WEEKLY QUESTIONS WEEK 2 4-8 MARCH 2012 CARDIOVASCULAR SYSTEM Histology of Blood Vessels 2 1.

Which of the following is FALSE regarding Weibel-Palade granules? I- It contains a protein known as Factor VII II- Present in veins III- Deficiency results in prolonged bleeding time IV- Its deficiency is among the causes of hemophilia A. B. C. D. 2. I and II III and IV I,II and III II,III and IV

Which of the following is responsible for peripheral resistance? A. Artery B. Arterioles C. Vein D. Venules

3. Which of the following is the TRUE statement about the tunica adventitia of portal vein? I- Thickest coat II- Consist of loose fibro-elastic connective tissue III- Smooth muscle has circular and transverse arrangement IV- Near their entry to heart, wall contain cardiac muscle A. I and II B. I and IV C. II,III and IV D. I,II and III 4. Which of the following layer will form valve of veins? A. Tunica intima B. Tunica media C. Tunica adventitia 5. Which of the following is TRUE statement regarding medium sized vein? A. Has thicker wall than medium sized artery B. Has narrow lumen usually circular in section C. Has well develop internal and external elastic lamina D. Has more vasa vasora

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Blood supply of the heart 6. All of following are the correct answer regarding the common carotid artery EXCEPT: A. It ascend within the carotid sheath with internal jugular vein, internal carotid artery andthe last four cranial nerves B. It ends by giving two terminal branches, external and internal carotid artery C. The right common carotid arises from the superior cephalic artery D. Left common carotid artery arises from the arch of aorta 7. Choose the correct branches of external carotid artery I- Common facial artery II- Lingual artery III- Ascending pharyngeal artery IV- Occipital artery A. I & II B. II & III C. II, III & IV D. All of the above 8. Choose the correct answer regarding external carotid artery: A. Superficial thyroid artery is the termination of external carotid artery at the level of superior border of thyroid cartilage B. Occipital artery supply the scalp after piercing the trapezius muscle C. Maxillary artery wind around the lower border of mandible to reach the face D. Ascending pharyngeal artery ascend along the wall of larynx to supply it 9. All of the following are CORRECT regarding the internal carotid artery EXCEPT: A. It ascend horizontally in the neck B. It enters carotid canal in the base of the skull C. It reach foramen lacerum D. Curves up to enter floor of cavernous sinus 10. All are related to surface anatomy of the arteries supplying the head and neck, EXCEPT: A. The external carotid artery can be found at the midpoint between mastoid process and angle of mandible B. At superior border of thyroid cartilage, the external carotid artery begins C. Opposite to the neck of mandible, ext. Carotid artery end as two terminal branches D. Superficial temporal artery can be felt behind the auricle Cardiac Cycle I Answer TRUE or FALSE 11. Cardiac cycle is the phases of contraction and relaxation through associated changes of pressure and volume in different chambers and great vessel also by closure of valves 12. Systole of all heart take place in 0.3 seconds

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13. Increasing heart rate affect more the diastolic time and may never affect cardiac performance 14. Choose the right statements below regarding the whole cardiac cycle I . Ventricular systole consist of isovolumetric contraction and ventricular ejection II. The stages of closure of all valves are during ventricular ejection and rapid ventricular filling III. The ventricular pressure during both isometric relaxation and contraction are constant IV. 75% ventricular filling is done by passive flow, through pressure gradient A B C D I , II, III II, III, IV I , III, IV All of the above

Match the stages with it duration of action correctly 15. 16. 17. 18. Atrial systole Ventricular systole Diastole of all heart Complete one beat A 0.3 seconds B 0.1 seconds C 0.4 seconds D 0.8 seconds

Cardiac Cycle II 19. The following statements are true regarding P wave except: A. Produced by the spread of depolarization wave from SA node to AV node B. Wave spreads from right to left therefore it is a positive wave C. It represents atrial depolarization and starts 0.02 seconds before atrial contraction D. Its duration is 0.2 sec and its amplitude is 0.1-0.0.3 mV 20. Choose the false statement regarding the QRS complex: A. Produced by ventricular depolarization B. Q wave is produced by depolarization of inter-ventricular septum C. R wave is produced by depolarization of the last segment of myocardium D. Its duration is 0.04-0.12 sec and its amplitude is 1-2 mV 21. Which is the correct statement about the abnormalities of QRS complex? A. Q wave is present but smaller in amplitude in ventricular septal defects B. Pathological deep Q wave appears in myocardial ischemia C. Duration of QRS complex is more than 0.12 sec in bundle branch block D. Amplitude of QRS complex decreases in ventricular hypertrophy 22. T wave is described as the following except: A. Due to the faster and stronger stage of ventricular depolarization B. The mean direction of depolarization wave in the ventricles is opposite to depolarization wave C. Its duration is 0.25 sec and its amplitude is 0.2-0.3 mV D. T wave is flattened in old age and inverted in myocardial infarction

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23. All the following are true regarding P-R interval except: A. It is the time between the start of P wave to the start of R wave B. Its duration exceeding 0.2 sec indicates the second degree heart block C. Its normal duration is in 0.12-0.2 sec D. Represents atrial depolarization and conduction through AV node and bundle HISTOLOGY OF PERIPHERAL CIRCULATION 24. Which of the following regarding capillaries sites is WRONG? A. Kidney B. Lung C. Skin D. Muscles E. Nerves 25. All the following fenestrated capillaries has their pores covered by a thin diaphragm EXCEPT A. Pancreas B. Kidney C. Intestine 26. Choose the correct sites for sinusoids. I- Bone marrow II- Liver III- Spleen IV- Certain endocrine glands V- Renal glomeruli VI- Skin A. I, II, III, IV B. I, III, IV, V C. II, III, IV, V, VI D. I, III, IV, V 27. Choose the correct sites for A-V shunts I- Palm II- Sole III- Thyroid gland IV- Bone marrow V- Lip VI- Nose VII- Spleen A. I, II, III, IV, V B. II, III, V, VI, VII C. I, II, III, V, VI D. III, IV, V, VI, VII E. I, III, IV, V

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28. What is the difference between sinusoid and lymph capillaries? A. Having wide lumen B. Irregular in shape C. Lack of continuous basal lamina D. Having anchoring filaments to the surrounding collagen Anti Arrythmic drug 29.

The phase 0 in the diagram equal to? A. B. C. D. P-R interval QRS complex R-T interval S-T interval

30. Which blocker that prolong action potential duration of cardiac muscle(refraction period)? A. B. C. D. Ca channel blocker Beta blocker Alpha blocker K+ channel blocker

31. Which of the following blocker that increase the P-R interval? A. B. C. D. Ca channel blocker Na channel blocker Alpha blocker K+ channel blocker

32. Which of the following blocker that slowing the conduction action potential of cardiac muscle? A. Ca channel blocker B. Na channel blocker C. Alpha blocker D. K+ channel blocker 33. Which of the following drugs that can produce Rythm Control? A. Beta and Ca channel blocker B. Alpha and Beta blocker C. Alpha blocker D. Na and K+ channel blocker

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Cardiovascular regulatory mechanism 34. All of the following are TRUE about vasomotor neurons EXCEPT A. Vasomotor tone occurs resulting from active vasoconstriction neurons during rest B. Stimulation of vasodilator neurons directly produce generalized vasodilation C. Vasoconstrictor fibers from medulla excite vasoconstrictor neurons of sympathetic nervous system leading to increases in arterial blood pressure a pressor effect D. Stimulation of vasoconstrictor neuron produces positive chronotropic, inotropic, and dromotropic effect E. Medullary sensory area project output signal to these neurons to adjust their activity according to the situation 35. Which of the following are regarding cardioinhibitory neurons? I. II. III. IV. Control the parasympathetic activity of the heart Preganglionic fibers of the vagus relay in terminal ganglia at right atrium The vagi dilate the coronary vessels The vagi continuously transmitting inhibitory impulses to decrease high rhythm of the S-A node at any level of arterial blood pressure V. Vagus tone is reflexly produced through the baroreceptor I, II and III I, II and V I, IV and V All of the above

A. B. C. D.

36. All of the following are FALSE about innervations of the heart EXCEPT A. Inhibitory vagal tone dominates over the +ve chronotropic sympathetic tone B. Sympathetic tonic discharge to the heart during activity increase the pumping capacity of the heart by 20% C. The sympathetic supply controlled by vasomotor neurons D. Heart rate is directly proportional to the metabolic rate 37. Physiological variation of heart rate according to I. II. III. IV. A. B. C. D. Athletes have lower heart rate due to high vagal tone Circadian rhythm of heart rate is lowest in early morning and highest in evening Heart rate slows down to 60 bpm during quite rest Heart rate increases during standing by up to 35% I and III II and IV I, II and III I, II, III and IV

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38. Choose the incorrect pair concerning relationship between age and heart rate A. B. C. D. Feotus 140-150 bpm Newborn 130-140 bpm 1-3 years 120-130 bpm Over 15 years- 70-80 bpm

Regulation of Myocardial Metabolism 39. The energy in the heart is mainly used in: A. B. C. D. Contraction Relaxation Both contraction and relaxation None of the above

40. Which of the following used by the healthy heart (well-perfused human heart) to generate energy? I. II. III. IV. Carbohydrate Lactate Fatty acid Protein

A, I, II and III B. I, III and IV C. II, III and IV D. I, II, III and IV 41. Lipolysis (breakdown of triglyceride) is regulated by the following hormone(s): A. B. C. D. Insulin Noradrenaline Adrenaline All of the above

42. The following events/hormones increase the membrane capacitance for glucose transport EXCEPT: A. B. C. D. Ischaemia Catecholamines Insulin Increase work demand

43. Important factors for transporting glucose into the cell are: I. II. III. IV. A. B. C. D. Carnitine shuttle system Presence of glucose transporter Glucose gradient Presence of adrenaline I and II II and III II and IV III and IV

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44. Randle et al (Randle cycle) states that high rates of fatty acid oxidation inhibit the uptake and oxidation of glucose and lactate by the heart. At which pathway does the inhibition occurs? A. B. C. D. Phosphorylation of glycose by hexokinase B-oxidation of acyl-CoA to Acetyl-CoA Pyruvate decarboxylation to Acetyl-CoA Entry of pyruvate into mitochondria

45. Which of the following stimulate the inhibition of pyruvate dehydrogenase? I. II. III. IV. A. B. C. D. NADH ATP Acetyl-CoA Pyruvate I, II and III I, II and IV I, III and IV II, III and IV

CARDIAC REGULATORY MECHANISM 2 46. Which of the following statement is false about heart rate? A. The normal heart rate for adult male is about 75 beats per minute B. Heart rate generally refers to the atrial rate of beating and not the ventricle C. Heart rate lower than 60 beat per minute is called bradycardia while heart rate higher than 90 beat per minute is called tachycardia D. The heart rate of female is slightly higher than male due to lower blood pressure and lower vagal tone 47. The heart rate of a person may vary according to A. B. C. D. Metabolic rate Respiration Time of the day All of the above

48. Which of the following is false about the physiological variation of heart rate? A. Under basal condition with complete physical and mental rest, or during quiet sleep, the heart rate slows down to 60 beats per minute B. Athletes have lower heart rate than non-athletes at rest due to high vagal tone C. The heart rate increases during standing by up to 35 per cent of its basal value D. Male has lower heart rate than female during rest

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49. Which of the following heart rate is not matched correctly with its corresponding age? A. B. C. D. Foetus 140-150 beats per minute Newborn 130-140 beats per minute From 1-3 years 100-120 Over 15 years 70-80

50. What is the factor that affects the cardiovascular centre? A. B. C. D. Changes in blood temperature Impulses from higher centre Changes in the chemical composition of blood All of the above

HAEMODYNAMICS CHANGES 51. Which of the following statement is FALSE regarding hyperemia & congestion. A. Hyperemia occurs when arterial and arteriolar dilatation produces the effects that open inactive capillaries. B. Congestion is due to impaired venous drainage C. Hyperemia is always pathological whereas congestion can be also due to physiological D. Grossly, hyperemia appear red while congestion appear much darker 52. Choose the correct statements regarding localized and systemic congestion. I. Localized venous congestion is due to impaired venous outflow from an organ while the systemic congestion is due to affection of central organ II. The effects of the acute localized congestion depend on the condition of the collateral. III. Dilatation of vessels proximal to the obstruction is the effects of the chronic local congestion IV. Mitral stenosis is one of the cause of acute generalized venous congestion A. B. C. D. I,II II,III I,III,IV I,II,III

53. Which of the following is NOT the general effects of venous congestion? A. B. C. D. Hypoxia Fibrosis Cyanosis Edema

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54. Which of the following is False regarding chronic venous congestion at the lungs? A. B. C. D. It is due to increase in the pressure at the left atrium Its cut surface is mottled and alternate with dark red areas At late stage it appears brown,firm and indurated. Macrophage in this case is known as heart failure cell

55. Choose the CORRECT statements regarding chronic venous congestion of the liver A. B. C. D. It is cause by the right-sided heart failure At late stage,it will increase in size due to cardiac cirrhosis Central vein and the sinusoid is distended with blood The tissues located nearest to the central region undergo atrophic

56. All the followings are higher centers involved in heart rate regulation EXCEPT: A. B. C. D. Cerebral cortex Thalamus and limbic system Respiratory center Hypothalamus

57. What is Bainbridge reflex? A. During increase in arterial pressure, it will increase the heart rate and strength of contraction B. Excitation of baroreceptors by increasing the pressure in arteries reflexly causes the arterial pressure to decrease C. Increase of atrial heart pressure reflexly will increase heart rate. D. None of above 58. One degree centigrade rise in body temperature increases the heart rate by about : A. B. C. D. 10 beats/min 15 beats/hour 10 beats/hour 15 beats/min

59. How mechanism of thyroxine hormone increase heart rate? I. II. III. IV. A. B. C. D. Directly stimulating SA node Increase metabolic rate of the body Direct stimulating AV node Stimulating effect on sympathetic system I AND II II, III AND IV I, II AND IV I, II ,III AND IV

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60. Which are the following is TRUE statement : A. B. C. D. Hypoxia increases herat rate * Severe emotions lead to reflex increased in heart rate Chemoreceptors are sensitive to pressure Carbon dioxide excess in moderate amounts decrease the heart rate

Physiological properties of heart 2 61. All of the following are true about myocardial rhythmicity EXCEPT A. Is myogenic in nature B. Is the ability of the cardiac muscle to generate action potential spontaneously and regularly C. Ectopic pacemaker possesses the greatest rhythmicity and initiate beat of the whole heart D. A-V nodal rhythm produce slower heart rate 62. Choose the incorrect pair A. B. C. D. S-A node - 105 beats /minute A-V node - 45-60 beats /minute Purkinje system - 25-40 beats/minute Idioventricular rhythm - 30-50 beats/minute

63. Which of the following false regarding the factors affecting myocardial rhythmicity ? I. Whole heart is innervated by vagus nerve and sympathetic nervous system except ventricle II. S-A node discharges at a rate about 105 impulse/minute intrinsic heart rate III. Myocardial rhythmicity increase with increase in body temperature IV. Excess of calcium can increase the diastole until the heart stops in diastole A. I and II B. II and III C. III and IV D. I, II and IV 64. All of the following incorrect about conductivity of the heart EXCEPT A. Physiologically, A-V node has very long relative refractory period B. A-V node protect the ventricle from pathological hyperkinesis of atria C. Rapid impulse conduction through purkinjes fiber because this fiber has many fascia adherens and gap junction D. A-V node is medium in size and its intercalated disc contain less gap junction

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65.

S-A node A-V node purkinjes fiber

bundle of His

bundle branches

terminal

Which of the following physiological properties of the heart describe the table above A. B. C. D. Rhythmicity Conductivity Excitability Contractility

Antiarrythmic Drug II 66. The following are true EXCEPT A. B. C. D. Flecainide can be given to patients with myocardial infarction All anti-dysrrhythmic drugs prolong QRS complex duration Lidocaine can be given to patients with heart failure Quinidine can be used in treatment of supraventricular dysrrhythmia

67. The following statements are true EXCEPT A. B. C. D. Class Ia and Ib prolong QT interval Torsade de pointes is not seen in calcium channel blocker drugs Lidocaine depresses nervous system Depression of cardiac contractility is most significant in Ic administration

68. Choose the correct statements I. Flecainide is used in both treatment of ventricular and supraventricular tachyarrhythmias II. Non lethal reentrant ventricular tachyarrhythmias is induced by flecainide III. Beta blockers can be used against arrhythmia in patient with myocardial infarction IV. Torsade de pointes rarely occur in administration of amiodarone due to its ability to block Na+ channel A. I & II B. II & III C. I & III D. III & IV

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69. Choose the correct statements I. II. III. IV. A. B. C. D. Extracardiac adverse effects of lidocaine can cause death All class I drugs are associated with proarrhythmia with the least significant being Ib Verapamil is used in the acute management of paroxysmal atrial tachycardia Verapamil can cause death if used in patients with ventricular tachycardias I & II II & III III & IV II, III & IV

70. The following are false EXCEPT A. Class II, III, IV and V antiarrhythmic drugs act by decreasing AV conduction B. Flecainide prolongs action potential duration C. Lidocaine must be given IV to have effects on the heart due to its minimal absorption in the GIT if given orally D. The safest antiarrhythmic drugs are class IV drugs ANSWERS: 1 2 3 4 5 6 7 8 9 10 A 69 B 68 B 69 A 70 D 70 C 26 11 12 13 14 15 16 T F F C B A C D 21 22 23 24 25 26 27 28 C 97 31 D 97 B 98 A 72 B 73 A 74 C 74 D 76 B D 32 33 34 35 36 37 38 39 40 A B D B 106 B 105 A 106 C 107 C 107 C A 41 42 43 44 45 46 47 48 49 50 D B B C A B 107 D 107 C 107 C 107 D 108 51 52 53 54 55 56 57 58 59 60 C D B B B B C D C A 61 62 63 64 65 66 67 68 69 70 C B7 D 87 D 87 B 89 B 89 A A C D A

C 27 17 B 27 A 28 D 27 18 19 20

D 29 96 C 97 30

YOUTH IS THE MOST PRECIOUS TIME OF YOUR LIFE, BE SURE TO MAKE THE BEST OUT OF IT! ALL THE BEST!!

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