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WorksheetsDAY2 FIRST YEAR — Chapters 13 and 16 Worksheet Questions
Total questions: 80
Worksheet time: 3600secs
A patient’s ECG shows a P-R interval of 0.28 seconds. There is a P wave for every QRS complex, and the rhythm is regular. What is the diagnosis?
Second-degree heart block (Mobitz I)
First-degree heart block
Third-degree heart block
Sinoatrial block
A 65-year-old male presents with palpitations. The ECG shows an absent P wave and an irregularly irregular QRS rhythm. What is the most likely physiological consequence?
Increased ventricular filling time
Loss of the "atrial kick," reducing ventricular pumping efficiency by 20-30%
Immediate ventricular fibrillation
Sustained increase in cardiac output
In a patient with "Circus Movements" leading to Ventricular Fibrillation, which of the following factors would most likely terminate the re-entry pathway?
Shortening of the refractory period
Increased pathway length (dilated heart)
Decreased conduction velocity (Purkinje system damage)
Lengthening of the refractory period (via drugs)
A "Wenckebach phenomenon" (Mobitz Type I) is characterized by:
Constant P-R interval with dropped QRS complexes
Progressive lengthening of the P-R interval until a QRS is dropped
Total dissociation between P waves and QRS complexes
Heart rate below 40 bpm with normal P-R interval
Which ECG finding is most characteristic of a Premature Ventricular Contraction (PVC)?
Narrow QRS complex
High-voltage, prolonged QRS complex with inverted T wave
Shortened P-R interval
Presence of an inverted P wave before the QRS
Stokes-Adams syndrome occurs in patients with periodic transition to total AV block. What is the primary cause of syncope in these patients?
Excessive vagal tone
Delay in the onset of ventricular "escape" rhythm (Overdrive suppression)
Atrial flutter
Acute myocardial infarction
A patient has an atrial rate of 300 bpm and a ventricular rate of 125 bpm. The ECG shows a "sawtooth" pattern. This is:
Atrial fibrillation
Atrial flutter
Ventricular tachycardia
Sinus tachycardia
High-voltage QRS complexes in the limb leads (greater than 4 mV) are most commonly associated with:
Pericardial effusion
Pulmonary emphysema
Hypertrophy of the ventricles
Old myocardial infarction
Which of the following describes the "Vasomotion" observed in capillaries?
Continuous flow regulated by heart rate
Intermittent flow due to contraction/relaxation of precapillary sphincters
Flow regulated strictly by the sympathetic nervous system
Retrograde flow during diastole
According to Starling forces, if the Capillary Hydrostatic Pressure (Pc) is 30 mmHg, Plasma Colloid Osmotic Pressure (πp) is 28 mmHg, and Interstitial Hydrostatic Pressure (Pif) is -3 mmHg, what is the Net Filtration Pressure (assuming πif = 8 mmHg)?
7 mmHg (Filtration)
13 mmHg (Filtration)
1 mmHg (Absorption)
5 mmHg (Absorption)
A patient has severe liver cirrhosis, leading to decreased albumin synthesis. Which Starling force is primarily affected?
Increased Pc
Decreased πp
Increased πif
Decreased Pif
The "Gel" nature of the interstitium is primarily due to the presence of:
Albumin
Proteoglycan filaments
Fibrinogen
Free fluid vesicles
What is the primary function of the "Anchoring Filaments" in the lymphatic system?
To propel lymph via active contraction
To pull open the junctions of endothelial cells when tissue swells
To filter bacteria from the lymph
To prevent the backflow of lymph
Which factor would decrease lymph flow?
Elevated capillary hydrostatic pressure
Decreased plasma colloid osmotic pressure
Significant compression of the tissue by an external bandage
Increased interstitial fluid protein concentration
The "Negative" interstitial fluid pressure in most loose subcutaneous tissues is primarily maintained by which factor?
The pumping action of the lymphatic system
High plasma oncotic pressure
Low capillary pressure
Presence of hyaluronan
Edema occurs when the interstitial fluid pressure rises from its normal negative value to what level?
A more negative value
A positive value (above 0 mmHg)
Exactly −1 mmHg
−7 mmHg
According to the "Metabolic Theory" of local blood flow control, which substance acts as a potent vasodilator?
Oxygen
Adenosine
Glucose
Calcium ions
"Reactive Hyperemia" occurs under which circumstance?
Metabolic rate increases significantly (e.g., exercise)
Blood supply is blocked for a short period and then released
Sympathetic tone is suddenly increased
Arterial pressure rises significantly
The "Myogenic Theory" of autoregulation suggests that blood vessels contract in response to which stimulus?
Accumulation of CO2
Sudden stretch of the vascular smooth muscle wall
Release of Nitric Oxide (NO)
Lack of nutrients
Nitric Oxide (NO) is a powerful vasodilator released by endothelial cells. Its mechanism involves activation of which enzyme pathway?
Adenylate cyclase
Soluble guanylate cyclase (increasing cGMP)
Phospholipase C
Sodium–Potassium pump
Angiogenesis (long-term blood flow control) is primarily stimulated by a deficiency of which substance in the tissues?
Carbon dioxide
Oxygen
Magnesium
Nitrogen
Which of the following is a powerful vasoconstrictor released by damaged vascular endothelium to prevent hemorrhage?
Bradykinin
Endothelin
Histamine
Prostacyclin
An increase in the concentration of which ion in local tissue causes profound vasodilation?
Calcium
Potassium
Sodium
Iron
Bradykinin causes powerful vasodilation and also which additional effect?
Decreases capillary permeability
Increases capillary permeability
Increases heart rate
Stimulates the renin–angiotensin system
The "Vasomotor Center" is located bilaterally in the reticular substance of which brain region(s)?
Hypothalamus
Pons and Medulla oblongata
Thalamus
Cerebellum
Stimulation of the "Vasoconstrictor Area" of the vasomotor center leads to the release of which neurotransmitter at sympathetic nerve endings?
Acetylcholine
Epinephrine
Norepinephrine
Dopamine
The baroreceptors are most sensitive to pressure changes in which range?
0–20 mmHg
30–60 mmHg
100–180 mmHg
Above 250 mmHg
When a person stands up suddenly from a lying position, the baroreceptor reflex causes which primary response?
Peripheral vasodilation
Decreased heart rate
Sympathetic discharge to increase peripheral resistance
Inhibition of the vasoconstrictor center
The "Bainbridge Reflex" is initiated by stretch receptors in the atria and results in which change?
Decreased heart rate to prevent overload
Increased heart rate to pump out excess venous return
Massive vasodilation
Renal shutdown
The "CNS Ischemic Response" is activated only when the arterial pressure falls below which level?
100 mmHg
80 mmHg
60 mmHg (and is most powerful below 20 mmHg)
120 mmHg
Which reflex is responsible for the "Cushing Reaction" (increased blood pressure in response to increased intracranial pressure)?
Baroreceptor reflex
CNS Ischemic Response
Chemoreceptor reflex
Volume reflex
Chemoreceptors in the carotid and aortic bodies are primarily stimulated by which set of changes?
Increased pH
Decreased O2 , increased CO2 , and increased H+
Low blood pressure only
High glucose levels
The "Pressure Natriuresis" mechanism refers to which process?
Increased sodium intake causing high blood pressure
Increased arterial pressure causing increased sodium excretion
Kidney failure causing hypertension
Renin secretion in response to high pressure
In the "Infinite Gain" principle of the renal–body fluid control system, the arterial pressure always returns to which level?
The equilibrium point where intake equals output
120/80 mmHg regardless of intake
The baroreceptor set point
A higher level after any salt intake
Renin is an enzyme secreted by the juxtaglomerular cells in response to which stimulus?
High sodium chloride at the macula densa
Increased stretch of the afferent arteriole
Decreased arterial pressure or sympathetic stimulation
High plasma potassium
Angiotensin II increases arterial pressure by two main mechanisms. One is vasoconstriction; what is the other?
Direct inhibition of the heart
Decreased renal excretion of salt and water
Vasodilation of skeletal muscle beds
Inhibition of aldosterone
"One-Goldblatt Hypertension" is caused by which condition?
Constriction of one renal artery with the other kidney normal
Constriction of the renal artery of a single remaining kidney
Bilateral adrenal tumor
High salt intake in a normal person
Which of the following is a characteristic of "Primary (Essential) Hypertension"?
It is always caused by a single gene mutation
It is often associated with obesity and a sedentary lifestyle
Plasma renin levels are always extremely high
It is usually cured by a single surgery
Aldosterone primarily acts on which part of the nephron to increase sodium reabsorption?
Proximal tubule
Loop of Henle
Cortical collecting tubules
Glomerulus
How long does it take for the Renin–Angiotensin system to become fully activated to adjust blood pressure?
Seconds
20 minutes to 1 hour
1 week
1 month
A patient has a heart rate of 45 bpm and a permanent P–R interval of 0.32 s. During exercise, the heart rate fails to increase significantly. The most likely site of the lesion is:
SA node
AV node/Bundle of His
Left bundle branch
Purkinje fibers
An ECG shows "Grouped Beating." The P–R interval gradually lengthens until a P-wave is not followed by a QRS. The next P–R interval is short. This is:
Mobitz Type II
Mobitz Type I (Wenckebach)
Third-degree block
Sinoatrial exit block
During ventricular fibrillation, the main reason the heart cannot pump blood is:
The ventricles are in a state of tetany (sustained contraction)
There is no coordinated contraction, only "quivering"
The valves are stuck open
The atria are not contracting
A patient with nephrotic syndrome has massive albuminuria. Which of the following is expected?
Increased plasma oncotic pressure
Decreased interstitial fluid hydrostatic pressure
Increased lymph flow and edema
Decreased capillary hydrostatic pressure
Which of the following would be the most effective physiological compensation for a chronic increase in capillary hydrostatic pressure?
Decreased lymph flow
Increased lymph flow and removal of interstitial proteins
Constriction of the veins
Increased plasma protein concentration
The "Fahraeus–Lindqvist Effect" refers to:
Increased viscosity in large vessels
Decreased viscosity of blood in very small capillaries (<1.5 mm diameter)
The role of platelets in clotting
Autoregulation in the brain
Skeletal muscle blood flow can increase up to 20-fold during exercise. The initial increase is due to:
Sympathetic vasodilator fibers (in some species) and local metabolites
Renin–angiotensin system
Increased plasma volume
Decreased heart rate
A patient is given a drug that blocks the conversion of Angiotensin I to Angiotensin II. What is the expected effect on the efferent arteriole of the kidney?
Vasoconstriction
Vasodilation
No change
Thickening of the basement membrane
In the "Auto-regulation" of blood flow, if the arterial pressure increases from 100 to 150 mmHg, the immediate response of the arterioles is to:
Dilate to allow more flow
Constrict to maintain constant flow
Burst
Close completely
Which substance is considered the "Endothelium-Derived Relaxing Factor" (EDRF)?
Endothelin
Nitric Oxide
Angiotensin
Vasopressin
In the "Pressure–Natriuresis" curve, a shift of the curve to the right (higher pressure) is a hallmark of:
Hypotension
Chronic Hypertension
Normal salt intake
Excessive water drinking
A tumor of the adrenal cortex secreting excessive aldosterone (Conn’s Syndrome) leads to hypertension. This is primarily because:
Aldosterone is a direct vasoconstrictor
Aldosterone causes salt and water retention
Aldosterone increases heart rate
Aldosterone inhibits renin
The "Sympathetic Vasoconstrictor Tone" is responsible for maintaining:
The basal level of vascular resistance
The heart's refractory period
Lymphatic valve closure
Capillary permeability
During the "CNS Ischemic Response," the sympathetic nervous system can increase the mean arterial pressure to as high as:
150 mmHg
250 mmHg
100 mmHg
500 mmHg
Which heart rhythm is often described as "a bag of worms" during surgery?
Atrial flutter
Atrial fibrillation
Ventricular fibrillation
Ventricular tachycardia
A patient has an accessory pathway (Bundle of Kent) bypassing the AV node. This leads to:
Long P–R interval
Delta wave on ECG (Wolff–Parkinson–White Syndrome)
Inverted T wave in all leads
Sinus bradycardia
The major reservoir of extra-lymphatic protein is:
The blood plasma
The interstitial space
The intracellular fluid
The cerebrospinal fluid
A patient is found to have "Salt-Sensitive" hypertension. This means:
Their BP only rises when they smell salt
Large changes in salt intake lead to significant changes in arterial pressure
They lack the Renin–Angiotensin system
They should be treated with potassium only
Which of the following describes the effect of Carbon Dioxide on the brain's blood flow?
Potent vasoconstrictor
Potent vasodilator
No effect
Increases blood viscosity
"Mean Circulatory Filling Pressure" is a measure of:
Left ventricular pressure
The fullness of the circulatory system (approx. 7 mmHg)
Capillary pressure only
Atmospheric pressure
A "Positive" interstitial fluid pressure is generally found in:
Subcutaneous tissue
Encapsulated organs like the kidney or brain
Skeletal muscle
Adipose tissue
The "Triple Response" of Lewis (Wheal, Flare, Redness) is primarily mediated by:
Histamine and local axon reflexes
Angiotensin II
Epinephrine
Vagus nerve
Vagal stimulation of the heart primarily decreases the heart rate by:
Decreasing the permeability of the SA node to Sodium
Increasing the permeability of the SA node to Potassium (Hyperpolarization)
Increasing the permeability to Calcium
Closing the AV valves
The "Windkessel Effect" refers to:
The pumping action of the atria
The elastic recoil of large arteries maintaining flow during diastole
The sound heard during BP measurement
The resistance of the arterioles
A patient with severe anemia has increased cardiac output. The primary reason is:
Increased blood viscosity
Decreased blood viscosity and local vasodilation due to hypoxia
Increased sympathetic tone
Decreased heart rate
Which segment of the circulation has the highest total cross-sectional area?
Aorta
Arterioles
Capillaries
Vena cava
According to Poiseuille's Law, if the radius of a vessel is reduced by half, the resistance to flow increases by:
2-fold
4-fold
8-fold
16-fold
The "Bezold–Jarisch Reflex" involves:
Tachycardia in response to hemorrhage
Bradycardia and hypotension in response to noxious stimuli in the ventricles
Hypertension in response to exercise
Apnea in response to cold water
"Critical Closing Pressure" is the pressure at which:
The heart stops
Blood flow through a small vessel ceases because the vessel collapses
The baroreceptors stop firing
The kidneys stop producing urine
Which of the following is NOT a component of the Baroreceptor reflex arc?
Hering's Nerve
Nucleus Tractus Solitarius (NTS)
Vagus Nerve
Phrenic Nerve
The most common cause of "Secondary Hypertension" is:
Adrenal tumor
Renal disease (parenchymal or vascular)
Stress
Obesity
A drug that inhibits "Angiotensin-Converting Enzyme" (ACE) will cause:
Increased levels of Angiotensin II
Increased levels of Bradykinin (causing cough)
Decreased levels of Potassium
Increased BP
The "Vasa Vasorum" are:
Valves in the veins
Small blood vessels that supply the walls of large arteries and veins
Lymphatic channels in the brain
Nerve fibers in the heart
In the presence of high levels of ADH (Vasopressin), the arterioles:
Dilate
Constrict (increasing BP)
Do nothing
Leak protein
The primary mechanism for "Long-term" blood pressure regulation is:
The Baroreceptor reflex
The Chemoreceptor reflex
The Renal–Body Fluid mechanism
The CNS Ischemic Response
A "Shift to the Left" of the Renal Function Curve can be caused by:
Angiotensin II
High sympathetic activity
Drugs that decrease renal resistance (vasodilators)
Chronic kidney disease
Which of the following is the "Pumping Station" for the lymphatic system?
The spleen
Segmental contraction of the lymphatic vessels (lymphatic pump)
The right atrium
The liver
What happens to the heart rate during the "Respiratory Sinus Arrhythmia"?
Increases during expiration
Increases during inspiration
Decreases during inspiration
Stops during expiration
If a person is exposed to 100% oxygen for a long period, their local blood flow will likely:
Increase significantly
Decrease due to local vasoconstriction
Not change
Increase only in the lungs
The "functional syncytium" of the heart is made possible by:
Intercalated discs with gap junctions
Nerve fibers between cells
Large amounts of connective tissue
Tight junctions (Zonula occludens)
