physio 1-5 Flashcards
What increases blood flow and diameter of blood vessels?
A. NO
B. BNP
C. Angiotensin II
D. Aldosterone
A. NO
B. BNP
what increases salt and water excretion?
A. BNP
B. NO
C. Angiotensin II
D. Aldosterone
A. BNP
A drug was given to a patient and it only affected vascular smooth muscles and not the
cardiac muscle contractility. Where does this drug act?
A. Troponin
B. Calmodulin
C. L-type calcium channels
B. Calmodulin
Which of the following is a biomarker of progressive heart failure?
A. BNP
What is the effect of neprilysin inhibition
A. Decreases arterial blood pressure
B. Decreases contractility
C. Increased arterial blood pressure
D. Increases heart rate
A. Decreases arterial blood pressure
- A football player was hit by a football and passed out, he was rushed to the hospital. (His
blood pressure was 243/127, his heart rate was slow (50 beats per minute), and his respiratory
rate was fluctuating (between 10 and 18). Later on his blood pressure was fluctuating around
210-230. What is the physiological phenomenon is responsible for this?
Cushing Reflex
How does the body response for increasing intracranial pressure?
increase Blood pressure and decrease HR
Which of the following is a biomarker of progressive heart failure?
A. BNP
B. NO
C. Ang II
D. ADH
A. BNP
- What activates ADH/Vasopressin?
A. Increased atrial receptor firing
B. Decreased osmolarity
C. Parasympathetic stimulation
D. Increase osmolarity
D. Increase osmolarity
- What is produced from the endothelial cells in response to high blood velocity?
A. ADH
B. Nitric Oxide
C. ANP
D. Ang II
B. Nitric Oxide
- Which of those happens in heart failure?
A. Increased Compliance
B. Increased heart rate
B. Increased heart rate
- Secretion of which hormone will be most likely elevated in response to an
increase in atrial blood pressure?
A. ANP
B. Adrenaline
C. Aldosterone
D. Thyroxine
A. ANP
“high BP Causes ANP secretion to decrease BP by promotion of salt excretion
& diuresis + Causes vasodilation”
Which reflex would protect the heart of a patient with acute kidney failure from the
increased central venous pressure?
A. Baroreceptor reflex
B. Atrial mechanoreceptor reflex
C. Cushing reflex
D. Arterial chemoreceptor reflex
B. Atrial mechanoreceptor reflex
A patient with diagnosed brainstem ischemia has an increased blood pressure, decreased
heart rate, and irregular breathing. Which of the following would explain the decrease in heart
rate?
A. Baroreceptor reflex
B. Atrial mechanoreceptor reflex
C. Cushing reflex
D. Arterial chemoreceptor reflex
A. Baroreceptor reflex
- Which of the following stimulates thirst?
A. Vasopressin
B. Aldosterone
C. Angiotensin II
D. Renin
C. Angiotensin II
- A suitable marker that can be used in the diagnosis of heart failure is?
A. Angiotensin II
B. NT-pro-BNP
C. Aldosterone
D. Angiotensin I
B. NT-pro-BNP
- increase in arterial blood pressure sensed by carotid sinus receptors leads to increase in
what?
A. sympathetic
B. parasympathetic
C. cardiac contractility
D. peripheral resistance
B. parasympathetic
“Direct Q when BP increases parasympathetic is activated to decrease BP”
What happens as a compensation if CVP drops to 0 (figure to the right)?
A. VR increases to 7
B. PVP increases to 4
C. VR increases to 2
A. VR increases to 7
“ CVP decreases > VR increases & CO decreases “
What is a mechanism by which CO will increase?
A. Increased venoconstriction
B. decreased venoconstiction
C. Decreased blood volume
D. Increased Total peripheral resistance
A. Increased venoconstriction
- A patient presented with Cardiac temponade. which of the following events will occur?
A. Increased afterload
B. Increased SV
C. Decreased preload
C. Decreased preload
“cardiac temponade: more blood around the heart -> low CVP & VR, it also leads to
pulmonary edema”
What happens in cardiac tamponade?
Low ventricular filling
Which of the following is decreased as a consequence of increased central venous pressure?
A. Venous return
B. Cardiac output
C. Venous compliance
D. Blood volume
E. Angiotensin II
A. Venous return
What is the main thing that regulates blood flow in the veins?
A. Valves
B. Negative intrathoracic pressure
B. Negative intrathoracic pressure
“during inspiration (breathing in) -> low CVP & high VR”
What increases when the venous compliance decreases?
resistance
The CO of a normal person is 5 L/min, when exercising it became 3 times more. What is the
new venous return?
A. 10 L/min
B. 5 L/min
C. 15 L/min
D. can’t be determined
C. 15 L/min
What is the effect of increased venous compliance on venous return?
A. Decreases
B. increases
A. Decreases
“high compliance > low preload > low venous return”
- What is the effect of increased Total peripheral resistance on venous return and on cardiac
output?
A. Decreases
B. increases
A. Decreases
“high TPR= high AL= Low SV= Low CO”
- How will the VR and CO curves shift in heart failure?
Increase in VR & decreases in CO
“as compensation class is activated to increase the blood volume to get it with Venus
construction low compliance by vasoconstrictor so stances angiotensin II , catecholamines
resulting in increased CVP ,whenever CVP increased VR decreases and CO increases”
Which of those happen in heart failure?
A. Increased Compliance
B. Increased heart rate
B. Increased heart rate
- Which decreases CO?
A. increased central venous pressure
B. decreased PVP
C. increased HR to below 150bpm
B. decreased PVP
- in a patient with heart failure when compared to a normal Person Central venous pressure
is?
A. Lower
B. Higher
C. The same
B. Higher
- Which of the following will increase central venous pressure?
A. Increased blood volume
B. Decreased blood volume
C. Decreased venous tone
D. Increased venous compliance
A. Increased blood volume
“ what increases CVP? High VR > high CVP > high CO > as compensation
low VR > low CO”
Why does venous return increase when someone takes a deep breath?
A. Troponin
B. Calmodulin
C. L-type calcium channels
B. Calmodulin
A drug was given to an patient and it only affected vascular smooth muscles and not the
cardiac muscle contractility. Where does this drug act?
A. Intra-thoracic pressure decreases while abdominal pressure increases
B. Intra-thoracic pressure increases while abdominal pressure decreases
C. Intra-thoracic and abdominal pressure increase
D. Intra-thoracic and abdominal pressure decrease
A. Intra-thoracic pressure decreases while abdominal pressure increases
- A patient his Cardiac output is 6 L/min. And his MEAN ARTERIAL PRESSURE is 212 mmhg. He
undergoes ECHO for more investigations so his Heart rate = 60 beat/min, EDV=150 What is his
stroke volume in ml?
A. 150
B. 100
C. 60
B. 100
“CO=HR x SV”
What increases venous return?
A. Arterial construction
B. inspiration
C. dilation of peripheral veins
D. increasing Rv
B. inspiration
“During inspiration, venous return increases as the thoracic cavity’s pressure becomes more
negative. This reduced intrathoracic pressure draws more blood into the right atrium. This
results in greater venous return.”
- Which of the following is last to repolarize?
A. SA node
B. AV node
C. Purkinje fibers
D. Ventricular septal
C. Purkinje fibers
“Repolarization begins in epicardium (epicardial cells have more K+ channels), purkinje
have more Na channels > repolarized at the end”
RULE: more Na= faster depol. / more K+= faster repol.
- Where does the ventricular repolarization begin?
A. Purkinje
B. Endocardium
C. Epicardium
C. Epicardium
“Depol.= from endocardium to epicardium/ Repol.= from epicardium to endocardium”
- Which of the following has the fastest spontaneous diastolic depolarization?
A. AV node
B. Internodal tract
C. SA node
C. SA node
“SA node initiates depolarization that activate all regions of heart > depolarize at more rapid
Rate (60-100 beats/min.)”
- What change will occur in the patient ECG after administering a drug that blocks delayed
rectifier K+ channel?
A.QRS
B. QT interval
C. PR interval
B. QT interval
“blocking delayed rectifier = slower repolarization = longer AP = Long QT”
- What increases dromotropy when SNS is stimulated?
Phosphorylation of L type Ca+2 channel
“1.SNS (catecholamines)> phosphorylation of Ca+2 & HCN channels /
2.thyroxine> sensitizes sympathetic receptors»_space; 1 & 2 increases speed of conduction”
What will happen in positive dromotropic effect?
Shorter PR interval
“ high velocity > short PR interval between AV & ventricle depolarization “
- What represents ventricular repolarization on ECG?
A. T wave
B. P wave
A. T wave
“ p wave= atrial depolarization/ QRS= ventricular depolarization / T wave= ventricular
repolarization”
- What is responsible for depolarization from -40 to +1 in this graph (pic of slow AP)?
A. Activation of L type Ca+2 channel
B. Activation of fast Na channel
A. Activation of L type Ca+2 channel
“In slow AP depolarization is due to L type Ca channels not Na & these channels
Are much slower than Na+”
Positive dromotropic effect of exercise?
Activation of HCN channel
Negative dromotropic effect of diving?
Hyperpolarization of SA node
“ more time is needed to reach TH lowering the slope”
- That resting membrane potential in pacemaker cell is -60 and in ventricular myocyte is -85
what is the reason behind the difference between the two?
A. K+ gradient across the membrane is stronger in ventricular myocyte
B. Lack of inward rectifier K channel in pacemaker cell
C. Ventricular myocytes lack HCN channel
C. Ventricular myocytes lack HCN channel
- What would be affected in ECG after administration of a drug that blocks fast sodium
channel?
A. QRS complex
B. T wave
C. ST segment
D. PR segment
A. QRS complex
“ QRS= ventricular depolarization = result of entrance of Na”
- Which of these has the slowest spontaneous diastolic depolarization?
A. SA node
B. AV node
C. AV bundle
B. AV node
- The graph shows?
A. Partial depolarization
B. NCX activation
A. Partial depolarization
“ You can see that the action potential is like fast AP then it becomes like slow AP and the
membrane potential becomes less negative. Partial depolarization is a reason for this for the
change from fast to slow AP.”
- Which of the following channel is mainly associated with spontaneous depolarization of the
heart?
A. L type Ca channel
B. HCN channel
C. iK channel
B. HCN channel
- Which part of ventricular muscle action potential is resistant to re-entry?
A. Phase 1
B. Phase 3
C. Phase 4
A. Phase 1
“Phase 0,1,2,3 partly > absolute APR= no AP could be generated limits freq. of AP
+ prevent reentry”
17.the graph represents a change (from grey trace to red trace) of AP in SA node. What might
16. Which part of ventricular muscle action potential is resistant to reentry?
A. Adenosine
B. Strenuous exercise
C. Hyperkalaemia
D. Digoxin
B. Strenuous exercise
“Exercise activate SNS= increases HR> opens more HCN channels + L type Ca= slope more
steeper = TH reach sooner= more AP generated”
- A 57-year-old male had a myocardial infarction which effected the SA node as well as other
parts of the right atrium. His resting heart rate is now 50bpm, what is the most likely
pacemaker after this myocardial infarction?
A. SA node
B. Ventricular muscle
C. AV node
D. Purkinje fibers
C. AV node
“AV node can serve as a pacemaker when SA node fails to function”
- Which shows ventricular AP?
- Partial depolarization of AP making membrane potential -50. what is true?
A. may lead to slow action potential
B. partial deactivation of fast Na channel
A. may lead to slow action potential
“partial depolarization changed from -90 to -50= more positive > at -60 Na channels
- Which phase of action potential of av node myocytes and atrial myocytes are Represented
when QRS is recorded on the ECG
A. Nodal 2, atrial 0
B. Nodal 0, atrial2
C. Atrial 3, nodal 4
D. Atrial 4, nodal
C. Atrial 3, nodal 4
Which is the most likely effect of inhibiting Na+/K+ ATPASE?
A. negative inotropy
B. Positive dromotropy
C. Positive RMP (reduced resting membrane potential)
D. Decrease intracellular Na+
C.Positive RMP (reduced resting membrane potential)
“Failure in the function of the sodium-potassium pump will result in the intracellular
deposition of sodium ions and extracellular deposition of potassium ions, resulting in
disruption of cellular osmolarity and change in the membrane potential.”
which drug inhibits Na/ATPase?
A. ACE-I
B. ARBs
C. digoxin
C. digoxin
“direct from the note”
Which of the following is the result of an inward Na+ current?
A. Upstroke of the action potential in the (SA) node
B. Upstroke of the action potential in Purkinje fibers
C. Plateau of the action potential in ventricular muscle
D. Repolarization of the action potential in ventricular muscle
B. Upstroke of the action potential in Purkinje fibers
In the (SA) node, phase 4 depolarization (pacemaker potential) is attributable to?
A. An increase in K+ conductance
B. An increase in Na+ conductance
C. A decrease in Cl– conductance
D. A decrease in Ca2+ conductance
B. An increase in Na+ conductance
The physiologic function of the relatively slow conduction through the atrioventricular (AV)
node is to allow sufficient time for?
A. runoff of blood from the aorta to the arteries
B. venous return to the atria
C. filling of the ventricles
D. contraction of the ventricles
C. filling of the ventricles
After depolarization is present in which of the following arrhythmic mechanisms ?
A. re-entry
B. bi- directional block
C. enhanced automaticity
D. triggered activity
E. Overdrive suppression
D. triggered activity
“Triggered activity= impulse is not produced automatically but induced by preceding AP
Not SA node > early and delayed after depolarization”
Pathophysiology of atrial fibrillation?
Micro-reentry
Pathophysiology of supraventricular tachycardia?
AV nodal reentry
What prolongs QT on ECG?
A. Quinidine
B. Hypercalcemia
C. CCB
D. K+ channel blocker
D. K+ channel blocker
“ k+ channels blocked> no repolarization > longer plateau> long APD>
Long QT > produce another AP”
Which drug is contradicted in patient with long QT syndrome?
K+ channel blocker
“Because k channel blockage causes long QT syndrome, so for sure we will not give k channel
blockers for those with long QT syndrome (because they will get worse if we did”
A young athlete experienced palpitations 2 hours after exercising and working out. His ECG
showed sinus beats interpolated between premature ventricular complexes. What is the reason
for these PVCs?
A. Bradycardia
B. Sympathetic effect of exercise
C. Delayed after depolarization
A. Bradycardia
“ These premature ectopic beats are not from the SA node. They are from the
ventricles. The ventricular cells can abnormally pace the heart if the SA node gets slower and
slower in case of bradycardia.”
What causes a decrease in heart rate?
A. Hypocalcemia
B. Hyperkalemia
C. Alkalosis
B. Hyperkalemia
“Hyper K= depolarization may (-) Ca channel= (-) AP generation & block comducation
-> Decreases HR”
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. sinoatrial (SA) node
B. atrioventricular (AV) node
C. bundle of His
D. Purkinje system
B. atrioventricular (AV) node
“ normal QRS= AV node , abnormal QRS = bundle of his, Purkinje “
What is characteristic of mitral stenosis?
A. diastolic murmur
B. loud s1
C. S3
A.diastolic murmur
“ASMR= systolic / ARMS= diastolic”
What is characteristic of Aortic stenosis?
A. Systolic murmur
B. loud S1
C.S3
A. Systolic murmur
- Decrease in ventricular pressure, decrease in aortic pressure and a gradual increase in atrial
pressure.
A. isovolumic relaxation
B. Reduced ejection
B. Reduced ejection
“Phase5= AV valve closes (S2) + ventricle starts to relax> ventricular P decreases”
What is the cause of rapid ejection phase ?
A. Increased intraventricular pressure
B. Closure of mitral valve
C. Increased aortic pressure
D. Decreased aortic blood flow
A. Increased intraventricular pressure
“P in ventricle> P in aorta > semilunar valve open = blood flow rapidly into aorta”
which of the following is marked by S1 sound?
A. isovolumic contraction
B. AV valves closure
Both correct (the one in the model answer is B but both were counted correct)
Last addition of volume at end of diastole?
Atrial kick
“Phase1= 1st phase of cardiac cycle & last phase of diastole»_space; ventricle is COMPLETELY
filled after this phase/ remaining 20% filled after contraction of atria”
Closure of mitral valve. What happens at the end of ventricular diastole?
Atrial kick
“concludes phase I of cardiac cycle not the closure of AV valves, which occurs in
phase II in response to an increase in intraventricular pressure after QRS initiation”
What causes the 1 st heart sound?
Mitral valve closure
A t which stage of the cardiac cycle does the aortic pressure reach its maximum?
A. Phase 1
B. Phase 2
C. Phase 3
D. Phase 4
C. Phase 3
“P in aorta is high bc of high velocity of BF”
“Max. P= rapid ejection phase/ Highest vol. = atrial contraction + isovol. Contraction /
lowest vol. =reduced ejection + isovol. Relaxation”
A patient coming to the ER with complains of dizziness and chest pain. Upon examination, itis found that he had a heart murmur which is best hear at the apex and is described as a mid-systolic click. Which heart defect is most likely associated with this case?
A. Aortic stenosis
B. Mitral regurgitation
C. Aortic regurgitation
D. Mitral stenosis
A. Aortic stenosis
“Mid systolic CLICK is a sign for MR”
What is true about the fast ejection phase in the cardiac cycle?
A. Increased atrial pressure
B. End of ST wave of ECG
C. decreased ventricle pressure
D. decreased aortic blood flow
A. Increased atrial pressure
“Atria at a low P but it begins to increase as blood is flowing back into atria from the body”
Which phase of the cardiac cycle you see maximal pressure?
A. isovolumetric contraction
B. isovolumetric relaxation
C. atrial contraction
D. Rapid ejection
D. Rapid ejection
When do you hear S4?
A. Rapid filling
B. Ventricular systole
C. Atrial systole
D. isovolumic relaxation
C. Atrial systole
What happens at the end of ventricular diastole?
Closure of mitral valve
What best describes the ventricular filling phase?
A. Depends mainly on atrial contraction
B. Begins after Isovolumic relaxation
C.S4 sound can be heard
D. End with the opening of aortic valve
B. Begins after Isovolumic relaxation
C.S4 sound can be heard
“Phase 6 features: atrial P> ventricular P= AV valve open / A and C for phase 1 / D is wrong
bc phase 6 start with opening of AV valve”
