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E-lfh FRCA Primary: Physiology Exam Prep Questions > Primary FRCA Course CVS Physiology Exam Prep Questions > Flashcards

Primary FRCA Course CVS Physiology Exam Prep Questions Flashcards

1
Q

Coronary blood flow:

Is approximately 500 mL/min at rest

A

False. Resting coronary BF is around 250 mL/min

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2
Q

Coronary blood flow:

Supplies muscle that extracts 40 mL/L of oxygen per minute at rest

A

False. Coronary O2 extraction is about 110 mL/L/min (55-65% of the available content)

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3
Q

Coronary blood flow:

Is altered directly by vagal activity

A

False. There is no direct parasympathetic innervation to the coronary vessels

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4
Q

Coronary blood flow:

Ceases in systole

A

False. Left sided coronary flow is reduced during systole, but does not cease

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5
Q

Coronary blood flow:

Undergoes autoregulation

A

True. It autoregulates between a MAP range of 50-120 mmHg

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6
Q

In the cardiac cycle:

Left ventricular volume is maximal at the end of atrial systole

A

True. Atrial contraction contributes to final part of ventricular filling

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7
Q

In the cardiac cycle:

The mitral valve closes by contraction of the papillary muscles

A

False. The papillary muscles maintain the correct tension in the chordae tendineae and so prevent mitral valve prolapse

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8
Q

In the cardiac cycle:

The left ventricular pressure is maximal just before the aortic valve opens

A

False. LV pressure continues to rise after aortic valve opening

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9
Q

In the cardiac cycle:

The ejection fraction is normally about 85%

A

False. Normal ejection fraction is around 70%

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10
Q

In the cardiac cycle:

The dicrotic notch is due to rebound of the aortic valve

A

False. The elastic aortic wall is stretched during peak ejection and then rebounds after aortic valve closure to produce a slight rise in arterial pressure, creating the dicrotic notch

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11
Q

In a healthy adult human heart the:

Left ventricular end systolic volume is approximately 30 mL

A

True. Normal LVESV is 30 mL

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12
Q

In a healthy adult human heart the:

First heart sound coincides with the onset of ventricular systole

A

True. The start of systole is defined by the closure of the mitral and tricuspid valves, which generate the first heart sound

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13
Q

In a healthy adult human heart the:

Stroke volume is approximately 70 mL

A

True. Normal SV is 70 mL

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14
Q

In a healthy adult human heart the:

Left ventricular end-diastolic pressure is about 50 mmHg

A

False. Normal LVEDP is 10 mmHg

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15
Q

In a healthy adult human heart the:

Second heart sound is caused by closure of the aortic and pulmonary valves

A

True. Aortic and pulmonary valve closure generate the second heart sound

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16
Q

Pulmonary vascular resistance:

Is increased in chronic hypoxia

A

True. Hypoxia produces pulmonary vasoconstriction, increasing PVR

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17
Q

Pulmonary vascular resistance:

Has a value appoximately one-sixth that of the systemic circulation

A

True. Mean PAP is 15 mmHg (around one sixth of systemic MAP), with both circulations having the same flow

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18
Q

Pulmonary vascular resistance:

Can be measured using a flow-directed balloon catheter with a thermistor tip

A

True. A Swan-Ganz catheter can measure cardiac output and PA pressure, enabling the PVR to be calculated

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19
Q

Pulmonary vascular resistance:

Is increased by isoprenaline

A

False. The role of adrenoreceptors in the pulmonary circulation is minor and still remains uncertain, but beta-2 agonism probably leads to modest pulmonary vasodilatation

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20
Q

Pulmonary vascular resistance:

Is decreased by 5-hydroxytryptamine (5-HT)

A

False. 5-HT produces pulmonary vasoconstriction, raising PAP

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21
Q

In the normal adult heart:

Mitral valve closure occurs before tricuspid valve closure

A

True. The mitral valve closes fractionally before the tricuspid, although it may well be heard as a single sound

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22
Q

In the normal adult heart:

Pulmonary valve closure occurs before aortic valve closure

A

False. The pulmonary valve closes fractionally after the aortic valve; this delay is slightly greater during inspiration

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23
Q

In the normal adult heart:

Atrial contraction is of more importance to ventricular filling if the heart rate increases

A

True. Total diastolic time falls as the HR increases, increasing the importance of active filling by atrial contraction

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24
Q

In the normal adult heart:

There is isometric contraction of the left ventricle after the aortic valve opens

A

False. Isovolumetric contraction occurs before aortic valve opening

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25
Q

In the normal adult heart:

The aortic valve cusps are immobile during ventricular filling

A

True. The aortic valve should be closed during ventricular filling

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26
Q

The Pressure:

Drop across major veins is simular to that across the major arteries

A

True. The largest pressure drop occurs across the arterioles; the drop across the major arteries and major veins are both small

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27
Q

The Pressure:

Drop across the hepatic portal bed is similar to that across the splenic vascular bed

A

False. The hepatic portal bed is a very low pressure/low resistance one

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28
Q

The Pressure:

In the hepatic portal vein is approximately 3 times higher than that in the inferior vena cava

A

False. Normal hepatic portal vein pressure is 5-10 mmHg, little different from that in the IVC

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29
Q

The Pressure:

Drop across the vascular bed in the foot is greater when standing than when lying down

A

False. When standing both the arterial and venous pressures in the foot increase to the same extent, leaving the pressure drop unchanged

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30
Q

The Pressure:

Drop across the pulmonary circulation is the same as across the systemic circulation

A

False. The drop across the pulmonary circulation is only about a sixth of that in the systemic circulation

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31
Q

In the central venous pressure waveform:

The c wave occurs after ventricular systole

A

False. The c wave occurs during early ventricular contraction (systole), as the closed tricuspid valve bulges back into the right atrium

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32
Q

In the central venous pressure waveform:

The v wave is caused by atrial contraction

A

False. The v wave represents atrial filling whilst the tricuspid valve is still closed

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33
Q

In the central venous pressure waveform:

The a wave is absent in atrial fibrillation

A

True. The a wave results from atrial contraction, so is absent in AF

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34
Q

In the central venous pressure waveform:

The a wave corresponds with the closure of the aortic valve

A

False. The a wave occurs in late diastole, long after aortic valve closure

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35
Q

In the central venous pressure waveform:

The v wave occurs during diastole

A

True. The v wave occurs during ventricular relaxation (diastole) but before the tricuspid valve opens - this is according to e-LfH but is debatable. Most time-pressure graphs would have the peak of the v-wave occurring on the cusp of systole and diastole.

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36
Q

With reference to the mechanical events in the cardiac cycle in a normal adult human:

The left ventricle ejects more blood per beat than the right ventricle

A

False. The ventricles must eject equal volumes of blood

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37
Q

With reference to the mechanical events in the cardiac cycle in a normal adult human:

The mitral valve opens when the left atrial pressure exceeds the left ventricular pressure

A

True. This is what opens the mitral valve

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38
Q

With reference to the mechanical events in the cardiac cycle in a normal adult human:

During strenuous work, the left ventricular end-diastolic volume may be double than at rest

A

False. It increases by about 10%. Left-ventricular end systolic volume decreases by about 10% due to increased ejection fraction.

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39
Q

With reference to the mechanical events in the cardiac cycle in a normal adult human:

The pulmonary valve opens when the right ventricular pressure reaches 20-25 mmHg

A

False. The pulmonary valve opens at a pressure of around 10-12 mmHg

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40
Q

With reference to the mechanical events in the cardiac cycle in a normal adult human:

During diastole, the left ventricular pressure is about 70 mmHg

A

False. LV pressure during diastole falls to around 5 mmHg

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41
Q

Myocardial contractility:

Is the degree of the inotropic state of heart independent of preload, afterload or heart rate

A

True. Force of contraction is dependent on preload, but strictly speaking contractility is the ability of the heart muscle to respond to a given preload which is therefore independent.

42
Q

Myocardial contractility:

determines the rate of development of ventricular Pressure (dp/dt)

A

True. Contractility defines the rate in rise of pressure

43
Q

Myocardial contractility:

Can be estimated by ventricular pressure-volume loops

A

True. Pressure-volume loops include information about contractility

44
Q

Myocardial contractility:

Is reduced by hypocalcaemia

A

True. Contractility is calcium dependent

45
Q

Myocardial contractility:

Accounts for approximately 90% of total mycardial oxygen consumption

A

True. Cardiac contraction requires a high oxygen consumption

46
Q

On changing from the upright to the supine position:

Baroreceptor firing rate decreases

A

False. The rise in venous return increases pulmonary blood volume, stroke volume and arterial BP, resulting in a greater firing rate in the baroreceptors (which respond to stretch)

47
Q

On changing from the upright to the supine position:

Leg vein pressure is reduced

A

True. Venous pressure in legs falls as they become at the level of the heart

48
Q

On changing from the upright to the supine position:

The blood volume in the pulmonary circulation falls

A

False. The rise in venous return increases pulmonary blood volume, stroke volume and arterial BP, resulting in a greater firing rate in the baroreceptors (which respond to stretch)

49
Q

On changing from the upright to the supine position:

Stroke volume increases

A

True. The rise in venous return increases pulmonary blood volume, stroke volume and arterial BP, resulting in a greater firing rate in the baroreceptors (which respond to stretch)

50
Q

On changing from the upright to the supine position:

Renin activity increases

A

False. The rise in arterial BP reduces the release of renin from the juxta-glomerular apparatus

51
Q

The following are true about the fetal circulation:

The PaO2 in the desending aortic is lower than that in the aortic arch

A

True. Blood in the descending aorta has a lower PO2 because deoxygenated blood has joined via the ductus arteriosus (which contains the deoxygenated blood from SVC which doesn’t go through foramen ovale - whereas most of oxygenated blood from IVC does go through foramen ovale)

52
Q

The following are true about the fetal circulation:

The ductus venosus contains mixed venous blood

A

False. The ductus venosus contain blood returning from the placenta via the umbilical vein which is therefore oxygenated.

53
Q

The following are true about the fetal circulation:

The ductus ateriosus closes due to the rise in the systemic blood pressure

A

False. Closure of the ductus arteriosus is prostaglandin-mediated

54
Q

The following are true about the fetal circulation:

Closure of the foramen ovale is due to the change in the left and right atrial pressure

A

True. Pressure reversal between the atria closes the foramen ovale

55
Q

The following are true about the fetal circulation:

Blood entering the right atrium can reach the systemic circulation without passing through the left side of the heart

A

True. Blood from the RA can reach the systemic circulation via the RV, pulmonary artery and ductus arteriosus. It is mostly SVC blood that follows this pathway, which is largely kept separate from IVC blood via streaming in the RA

56
Q

Chemoreceptors in the arterial system:

Have a higher rate of oxygen consumption per gram than brain tissue

A

False. The carotid bodies have a very high blood flow per gram of tissue, not oxygen consumption

57
Q

Chemoreceptors in the arterial system:

Respond to changes in oxygen tension and not content

A

True. These chemoreceptors respond to the partial pressure of dissolved O2 not total O2 content

58
Q

Chemoreceptors in the arterial system:

Respond to changes in pH

A

True. A metabolic acidosis is sensed by these peripheral chemoreceptors

59
Q

Chemoreceptors in the arterial system:

Conduct afferent information via the glossopharyngeal and vagus nerves

A

True. Impulses are conducted via IX (carotid) and X (aorta)

60
Q

Chemoreceptors in the arterial system:

Are found in the carotid sinus

A

False. Chemoreceptors are found in the carotid and aortic bodies - the sinus contains baroreceptors

61
Q

The following statements are true:

Of the major organs, the heart has the highest A-V O2 difference

A

True. Coronary oxygen extraction is high, at an extraction ratio of 0.55-0.6

62
Q

The following statements are true:

Arterial baroreceptors respond to pressure

A

True. They are stretch receptors that respond to a rise in pressure

63
Q

The following statements are true:

Each kidney receives about 10% of the cardiac output

A

True. Overall renal blood flow is 1000 mL/min, 20% of cardiac output

64
Q

The following statements are true:

On the ECG, lead II is from the left arm to the left leg

A

False. Lead II looks at the view from right arm to left leg

65
Q

The following statements are true:

LV diastolic compliance falls sharply above a volume of 70 mL

A

False. The LV remains very compliant up to around 120 mL

66
Q

The vagus:

Innervates the heart primarily via M3 receptors

A

False. M2 receptors are present in the heart - M3 are mainly located on smooth muscle

67
Q

The vagus:

Increases L-type calcium channel opening

A

False. The vagus works mainly by increasing permeability to potassium

68
Q

The vagus:

Slows conduction through the A-V node

A

True. It slows A-V conduction

69
Q

The vagus:

Lowers the trough potential of the sino-atrial node

A

True. Increasing potassium permeability lowers the trough potential slightly and flattens the rise in phase 4

70
Q

The vagus:

Is the dominant autonomic effect at rest

A

True. The natural S-A node rate is 100-110/min, as seen in a denervated heart

71
Q

Myocardial contractility is enhanced by:

Glucagon

A

True. Glucagon increases intracellular cAMP via adenylate cyclase activation and phosphodiesterase inhibition

72
Q

Myocardial contractility is enhanced by:

Noradrenaline

A

True. Noradrenaline is a potent agonist at beta-2 receptors (though not as potent as adrenaline)

73
Q

Myocardial contractility is enhanced by:

A decrease in arterial pH

A

False. Acidosis inhibits myocardial contractility

74
Q

Myocardial contractility is enhanced by:

An increase in vagal tone

A

False. Vagal stimulation produces a negative chronotropic action, but has little effect on inotropicity

75
Q

Myocardial contractility is enhanced by:

A fall in extracellular calcium concentration

A

False. Calcium is essential component of the contractile process

76
Q

Regarding the heart and major vessels:

The right ventricle is normally about 8-10 mm thick

A

False. The RV is normally 3-4 mm thick

77
Q

Regarding the heart and major vessels:

The right pulmonary artery passes beneath the aortic arch

A

True. The aorta arches over the right PA

78
Q

Regarding the heart and major vessels:

The normal pulmonary artery pressure is 25/10 mmHg

A

True. This is the normal PA pressure

79
Q

Regarding the heart and major vessels:

All cardiac valves have three leaflets

A

False. The mitral valve has 2 leaflets

80
Q

Regarding the heart and major vessels:

The tricuspid valve is anchored by chordae tendineae

A

True. Both the mitral and tricuspid valves are anchored by chordae tendineae

81
Q

The following are normal values:

Right ventricular pressure 25/0 mmHg

A

True. RV systolic pressure is about one fifth of the LV

82
Q

The following are normal values:

Pulmonary capillary hydrostatic pressure 10 mmHg

A

True. Pulmonary capillary hydrostatic pressure starts at approximately 12 mmHg, falling to around 7 at the distal end; this is the main reason for minimal fluid loss into the alveoli

83
Q

The following are normal values:

Glomerular capillary hydrostatic pressure 30 mmHg

A

False. The glomerular capillary pressure is around 55 mmHg, enabling a large volume of filtrate to be produced

84
Q

The following are normal values:

Plasma oncotic pressure 25 mmHg

A

True. Plasma oncotic pressure is around 25 mmHg (just over 1 mOsmol/L), a tiny proportion of the total osmotic pressure (~280 mOsmol/L)

85
Q

The following are normal values:

Right ventricular end-diastolic volume 110 mL

A

True. The end-diastolic and end-systolic volumes in the right and left ventricles are similar at around 110 mL and 40 mL respectively

86
Q

When considering fluid movement at the level of the capillary:

The biggest component of plasma osmotic pressure is generated by electrolytes

A

True. Electrolytes (mostly sodium and chloride) make up the vast majority of plasma osmotic pressure - it is the number of particles, not their size which counts

87
Q

When considering fluid movement at the level of the capillary:

Oncotic pressure is approximately one fifth of total plasma osmotic pressure

A

False. The oncotic pressure, generated by proteins, is less than 0.5% of the total, but is the difference between intravascular and extravascular compartments

88
Q

When considering fluid movement at the level of the capillary:

Electrolytes can move freely between plasma and interstitial fluid

A

True. Small particles move freely through the gaps between endothelial cells

89
Q

When considering fluid movement at the level of the capillary:

There is a net inward movement of fluid at the venous end

A

True. About 20 L leaves the capillary per day, at the arterial end; 18 L returns at the venous end, with the remaining 2 L returning via the lymphatics

90
Q

When considering fluid movement at the level of the capillary:

Approximately 2 L of fluid per day return via the lymphatic system

A

True. About 20 L leaves the capillary per day, at the arterial end; 18 L returns at the venous end, with the remaining 2 L returning via the lymphatics

91
Q

In a standard cardiac myocyte:

The resting membrane potential is approximately -85 mV

A

True. Cardiac myocyte RMP is -85 mV intracellularly

92
Q

In a standard cardiac myocyte:

Sodium inflow is responsible for initial depolarization (phase 0)

A

True. Sodium inflow initiates phase 0, augmented by calcium inflow through T type channels

93
Q

In a standard cardiac myocyte:

Calcium inflow is responsible for repolarization (phase 3)

A

False. Potassium outflow is responsible for phase 3 (repolarization)

94
Q

In a standard cardiac myocyte:

The action potential lasts approximately 30 ms

A

False. The AP in a standard cardiac myocyte is approximately 300 ms in length

95
Q

In a standard cardiac myocyte:

Automaticity is a normal feature

A

False. Only pacemaker cells normally exhibit automaticity

96
Q

The following produce a fall in the systemic vascular resistance:

Hypercapnia

A

True. Hypercapnia produces vasodilatation

97
Q

The following produce a fall in the systemic vascular resistance:

Pregnancy

A

True. Vasodilatation occurs during pregnancy, largely mediated by progesterone

98
Q

The following produce a fall in the systemic vascular resistance:

Increased intracranial pressure

A

False. As the ICP rises, Cushing’s response leads to vasoconstriction to raise MAP

99
Q

The following produce a fall in the systemic vascular resistance:

ANP

A

True. ANP produces vasodilatation as well as natriuresis

100
Q

The following produce a fall in the systemic vascular resistance:

Changing from fetal to adult circulation

A

False. Loss of the placental circulation at birth increases SVR

E-lfh FRCA Primary: Physiology Exam Prep Questions (6 decks)

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