Free Printable Cardiovascular

1.

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2.

3.1. A 53-year-old woman is found, by arteriography, to have 50% narrowing of her left renal artery. What is the expected change in blood flow through the stenotic artery?

a)

(A) Decrease to 1⁄2

b)

(B) Decrease to 1⁄4

c)

(C) Decrease to 1⁄8

d)

(D) Decrease to 1⁄16

e)

(E) No change

3.

3.2. When a person moves from a supine position to a standing position, which of the following compensatory changes occurs?

a)

(A) Decreased heart rate

b)

(B) Increased contractility

c)

(C) Decreased total peripheral resistance

( TPR)

d)

(D) Decreased cardiac output

e)

(E) Increased PR intervals

4.

3.3 At which site is systolic blood pressure the

highest?

a)

(A) Aorta

b)

(B) Central vein

c)

(C) Pulmonary artery

d)

(D) Right atrium

e)

(E) Renal artery

5.

3.3 At which site is systolic blood pressure the

highest?

a)

(A) Renal vein

b)

(B) Central vein

c)

(C) Pulmonary artery

d)

(D) Right atrium

e)

(E) Renal artery

6.

3.4. A person's electrocardiogram (ECG) has no P wave, but has a normal QRS complex and a normal T wave. Therefore, his pacemaker is located in the

a)

(A) sinoatrial (SA) node

b)

(B) atrioventricular (AV) node

c)

(C) bundle of His

d)

(D) Purkinje system

e)

(E) ventricular muscle

7.

3.5. If the ejection fraction increases, there will

be a decrease in

a)

(A) cardiac output

b)

(B) end-systolic volume

c)

(C) heart rate

d)

(D) pulse pressure

e)

(E) stroke volume

8.

3.5. If the ejection fraction increases, there will

be a decrease in

a)

(A) systolic pressure

b)

(B) end-systolic volume

c)

(C) heart rate

d)

(D) pulse pressure

e)

(E) stroke volume

9.

3.6. An electrocardiogram (ECG) on a person shows ventricular extrasystoles.

The extrasystolic beat would produce

a)

(A) increased pulse pressure because contractility is increased

b)

(B) increased pulse pressure because heart rate is increased

c)

(C) decreased pulse pressure because ventricular filling time is increased

d)

(D) decreased pulse pressure because stroke volume is decreased

e)

(E) decreased pulse pressure because the PR interval is increased

10.

3.7. An electrocardiogram (ECG) on a person shows ventricular extrasystoles.

After an extrasystole, the next “normal” ventricular contraction produces

a)

(A) increased pulse pressure because the contractility of the ventricle is increased

b)

(B) increased pulse pressure because total peripheral resistance (TPR) is decreased

c)

(C) increased pulse pressure because compliance of the veins is decreased

d)

(D) decreased pulse pressure because the contractility of the ventricle is increased

e)

(E) decreased pulse pressure because TPR is

decreased

11.

3.8. Anincreaseincontractilityisdemonstrated on a Frank-Starling diagram by

a)

(A) increased cardiac output for a given end- diastolic volume

b)

(B) increased cardiac output for a given end- systolic volume

c)

(C) decreased cardiac output for a given end-diastolic volume

d)

(D) decreased cardiac output for a given end-systolic volume

12.

3.9. On the graph showing left ventricular volume and pressure, isovolumetric contraction occurs between points

a)

(A) 4→1

b)

(B) 1→2

c)

(C) 2→3

d)

(D) 3→4

13.

3.10. The aortic valve closes at point

a)

(A) 1

b)

(B) 2

c)

(C) 3

d)

(D) 4

14.

3.11. The first heart sound corresponds to point

a)

(A) 1

b)

(B) 2

c)

(C) 3

d)

(D) 4

15.

3.12. If the heart rate is 70 beats/min, then the cardiac output of this ventricle is closest to

a)

(A) 3.45 L/min

b)

(B) 4.55 L/min

c)

(C) 5.25 L/min

d)

(D) 8.00 L/min

e)

(E) 9.85 L/min

16.

In a capillary, Pc is30mmHg,Pi is−2mmHg, πc is 25 mm Hg, and πi is 2 mm Hg.

3.13. What is the direction of fluid movement and the net driving force?

a)

(A) Absorption; 6 mm Hg

b)

(B) Absorption; 9 mm Hg

c)

(C) Filtration; 6 mm Hg

d)

(D) Filtration; 9 mm Hg

e)

(E) There is no net fluid movement

17.

In a capillary, Pc is30mmHg,Pi is−2mmHg, πc is 25 mm Hg, and πi is 2 mm Hg.

3.14. If Kf is 0.5 mL/min/mm Hg, what is the

rate of water flow across the capillary wall?

a)

(A) 0.06 mL/min

b)

(B) 0.45 mL/min

c)

(C) 4.50 mL/min

d)

(D) 9.00 mL/min

e)

(E) 18.00 mL/min

18.

3.15. The tendency for blood flow to be turbulent is increased by

a)

(A) increased viscosity

b)

(B) increased hematocrit

c)

(C) partial occlusion of a blood vessel

d)

(D) decreased velocity of blood flow

19.

3.16. A 66-year-old man, who has had a sympathectomy, experiences a greater- than-normal fall in arterial pressure upon standing up. The explanation for this occurrence is

a)

(A) an exaggerated response of the renin– angiotensin–aldosterone system

b)

(B) a suppressed response of the renin– angiotensin–aldosterone system

c)

(C) an exaggerated response of the baroreceptor mechanism

d)

(D) a suppressed response of the baroreceptor mechanism

20.

3.17. The ventricles are completely depolarized during which isoelectric portion of the electrocardiogram (ECG)?

a)

(A) PR interval

b)

(B) QRS complex

c)

(C) QT interval

d)

(D) ST segment

e)

(E) T wave

21.

3.18. In which of the following situations is pulmonary blood flow greater than aortic blood flow?

a)

(A) Normal adult

b)

(B) Fetus

c)

(C) Left-to-right ventricular shunt

d)

(D) Right-to-left ventricular shunt

e)

(E) Right ventricular failure

22.

3.18. In which of the following situations is pulmonary blood flow greater than aortic blood flow?

a)

(A) Administration of a positive inotropic

agent

b)

(B) Fetus

c)

(C) Left-to-right ventricular shunt

d)

(D) Right-to-left ventricular shunt

e)

(E) Right ventricular failure

23.

3.19. The change indicated by the dashed lines on the cardiac output/venous return curves shows

a)

(A) decreased cardiac output in the “new” steady state

b)

(B) decreased venous return in the “new” steady state

c)

(C) increased mean systemic pressure

d)

(D) decreased blood volume

e)

(E) increased myocardial contractility

24.

3.20. A 30-year-old female patient's electrocardiogram (ECG) shows two P waves preceding each QRS complex. The interpretation of this pattern is

a)

(A) decreased firing rate of the pacemaker in the sinoatrial (SA) node

b)

(B) decreased firing rate of the pacemaker in the atrioventricular (AV) node

c)

(C) increased firing rate of the pacemaker in the SA node

d)

(D) decreasedconductionthroughtheAVnode

e)

(E) increased conduction through the His-

Purkinje system

25.

3.21. An acute decrease in arterial blood pressure elicits which of the following compensatory changes?

a)

(A) Decreased firing rate of the carotid sinus nerve

b)

(B) Increased parasympathetic outflow to the heart

c)

(C) Decreased heart rate

d)

(D) Decreased contractility

e)

(E) Decreased mean systemic pressure

26.

3.22. The tendency for edema to occur will be

increased by

a)

(A) arteriolar constriction

b)

(B) increased venous pressure

c)

(C) increased plasma protein concentration

d)

(D) muscular activity

27.

3.23. Inspiration “splits” the second heart sound because

a)

(A) the aortic valve closes before the pulmonic valve

b)

(B) the pulmonic valve closes before the aortic valve

c)

(C) the mitral valve closes before the tricuspid valve

d)

(D) the tricuspid valve closes before the mitral valve

e)

(E) filling of the ventricles has fast and slow components

28.

3.24. During exercise, total peripheral resistance (TPR) decreases because of the effect of

a)

(A) the sympathetic nervous system on splanchnic arterioles

b)

(B) the parasympathetic nervous system on skeletal muscle arterioles

c)

(C) local metabolites on skeletal muscle arterioles

d)

(D) local metabolites on cerebral arterioles

e)

(E) histamine on skeletal muscle arterioles

29.

3.25. Curve A in the figure represents

a)

(A) aortic pressure

b)

(B) ventricular pressure

c)

(C) atrial pressure

d)

(D) ventricular volume

30.

26. Curve B in the figure represents

a)

(A) left atrial pressure

b)

(B) ventricular pressure

c)

(C) atrial pressure

d)

(D) ventricular volume

31.

3.27. An increase in arteriolar resistance, without a change in any other component of the cardiovascular system, will produce

a)

(A) a decrease in total peripheral resistance ( TPR)

b)

(B) an increase in capillary filtration

c)

(C) an increase in arterial pressure

d)

(D) a decrease in afterload

32.

3.28. The following measurements were obtained in a male patient:

Central venous pressure: 10 mm Hg Heart rate: 70 beats/min Systemic arterial [O2] = 0.24 mL O2/mL Mixed venous [O2] = 0.16 mL O2/mL Whole body O2 consumption: 500 mL/min What is this patient's cardiac output?

a)

(A) 1.65 L/min

b)

(B) 4.55 L/min

c)

(C) 5.00 L/min

d)

(D) 6.25 L/min

e)

(E) 8.00 L/min

33.

3.29. Which of the following is the result of an inward Na+ current?

a)

(A) Upstroke of the action potential in the sinoatrial (SA) node

b)

(B) Upstroke of the action potential in Purkinje fibers

c)

(C) Plateau of the action potential in ventricular muscle

d)

(D) Repolarization of the action potential in ventricular muscle

e)

(E) Repolarization of the action potential in the SA node

34.

3. 30. The dashed line in the figure illustrates the effect of

a)

(A) increasedtotalperipheralresistance (TPR)

b)

(B) increased blood volume

c)

(C) increased contractility

d)

(D) a negative inotropic agent

e)

(E) increased mean systemic pressure

35.

3.31. The x-axis in the figure could have been

labeled

a)

(A) end-systolic volume

b)

(B) end-diastolic volume

c)

(C) pulse pressure

d)

(D) mean systemic pressure

e)

(E) heart rate

36.

3.32. The greatest pressure decrease in the circulation occurs across the arterioles because

a)

(A) they have the greatest surface area

b)

(B) theyhavethegreatestcross-sectionalarea

c)

(C) the velocity of blood flow through them

is the highest

d)

(D) the velocity of blood flow through them

is the lowest

e)

(E) they have the greatest resistance

37.

3.33. Pulse pressure is

a)

(A) the highest pressure measured in the arteries

b)

(B) the lowest pressure measured in the arteries

c)

(C) measured only during diastole

d)

(D) determined by stroke volume

38.

3.33. Pulse pressure is

a)

(A) decreased when the capacitance of the arteries decreases

b)

(B) the difference between mean arterial pressure and central venous pressure

c)

(C) measured only during diastole

d)

(D) determined by stroke volume

39.

3.34. In the sinoatrial (SA) node, phase 4 depolarization (pacemaker potential) is attributable to

a)

(A) an increase in K+ conductance

b)

(B) an increase in Na+ conductance

c)

(C) a decrease in Cl– conductance

d)

(D) a decrease in Ca2+ conductance

e)

(E) simultaneous increases in K+ and Cl– conductances

40.

35. A healthy 35-year-old man is running a marathon. During the run, there is a increase in his splanchnic vascular resistance. Which receptor is responsible for the increased resistance?

a)

(A) α1 Receptors

b)

(B) β1 Receptors

c)

(C) β2 Receptors

d)

(D) Muscarinic receptors

41.

3. 36. During which phase of the cardiac cycle

is aortic pressure highest?

(E) Isovolumetric ventricular relaxation

(F) Rapid ventricular filling

(G) Reduced ventricular filling (diastasis)

a)

(A) Atrial systole

b)

(B) Isovolumetric ventricular contraction

c)

(C) Rapid ventricular ejection

d)

(D) Reduced ventricular ejection

42.

3. 36. During which phase of the cardiac cycle

is aortic pressure highest?

a)

(A) Reduced ventricular filling (diastasis)

b)

(B) Rapid ventricular filling

c)

(C) Isovolumetric ventricular relaxation

d)

(D) Reduced ventricular ejection

43.

3.37. Myocardialcontractilityisbestcorrelated

with the intracellular concentration of

a)

(A) Na+

b)

(B) K+

c)

(C) Ca2+

d)

(D) Cl–

e)

(E) Mg2+

44.

3.38. Which of the following is an effect of

histamine?

a)

(A) Decreased capillary filtration

b)

(B) Vasodilation of the arterioles

c)

(C) Vasodilation of the veins

d)

(D) Decreased Pc

e)

(E) Interaction with the muscarinic receptors on the blood vessels

45.

3.39. Carbon dioxide (CO2) regulates blood flow to which one of the following organs?

a)

(A) Heart

b)

(B) Skin

c)

(C) Brain

d)

(D) Skeletal muscle at rest

e)

(E) Skeletal muscle during exercise

46.

3.40. Cardiac output of the right side of the heart is what percentage of the cardiac output of the left side of the heart?

a)

(A) 25%

b)

(B) 50%

c)

(C) 75%

d)

(D) 100%

e)

(E) 125%

47.

3.41. The physiologic function of the relatively slow conduction through the atrioventricular (AV) node is to allow sufficient time for

a)

(A) runoff of blood from the aorta to the arteries

b)

(B) venous return to the atria

c)

(C) filling of the ventricles

d)

(D) contraction of the ventricles

e)

(E) repolarization of the

ventricles

48.

3.42. Blood flow to which organ is controlled primarily by the sympathetic nervous system rather than by local metabolites?

a)

(A) Skin

b)

(B) Heart

c)

(C) Brain

d)

(D) Skeletal muscle during exercise

49.

3.43. Which of the following parameters is decreased during moderate exercise?

a)

(A) Arteriovenous O2 difference

b)

(B) Heart rate

c)

(C) Cardiac output

d)

(D) Pulse pressure

e)

(E) Total peripheral resistance (TPR)

50.

3.44. A 72-year-old woman, who is being treated with propranolol, finds that she cannot maintain her previous exercise routine. Her physician explains that the drug has reduced her cardiac output. Blockade

of which receptor is responsible for the decrease in cardiac output?

a)

(A) α1 Receptors

b)

(B) β1 Receptors

c)

(C) β2 Receptors

d)

(D) Muscarinic receptors

e)

(E) Nicotinic receptors

51.

3.45. During which phase of the cardiac cycle

is ventricular volume lowest?

a)

(A) Atrial systole

b)

(B) Isovolumetric ventricular contraction

c)

(C) Rapid ventricular ejection

d)

(D) Reduced ventricular ejection

e)

(E) Isovolumetric ventricular relaxation

52.

3.45. During which phase of the cardiac cycle

is ventricular volume lowest?

a)

(A) Rapid ventricular filling

b)

(B) Reduced ventricular filling (diastasis)

c)

(C) Rapid ventricular ejection

d)

(D) Reduced ventricular ejection

e)

(E) Isovolumetric ventricular relaxation

53.

3.46. Which of the following changes will cause

anincreaseinmyocardialO consumption? 2

a)

(A) Decreased aortic pressure

b)

(B) Decreased heart rate

c)

(C) Decreased contractility

d)

(D) Increased size of the heart

e)

(E) Increased influx of Na+ during the upstroke of the action potential

54.

3.47. Which of the following substances crosses capillary walls primarily through water-filled clefts between the endothelial cells?

a)

(A) O2

b)

(B) CO2

c)

(C) CO

d)

(D) Glucose

55.

3. 48. A 24-year-old woman presents to the emergency department with severe diarrhea. When she is supine (lying down), her blood pressure is 90/60 mm Hg (decreased) and her heart rate is 100 beats/min (increased). When she is moved to a standing position, her heart rate further increases to 120 beats/ min. Which of the following accounts for the further increase in heart rate upon standing?

a)

(A) Decreased total peripheral resistance

b)

(B) Increased venoconstriction

c)

(C) Increased contractility

d)

(D) Increased afterload

e)

(E) Decreased venous return

56.

3.49. A 60-year-old businessman is evaluated by his physician, who determines that his blood pressure is significantly elevated at 185/130 mm Hg. Laboratory tests reveal an increase in plasma renin activity, plasma aldosterone level, and left renal vein renin level. His right renal vein renin level is decreased. What is the most likely cause of the patient's hypertension?

a)

(A) Aldosterone-secreting tumor

b)

(B) Adrenal adenoma secreting aldosterone and cortisol

c)

(C) Pheochromocytoma

d)

(D) Left renal artery stenosis

e)

(E) Right renal artery stenosis

57.

3. 50. During which phase of the ventricular action potential is the membrane potential closest to the K+ equilibrium potential?

a)

(A) Phase 0

b)

(B) Phase 1

c)

(C) Phase 2

d)

(D) Phase 3

e)

(E) Phase 4

58.

3.51. During which phase of the ventricular action potential is the conductance to Ca2+ highest?

a)

(A) Phase 0

b)

(B) Phase 1

c)

(C) Phase 2

d)

(D) Phase 3

e)

(E) Phase 4

59.

3.52. Which phase of the ventricular action potential coincides with diastole?

a)

(A) Phase 0

b)

(B) Phase 1

c)

(C) Phase 2

d)

(D) Phase 3

e)

(E) Phase 4

60.

3.53. Propranolol has which of the following effects?

a)

(A) Decreases heart rate

b)

(B) Increases left ventricular ejection

fraction

c)

(C) Increases stroke volume

d)

(D) Decreases splanchnic vascular resistance

e)

(E) Decreases cutaneous vascular resistance

61.

3.54. Which receptor mediates slowing of the

a)

(A) α1 Receptors

b)

(B) β1 Receptors

c)

(C) β2 Receptors

d)

(D) Muscarinic receptors

62.

3.55. Which of the following agents or changes has a negative inotropic effect on the heart?

a)

(A) Increased heart rate

b)

(B) Sympathetic stimulation

c)

(C) Norepinephrine

d)

(D) Acetylcholine (ACh)

e)

(E) Cardiac glycosides

63.

3.56. The low-resistance pathways between myocardial cells that allow for the spread of action potentials are the

a)

(A) gap junctions

b)

(B) T tubules

c)

(C) sarcoplasmic reticulum (SR)

d)

(D) intercalated disks

e)

(E) mitochondria

64.

3.57. Which agent is released or secreted after a hemorrhage and causes an increase in renal Na+ reabsorption?

a)

(A) Aldosterone

b)

(B) Angiotensin I

c)

(C) Angiotensinogen

d)

(D) Antidiuretic hormone (ADH)

e)

(E) Atrial natriuretic peptide

65.

3.58. During which phase of the cardiac cycle

does the mitral valve open?

a)

(A) Atrial systole

b)

(B) Isovolumetric ventricular contraction

c)

(C) Rapid ventricular ejection

d)

(D) Reduced ventricular ejection

e)

(E) Isovolumetric ventricular relaxation

66.

3.58. During which phase of the cardiac cycle

does the mitral valve open?

a)

(A) Rapid ventricular filling

b)

(B) Isovolumetric ventricular contraction

c)

(C) Reduced ventricular filling (diastasis)

d)

(D) Reduced ventricular ejection

e)

(E) Isovolumetric ventricular relaxation

67.

3.59. A hospitalized patient has an ejection fraction of 0.4, a heart rate of 95 beats/min, and a cardiac output of 3.5 L/min. What is the patient's end-diastolic volume?

a)

(A) 14 mL

b)

(B) 37 mL

c)

(C) 55 mL

d)

(D) 92 mL

e)

(E) 140 mL

68.

G3. A 60-year-old woman has a resting heart rate of 70 beats per minute, arterial pressure of 130/85 mm Hg, and normal body temperature. Use the pressure-volume diagram of her left ventricle below to answer Questions 1–4.

1. What is her cardiac output in milliliters per minute?

a)

A) 2000

b)

B) 3000

c)

C) 4000

d)

D) 6000

e)

E) 7000

69.

G3. A 60-year-old woman has a resting heart rate of 70 beats per minute, arterial pressure of 130/85 mm Hg, and normal body temperature. Use the pressure-volume diagram of her left ventricle below to answer Questions 1–4.

2. When does the first heart sound occur in the ventricu- lar pressure–volume relationship?

a)

A) At point B

b)

B) Between point A and point B

c)

C) Between point B and point C

d)

D) Between point C and point D

e)

E) Between point D and point A

70.

G3. A 60-year-old woman has a resting heart rate of 70 beats per minute, arterial pressure of 130/85 mm Hg, and normal body temperature. Use the pressure-volume diagram of her left ventricle below to answer Questions 1–4.

3. When does the fourth heart sound occur in the ven- tricular pressure–volume relationship?

a)

A) At point D

b)

B) Between point A and point B

c)

C) Between point B and point C

d)

D) Between point C and point D

e)

E) Between point D and point A

71.

G3. A 60-year-old woman has a resting heart rate of 70 beats per minute, arterial pressure of 130/85 mm Hg, and normal body temperature. Use the pressure-volume diagram of her left ventricle below to answer Questions 1–4.

4. What is her ventricular ejection fraction?

a)

A) 33%

b)

B) 50%

c)

C) 60%

d)

D) 67%

e)

E) 80%

72.

G3.5. Which statement about cardiac muscle is most accurate?

a)

A) The T-tubules of cardiac muscle can store much less calcium than the T-tubules in skeletal muscle

b)

B) The strength and contraction of cardiac muscle de- pends on the amount of calcium surrounding cardiac myocytes

c)

C) Incardiacmuscle,theinitiationoftheactionpoten- tial causes an immediate opening of slow calcium channels

d)

D) Cardiac muscle repolarization is caused by opening of sodium channels

e)

E) Mucopolysaccharides inside the T-tubules bind chloride ions

73.

G3.6. A 30-year-old man has an ejection fraction of 0.25 and an end-systolic volume of 150 milliliters. What is his end-diastolic volume?

a)

A) 50 milliliters

b)

B) 100 milliliters

c)

C) 125 milliliters

d)

D) 200 milliliters

e)

E) 250 milliliters

74.

G3.7. In a resting adult, the typical ventricular ejection frac- tion has what value?

a)

A) 20%

b)

B) 30%

c)

C) 40%

d)

D) 60%

e)

E) 80%

75.

G3. 8. In which phase of the ventricular muscle action potential is the potassium permeability the highest?

a)

A)0

b)

B) 1

c)

C)2

d)

D)3

e)

E) 4

76.

G3.9. A 60-year-old man’s ECG shows that he has an R-R interval of 1.5 seconds at rest. Which statement best explains his condition?

a)

A) He has fever

b)

B) He has a normal heart rate

c)

C) He has decreased parasympathetic stimulation of the S-A node

d)

D) He is a trained athlete at rest

e)

E) He has normal polarization of the S-A node

77.

G3.10. Which of the following is most likely to cause the heart to go into spastic contraction?

a)

A) Increased body temperature

b)

B) Increased sympathetic activity

c)

C) Decreased extracellular fluid potassium ions

d)

D) Excess extracellular fluid potassium ions

e)

E) Excess extracellular fluid calcium ions

78.

G3. 11. What happens at the end of ventricular isovolumic re- laxation?

a)

A) The A-V valves close

b)

B) The aortic valve opens

c)

C) The aortic valve closes

d)

D) The mitral valve opens

e)

E) The pulmonary valve closes

79.

G3.12. Which event is associated with the first heart sound?

a)

A) Closing of the aortic valve

b)

B) Inrushingofbloodintotheventriclesduringdiastole

c)

C) Beginning of diastole

d)

D) Opening of the A-V valves

e)

E) Closing of the A-V valves

80.

G3.13. Which condition will result in a dilated, flaccid heart?

a)

A) Excess calcium ions in the blood

b)

B) Excess potassium ions in the blood

c)

C) Excess sodium ions in the blood

d)

D) Increased sympathetic stimulation

e)

E) Increased norepinephrine concentration in the blood

81.

G3.14. A 25-year-old well-conditioned athlete weighs 80 kilograms (176 pounds). During maximal sympa- thetic stimulation, what is the plateau level of his car- diac output function curve?

a)

A) 3 liters per minute

b)

B) 5 liters per minute

c)

C) 10 liters per minute

d)

D) 13 liters per minute

e)

E) 25 liters per minute

82.

G3.15. Which phase of the cardiac cycle follows immediately after the beginning of the QRS wave?

a)

A) Isovolumic relaxation

b)

B) Ventricular ejection

c)

C) Atrial systole

d)

D) Diastasis

e)

E) Isovolumic contraction

83.

G3. 16. Which of the following structures will have the slowest rate of conduction of the cardiac action potential?

a)

A) Atrial muscle

b)

B) Anterior internodal pathway

c)

C) A-V bundle fibers

d)

D) Purkinje fibers

e)

E) Ventricular muscle

84.

G3. 17. What is the normal total delay of the cardiac impulse in the A-V node + bundle?

a)

A) 0.22 second

b)

B) 0.18 second

c)

C) 0.16 second

d)

D) 0.13 second

e)

E) 0.09 second

85.

G3. 18. Sympathetic stimulation of the heart does which of the following?

a)

A) Releases acetylcholine at the sympathetic endings

b)

B) Decreases sinus nodal discharge rate

c)

C) Decreases excitability of the heart

d)

D) Releases norepinephrine at the sympathetic endings

e)

E) Decreases cardiac contractility

86.

G3. 19. If the S-A node discharges at 0.00 seconds, when will the action potential normally arrive at the epicardial surface at the base of the left ventricle?

a)

A) 0.22 second

b)

B) 0.18 second

c)

C) 0.16 second

d)

D) 0.12 second

e)

E) 0.09 second

87.

G3. 20. Which condition at the A-V node will cause a decrease in heart rate?

a)

A) Increased sodium permeability

b)

B) Decreased acetylcholine levels

c)

C) Increased norepinephrine levels

d)

D) Increased potassium permeability

e)

E) Increased calcium permeability

88.

G3. 21. Which statement best explains how sympathetic stim- ulation affects the heart?

a)

A) The permeability of the S-A node to sodium decreases

b)

B) The permeability of the A-V node to sodium decreases

c)

C) The permeability of the S-A node to potassium

increases

d)

D) There is an increased rate of upward drift of the

resting membrane potential of the S-A node

e)

E) The permeability of the cardiac muscle to calcium

decreases

28

89.

G3.22. What is the membrane potential (threshold level) at which the S-A node discharges?

a)

A) −40 millivolt

b)

B) −55 millivolt

c)

C) −65 millivolt

d)

D) −85 millivolt

e)

E) −105 millivolt

90.

G3.23. Which condition at the S-A node will cause heart rate to decrease?

a)

A) Increased norepinephrine level

b)

B) Increased sodium permeability

c)

C) Increased calcium permeability

d)

D) Increased potassium permeability

e)

E) Decreased acetylcholine level

91.

G3. 24. In which phase of the ventricular muscle action potential is the sodium permeability the highest?

a)

A) 0

b)

B) 1

c)

C)2

d)

D)3

e)

E) 4

92.

G3. 25. If the S-A node discharges at 0.00 seconds, when will the action potential normally arrive at the A-V bundle (bundle of His)?

a)

A) 0.22 second

b)

B) 0.18 second

c)

C) 0.16 second

d)

D) 0.12 second

e)

E) 0.09 second

93.

G3. 26. If the Purkinje fibers, situated distal to the A-V junction, become the pacemaker of the heart, what is the expected heart rate?

a)

A) 30/min

b)

B) 50/min

c)

C) 60/min

d)

D) 70/min

e)

E) 80/min

94.

G3.27. If the S-A node discharges at 0.00 seconds, when will the action potential normally arrive at the A-V node?

a)

A) 0.03 second

b)

B) 0.09 second

c)

C) 0.12 second

d)

D) 0.16 second

e)

E) 0.80 second

95.

G3. 28. What is the delay between the S-A node discharge and arrival of the action potential at the ventricular sep- tum?

a)

A) 0.80 second

b)

B) 0.16 second

c)

C) 0.12 second

d)

D) 0.09 second

e)

E) 0.03 second

96.

G3.29. A patient had an ECG at the local emergency depart- ment. The attending physician stated that the patient had an A-V nodal rhythm. What is the likely heart rate?

a)

A) 30/min

b)

B) 50/min

c)

C) 65/min

d)

D) 75/min

e)

E) 85/min

97.

G3. 30. Which condition at the A-V node will cause a decrease in heart rate?

a)

A) Increased sodium permeability

b)

B) Decreased acetylcholine level

c)

C) Increased norepinephrine level

d)

D) Increased potassium permeability

e)

E) Increased calcium permeability

98.

G3.31. When recording lead aVL on an ECG, which is the positive electrode?

a)

A) Left arm

b)

B) Left leg

c)

C) Right leg

d)

D) Left arm + left leg

e)

E) Right arm + left leg

99.

G3. 32. When recording lead II on an ECG, the right arm is the negative electrode and the positive electrode is the

a)

A) Left arm

b)

B) Left leg

c)

C) Right leg

d)

D) Left arm + left leg

e)

E) Right arm + left leg

100.

G3. 33. Sympathetic stimulation of the heart normally causes which condition?

a)

A) Acetylcholine release at the sympathetic endings

b)

B) Decreased heart rate

c)

C) Decreased rate of conduction of the cardiac im- pulse

d)

D) Decreased force of contraction of the atria

e)

E) Increased force of contraction of the ventricles

101.

G3. A 70-year-old woman had an ECG at her annual checkup. Use her lead II recording below to answer Questions 34 and 35.

34. What is her heart rate in beats per minute?

a)

A) 70

b)

B) 78

c)

C) 84

d)

D) 94

e)

E) 104

102.

G3. A 70-year-old woman had an ECG at her annual checkup. Use her lead II recording below to answer Questions 34 and 35.

35. According to Einthoven’s law, if the QRS voltage in lead III is 0.4 millivolt, what is the QRS voltage in lead I?

a)

A) 0.05 millivolt

b)

B) 0.50 millivolt

c)

C) 1.05 millivolts

d)

D) 1.25 millivolts

e)

E) 2.05 millivolts

103.

G3. 36 What is the normal QT interval?

a)

A) 0.03 second

b)

B) 0.13 second

c)

C) 0.16 second

d)

D) 0.20 second

e)

E) 0.35 second

104.

G3. 37. When recording lead II on an ECG, the negative elec- trode is the

a)

A) Right arm

b)

B) Left leg

c)

C) Right leg

d)

D) Left arm + left leg

e)

E) Right arm + left leg

105.

G3. 38. When recording lead I on an ECG, the right arm is the negative electrode and the positive electrode is the

a)

A) Left arm

b)

B) Left leg

c)

C) Right leg

d)

D) Left arm + left leg

e)

E) Right arm + left leg

106.

G3. 39. A 65-year-old man had an ECG at a local emergency department after a biking accident. His weight was 80 kilograms (176 pounds), and his aortic blood pressure was 160/90 mm Hg. The QRS voltage was 0.5 millivolt in lead I and 1.5 millivolts in lead III. What is the QRS voltage in lead II?

a)

A) 0.5 millivolt

b)

B) 1.0 millivolt

c)

C) 1.5 millivolts

d)

D) 2.0 millivolts

e)

E) 2.5 millivolts

107.

G3. 40. A ventricular depolarization wave, when traveling −60 degrees in the frontal plane, will cause a large negative deflection in which lead?

a)

A) aVR

b)

B) aVL

c)

C) Lead II

d)

D) Lead III

e)

E) aVF

108.

G3. 41. A 60-year-old woman had an ECG recorded at a local emergency department after an automobile accident. Her weight was 70 kilograms (154 pounds), and her aortic blood pressure was 140/80 mm Hg. Use this information and the figure below to answer Questions 41–43.

41. What is the mean electrical axis calculated from stan- dard leads I, II, and III shown in the woman’s ECG?

a)

A) −90 degrees

b)

B) −50 degrees

c)

C) −12 degrees

d)

D) +100 degrees

e)

E) +170 degrees

109.

G3. 42. A 60-year-old woman had an ECG recorded at a local emergency department after an automobile accident. Her weight was 70 kilograms (154 pounds), and her aortic blood pressure was 140/80 mm Hg. Use this information and the figure below to answer Questions 41–43.

42. What is the heart rate using lead I for the calculation?

a)

A) 70

b)

B) 88

c)

C) 100

d)

D) 112

e)

E) 148

110.

G3. 43. A 60-year-old woman had an ECG recorded at a local emergency department after an automobile accident. Her weight was 70 kilograms (154 pounds), and her aortic blood pressure was 140/80 mm Hg. Use this information and the figure below to answer Questions 41–43.

43. What is her likely diagnosis?

a)

A) Tricuspid valve stenosis

b)

B) Left bundle branch block

c)

C) Pulmonary valve stenosis

d)

D) Pulmonary valve insufficiency

e)

E) Aortic insufficiency

111.

G3. 44. Which condition will usually result in left axis deviation in an ECG?

a)

A) Systemic hypertension

b)

B) Pulmonary valve stenosis

c)

C) Pulmonary valve regurgitation

d)

D) Rightward angulation of the heart

e)

E) Pulmonary hypertension

112.

G3. 45. A ventricular depolarization wave, when traveling 60 degrees in the frontal plane, will cause a large positive deflection in which of the following leads?

a)

A) aVR

b)

B) aVL

c)

C) Lead I

d)

D) Lead II

e)

E) aVF

113.

G3.46. A 50-year-old woman was admitted to a local emergency department after a motorcycle accident. The following ECG was obtained.

46. What is her heart rate? Use lead I for the calculation.

a)

A) 56

b)

B) 66

c)

C) 76

d)

D) 103

e)

E) 152

114.

G3.47. A 50-year-old woman was admitted to a local emergency department after a motorcycle accident. The following ECG was obtained.

47. What type of murmur is present in this patient?

a)

A) Aortic valve insufficiency

b)

B) Left bundle branch block

c)

C) Pulmonary valve stenosis

d)

D) Right bundle branch block

e)

E) Systemic hypertension

115.

G3. 48. Mr.Smith had an ECG at a local hospital, but his records were lost. The ECG technician remembered that the QRS deflection was large and positive in lead II and 0 in aVL. What is his mean electrical axis in the frontal plane?

a)

A) 90 degrees

b)

B) 60 degrees

c)

C) 0 degree

d)

D) −60 degrees

e)

E) -90 degrees

116.

G3. 49. A 70-year-old woman came to a hospital emergency de- partment because she was experiencing chest pain. Based on the ECG shown above, what is the likely diagnosis?

a)

A) Acute anterior infarction in the left ventricle of the heart

b)

B) Acute anterior infarction in the right ventricle of the heart

c)

C) Acute posterior infarction in the left ventricle of the heart

d)

D) Acute posterior infarction in the right ventricle of the heart

e)

E) Right ventricular hypertrophy

117.

G3. 50. A 55-year-old man underwent an ECG at an annual physical, and his net deflection (R wave minus Q or S wave) in standard limb lead I was −1.2 millivolts. Stan- dard limb lead II has a net deflection of +1.2 millivolts. What is the mean electrical axis of his QRS?

a)

A) −30 degrees

b)

B) +30 degrees

c)

C) +60 degrees

d)

D) +120 degrees

e)

E) −120 degrees

118.

G3. 51. During the T-P interval in an ECG of a patient with a damaged cardiac muscle, which of the following is true?

a)

A) The entire ventricle is depolarized

b)

B) The entire ventricle is depolarized except for the

damaged cardiac muscle

c)

C) About half the ventricle is depolarized

d)

D) The entire ventricle is repolarized

e)

E) The entire ventricle is repolarized except for the damaged cardiac muscle

119.

G3.52. A 50-year-old man is a new employee at ABC Software. The above ECG was recorded during a routine physical examination. What is his likely diagnosis?

a)

A) Chronic systemic hypertension

b)

B) Chronic pulmonary hypertension

c)

C) Second-degree heart block

d)

D) Paroxysmal tachycardia

e)

E) Tricuspid valve stenosis

120.

G3. 53. A 30-year-old man had an ECG at his physician’s office, but his records were lost. The ECG technician remem- bered that the QRS deflection was large and positive in lead aVF and 0 in lead I. What is the mean electrical axis in the frontal plane?

a)

A) 90 degrees

b)

B) 60 degrees

c)

C) 0 degree

d)

D) −60 degrees

e)

E) −90 degrees

121.

G3. 54. A 60-year-old woman tires easily. Her ECG shows a QRS complex that is positive in the aVF lead and nega- tive in standard limb lead I. What is a likely cause of this condition?

a)

A) Chronic systemic hypertension

b)

B) Pulmonary hypertension

c)

C) Aortic valve stenosis

d)

D) Aortic valve regurgitation

122.

G3. 55. A 65-year-old patient with a heart murmur has a mean QRS axis of 120 degrees, and the QRS complex lasts 0.18 second. What is the likely diagnosis?

a)

A) Aortic valve stenosis

b)

B) Aortic valve regurgitation

c)

C) Pulmonary valve stenosis

d)

D) Right bundle branch block

e)

E) Left bundle branch block

123.

G3. 56. A 60-year-old woman came to the hospital emergency department and reported chest pain. Based on the ECG tracing shown above, what is the most likely diagnosis?

a)

A) Acute anterior infarction in the base of the heart

b)

B) Acute anterior infarction in the apex of the heart

c)

C) Acute posterior infarction in the base of the heart

d)

D) Acute posterior infarction in the apex of the heart

e)

E) Right ventricular hypertrophy

124.

G3.57. A 50-year-old man has been having fainting “spells” for about 2 weeks. During the episodes, his ECG shows a ventricular rate of 25 beats/min and 100 P waves per minute. After about 30 seconds of fainting, a normal sinus rhythm recurs. What is his likely diagnosis?

a)

A) Atrial flutter

b)

B) First-degree A-V block

c)

C) Second-degree A-V block

d)

D) Third-degree A-V block

e)

E) Stokes-Adams syndrome

125.

G3. 58. An 80-year-old man had an ECG taken at his local doctor’s office, and the diagnosis was atrial fibrillation. Which condition is likely in someone with atrial fibril- lation?

a)

A) Ventricular fibrillation, which normally accompa- nies atrial fibrillation

b)

B) Strong P waves on the ECG

c)

C) An irregular and fast rate of ventricular contraction

d)

D) A normal atrial “a” wave

e)

E) A smaller atrial volume than normal

126.

G3. 59. Circusmovementsintheventriclecanleadtoventricu- lar fibrillation. Which condition in the ventricular mus- cle will increase the tendency for circus movements?

a)

A) Decreased refractory period

b)

B) Low extracellular potassium concentration

c)

C) Increased refractory period

d)

D) Shorter conduction pathway (decreased ventricular

volume)

e)

E) Increase in parasympathetic impulses to the heart

127.

G3. 60. A 50-year-old man has a blood pressure of 140/85 mm Hg and weighs 90.7 kilograms (200 pounds). He reports that he is not feeling well, his ECG has no P waves, he has a heart rate of 46 beats/min, and the QRS com- plexes occur regularly. What is his likely condition?

a)

A) First-degree heart block

b)

B) Second-degree heart block

c)

C) Third-degree heart block

d)

D) Sinoatrial heart block

e)

E) Sinus bradycardia

128.

G3. 61. The following ECG tracing was obtained for a 60-year- old man who weighs 99.8 kilograms (220 pounds). Standard lead II is shown above. What is his diagnosis?

a)

A) A-V nodal rhythm

b)

B) First-degree A-V heart block

c)

C) Second-degree A-V heart block

d)

D) Third-degree A-V heart block

e)

E) Atrial flutter

129.

G3.62. A 35-year-old woman had unusual sensations in her chest after she smoked a cigarette. Her ECG tracing is shown above. What is the likely diagnosis?

a)

A) Premature contraction originating in the atrium

b)

B) Premature contraction originating high in the A-V

node

c)

C) Premature contraction originating low in the A-V

node

d)

D) Premature contraction originating in the apex of

the ventricle

e)

E) Premature contraction originating in the base of

the ventricle

130.

G3. Questions 63 and 64

A 55-year-old man had the below ECG tracing recorded at his doctor’s office at a routine physical examination. Use this tracing to answer Questions 63 and 64.

63. What is his diagnosis?

a)

A) Normal ECG

b)

B) Atrial flutter

c)

C) A high A-V junctional pacemaker

d)

D) A middle A-V junctional pacemaker

e)

E) A low A-V junctional pacemaker

131.

G3. Questions 63 and 64

A 55-year-old man had the below ECG tracing recorded at his doctor’s office at a routine physical examination. Use this tracing to answer Questions 63 and 64.

64. What is his ventricular heart rate in beats/min?

a)

A) 37.5

b)

B) 60

c)

C) 75

d)

D) 100

e)

E) 150

132.

G3. 65. What decreases the risk of ventricular fibrillation?

a)

A) A dilated heart

b)

B) An increased ventricular refractory period

c)

C) Decreased electrical conduction velocity

d)

D) Exposure of the heart to 60-cycle alternating current

e)

E) Epinephrine administration

133.

G3. 66. Whichofthefollowingwillusuallyresultinaninverted P wave that occurs after the QRS complex?

a)

A) Premature contraction originating in the atrium

b)

B) Premature contraction originating high in the A-V

junction

c)

C) Premature contraction originating in the middle of

the A-V junction

d)

D) Premature contraction originating low in the A-V

junction

e)

E) Atrial fibrillation

134.

G3. 67. A 65-year-old woman who had a myocardial infarction 10 days ago returned to her family physician’s office and reported that her pulse rate felt rapid. Based on the above ECG tracing, what is the likely diagnosis?

a)

A) Stokes-Adams syndrome

b)

B) Atrial fibrillation

c)

C) A-V nodal tachycardia

d)

D) Atrial paroxysmal tachycardia

e)

E) Ventricular paroxysmal tachycardia

135.

G3. 68. A 65-year-old man had the above ECG tracing re- corded at his annual physical examination. What is the likely diagnosis?

a)

A) Atrial paroxysmal tachycardia

b)

B) First-degree A-V block

c)

C) Second-degree A-V block

d)

D) Third-degree A-V block

e)

E) Atrial flutter

136.

G3. 69. A 60-year-old woman has been diagnosed with atrial fibrillation. Which statement best describes this con- dition?

a)

A) The ventricular rate of contraction is 140 beats/min

b)

B) The P waves of the ECG are pronounced

c)

C) Ventricular contractions occur at regular intervals

d)

D) The QRS waves are more pronounced than normal

e)

E) The atria are smaller than normal

137.

G3. 70. What occurs after electrical shock of the heart with a 60-cycle alternating current?

a)

A) A normal arterial pressure

b)

B) A decreased ventricular refractory period

c)

C) Increased electrical conduction velocity

d)

D) A shortened conduction pathway around the heart

e)

E) Normal cardiac output

138.

G3. 71. A 55-year-old man has been diagnosed with Stokes- Adams syndrome. Two minutes after the syndrome starts to cause active blockade of the cardiac im- pulse, which of the following is the pacemaker of the heart?

a)

A) Sinus node

b)

B) A-V node

c)

C) Purkinje fibers

d)

D) Cardiac septum

e)

E) Left atrium

139.

G3. 72. Questions 72 and 73

A man had a myocardial infarction at age 55 years. He is now 63 years old. Use the standard limb lead I tracing on his ECG shown below to answer Questions 72 and 73.

72. What is his heart rate?

a)

A) 40 beats/min

b)

B) 50 beats/min

c)

C) 75 beats/min

d)

D) 100 beats/min

e)

E) 150 beats/min

140.

G3. 72. Questions 72 and 73

A man had a myocardial infarction at age 55 years. He is now 63 years old. Use the standard limb lead I tracing on his ECG shown below to answer Questions 72 and 73.

73. What is his current diagnosis?

a)

A) Sinus tachycardia

b)

B) First-degree heart block

c)

C) Second-degree heart block

d)

D) ST segment depression

e)

E) Third-degree heart block

141.

G3. 74. Which statement best describes a patient with prema- ture atrial contraction?

a)

A) The pulse taken from the radial artery immediately after the premature contraction will be weak

b)

B) Stroke volume immediately after the premature contraction will be increased

c)

C) The P wave is never seen

d)

D) The probability of these premature contractions

occurring is decreased in people with a large caf-

feine intake

e)

E) It causes the QRS interval to be lengthened

142.

G3.75. If the origin of the stimulus that causes atrial paroxys- mal tachycardia is near the A-V node, which statement about the P wave in standard limb lead I is most accurate?

a)

A) The P wave will originate in the sinus node

b)

B) The P wave will be upright

c)

C) The P wave will be inverted

d)

D) The P wave will be missing

143.

G3. 76. A 45-year-old man had the above ECG recorded at his annual physical. What is the likely diagnosis?

a)

A) Atrial paroxysmal tachycardia

b)

B) First-degree A-V block

c)

C) Second-degree A-V block

d)

D) Ventricular paroxysmal tachycardia

e)

E) Atrial flutter

144.

G3. 77. A 60-year-old woman sees her physician for her annual physical examination. The physician ordered an ECG, which is shown above. What is the likely diagnosis?

a)

A) First-degree A-V block

b)

B) Second-degree A-V block

c)

C) Third-degree A-V block

d)

D) Atrial paroxysmal tachycardia

e)

E) Atrial fibrillation

145.

G3. Questions 78 and 79

An 80-year-old man went to his family physician for his annual checkup. Use the ECG tracing shown below to answer Questions 78 and 79.

78. What is his heart rate?

a)

A) 105

b)

B) 95

c)

C) 85

d)

D) 75

e)

E) 37

146.

G3. Questions 78 and 79

An 80-year-old man went to his family physician for his annual checkup. Use the ECG tracing shown below to answer Questions 78 and 79.

79. What is the likely diagnosis?

a)

A) Left bundle branch block

b)

B) First-degree A-V block

c)

C) Second-degree A-V block

d)

D) Electrical alternans

e)

E) Complete A-V block

Cardiovascular - The heart

Total questions: 146

Worksheet time: 1hrs 13mins

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