conduction through the AV
node
(E) increased conduction through the His- Time
Purkinje system 25. Curve A in the figure represents
21. An acute decrease in arterial blood pres- (A) aortic pressure
sure elicits which of the following compen- (B) ventricular pressure
satory changes? (C) atrial pressure
(D) ventricular volume
(A) Decreased firing rate of the carotid
sinus nerve 26. Curve B in the figure represents
(B) Increased parasympathetic outflow to (A) left atrial pressure
the heart (B) ventricular pressure
(C) Decreased heart rate (C) atrial pressure
(D) Decreased contractility (D) ventricular volume
(E) Decreased mean systemic pressure
27. An increase in arteriolar resistance, with-
22. The tendency for edema to occur will be out a change in any other component of the
increased by cardiovascular system, will produce
(A) arteriolar constriction (A) a decrease in total peripheral resistance
(B) increased venous pressure (TPR)
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Chapter 3 Cardiovascular Physiology 103

(B) an increase in capillary filtration 31. The x-axis in the figure could have been
(C) an increase in arterial pressure labeled
(D) a decrease in afterload (A) end-systolic volume
(B) end-diastolic volume
28. The following measurements were (C) pulse pressure
obtained in a male patient: (D) mean systemic pressure
Central venous pressure: 10 mm Hg (E) heart rate
Heart rate: 70 beats/min 32. The greatest pressure decrease in the cir-
Pulmonary vein [O2] = 0.24 mL O2/mL culation occurs across the arterioles because
Pulmonary artery [O2] = 0.16 mL O2/mL
Whole body O2 consumption: 500 mL/min (A) they have the greatest surface area
What is this patient’s cardiac output? (B) they have the greatest cross-sectional area
(C) the velocity of blood flow through them
(A) 1.65 L/min is the highest
(B) 4.55 L/min (D) the velocity of blood flow through them
(C) 5.00 L/min is the lowest
(D) 6.25 L/min (E) they have the greatest resistance
(E) 8.00 L/min
33. Pulse pressure is
29. Which of the following is the result of an (A) the highest pressure measured in the
inward Na+ current? arteries
(B) the lowest pressure measured in the
(A) Upstroke of the action potential in the arteries
sinoatrial (SA) node (C) measured only during diastole
(B) Upstroke of the action potential in (D) determined by stroke volume
Purkinje fibers (E) decreased when the capacitance of the
(C) Plateau of the action potential in ven- arteries decreases
tricular muscle (F) the difference between mean arterial
(D) Repolarization of the action potential in pressure and central venous pressure
ventricular muscle
(E) Repolarization of the action potential in 34. In the sinoatrial (SA) node, phase 4
the SA node depolarization (pacemaker potential) is
attributable to
Questions 30 and 31 (A) an increase in K+ conductance
(B) an increase in Na+ conductance
(C) a decrease in Cl− conductance
Cardiac output (D) a decrease in Ca2+ conductance
venous return (L/min)

(E) simultaneous increases in K+ and Cl−

Cardiac output

conductances
or

Ve 35. Which receptor mediates constriction of

no arteriolar smooth muscle?
us
re
tu (A) α1 Receptors
rn
(B) β1 Receptors
(C) β2 Receptors
(D) Muscarinic receptors
Right atrial pressure (mm Hg)
36. During which phase of the cardiac cycle
30. The dashed line in the figure illustrates is aortic pressure highest?
the effect of
(A) Atrial systole
(A) increased total peripheral resistance (B) Isovolumetric ventricular contraction
(TPR) (C) Rapid ventricular ejection
(B) increased blood volume (D) Reduced ventricular ejection
(C) increased contractility (E) Isovolumetric ventricular relaxation
(D) a negative inotropic agent (F) Rapid ventricular filling
(E) increased mean systemic pressure (G) Reduced ventricular filling (diastasis)
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104 Board Review Series: Physiology

37. Myocardial contractility is best correlat- 43. Which of the following parameters is
ed with the intracellular concentration of decreased during moderate exercise?
(A) Na+ (A) Arteriovenous O2 difference
(B) K+ (B) Heart rate
(C) Ca2+ (C) Cardiac output
(D) Cl− (D) Pulse pressure
(E) Mg2+ (E) Total peripheral resistance (TPR)

38. Which of the following is an effect of 44. When propranolol is administered,

histamine? blockade of which receptor is responsible for
(A) Decreased capillary filtration the decrease in cardiac output that occurs?
(B) Vasodilation of the arterioles (A) α1 Receptors
(C) Vasodilation of the veins (B) β1 Receptors
(D) Decreased Pc (C) β2 Receptors
(E) Interaction with the muscarinic (D) Muscarinic receptors
receptors on the blood vessels (E) Nicotinic receptors

39. Carbon dioxide (CO2) regulates blood 45. During which phase of the cardiac cycle
flow to which one of the following organs? is ventricular volume lowest?
(A) Heart (A) Atrial systole
(B) Skin (B) Isovolumetric ventricular contraction
(C) Brain (C) Rapid ventricular ejection
(D) Skeletal muscle at rest (D) Reduced ventricular ejection
(E) Skeletal muscle during exercise (E) Isovolumetric ventricular relaxation
(F) Rapid ventricular filling
(G) Reduced ventricular filling (diastasis)
40. Cardiac output of the right side of the
heart is what percentage of the cardiac out-
put of the left side of the heart? 46. Which of the following changes will
cause an increase in myocardial O2
(A) 25%
consumption?
(B) 50%
(C) 75% (A) Decreased aortic pressure
(D) 100% (B) Decreased heart rate
(E) 125% (C) Decreased contractility
(D) Increased size of the heart
(E) Increased influx of Na+ during the
41. The physiologic function of the relative-
upstroke of the action potential
ly slow conduction through the atrioven-
tricular (AV) node is to allow sufficient
47. Which of the following substances
time for
crosses capillary walls primarily through
(A) runoff of blood from the aorta to the water-filled clefts between the endothelial
arteries cells?
(B) venous return to the atria
(A) O2
(C) filling of the ventricles
(B) CO2
(D) contraction of the ventricles
(C) CO
(E) repolarization of the ventricles
(D) Glucose

42. Blood flow to which organ is 48. A 24-year-old woman presents to the
controlled primarily by the sympathetic emergency department with severe diar-
nervous system rather than by local rhea. When she is supine (lying down), her
metabolites? blood pressure is 90/60 mm Hg (decreased)
(A) Skin and her heart rate is 100 beats/min
(B) Heart (increased). When she is moved to a stand-
(C) Brain ing position, her heart rate further increases
(D) Skeletal muscle during exercise to 120 beats/min. Which of the following
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Chapter 3 Cardiovascular Physiology 105

accounts for the further increase in heart (D) Phase 3

rate upon standing? (E) Phase 4
(A) Decreased total peripheral resistance
(B) Increased venoconstriction 52. Which phase of the ventricular action
(C) Increased contractility potential coincides with diastole?
(D) Increased afterload (A) Phase 0
(E) Decreased venous return (B) Phase 1
(C) Phase 2
49. A 60-year-old businessman is evaluated (D) Phase 3
by his physician, who determines that (E) Phase 4
his blood pressure is significantly elevated
at 185/130 mm Hg. Laboratory tests 53. Propranolol has which of the following
reveal an increase in plasma renin effects?
activity, plasma aldosterone level, and (A) Decreases heart rate
left renal vein renin level. His right renal (B) Increases left ventricular ejection
vein renin level is decreased. What is fraction
the most likely cause of the patient’s (C) Increases stroke volume
hypertension? (D) Decreases splanchnic vascular
(A) Aldosterone-secreting tumor resistance
(B) Adrenal adenoma secreting aldosterone (E) Decreases cutaneous vascular resistance
and cortisol
(C) Pheochromocytoma 54. Which receptor mediates slowing of the
(D) Left renal artery stenosis heart?
(E) Right renal artery stenosis (A) α1 Receptors
(B) β1 Receptors
Questions 50–52
(C) β2 Receptors
+20 1 (D) Muscarinic receptors
2
0
55. Which of the following agents or
–20 changes has a negative inotropic effect on
the heart?
–40 0 3 (A) Increased heart rate
–60 (B) Sympathetic stimulation
(C) Norepinephrine
–80 4 (D) Acetylcholine (ACh)
(E) Cardiac glycosides
–100
100 msec
56. The low-resistance pathways between
50. During which phase of the ventricular myocardial cells that allow for the spread of
action potential is the membrane action potentials are the
potential closest to the K+ equilibrium (A) gap junctions
potential? (B) T tubules
(A) Phase 0 (C) sarcoplasmic reticulum (SR)
(B) Phase 1 (D) intercalated disks
(C) Phase 2 (E) mitochondria
(D) Phase 3
(E) Phase 4 57. Which agent is released or secreted after
a hemorrhage and causes an increase in
51. During which phase of the ventricular renal Na+ reabsorption?
action potential is the conductance to Ca2+ (A) Aldosterone
highest? (B) Angiotensin I
(A) Phase 0 (C) Angiotensinogen
(B) Phase 1 (D) Antidiuretic hormone (ADH)
(C) Phase 2 (E) Atrial natriuretic peptide
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106 Board Review Series: Physiology

58. During which phase of the cardiac cycle 59. A hospitalized patient has an ejection
does the mitral valve open? fraction of 0.4, a heart rate of 95 beats/min,
(A) Atrial systole and a cardiac output of 3.5 L/min. What is
(B) Isovolumetric ventricular contraction the patient’s end-diastolic volume?
(C) Rapid ventricular ejection (A) 14 mL
(D) Reduced ventricular ejection (B) 37 mL
(E) Isovolumetric ventricular relaxation (C) 55 mL
(F) Rapid ventricular filling (D) 92 mL
(G) Reduced ventricular filling (diastasis) (E) 140 mL