Part I 1. The entry of calcium into a ventricular muscle cell he...
Question
Part I
1. The entry of calcium into a ventricular muscle cell helps to maintain depolarization of the membrane during the plateau phase of the action potential, but this calcium also performs what other function?
2. What event is associated with the first heart sound? With the second heart sound?t ventricular contraction varies directly with EDV.as EDV increase,myocardium is stretched more,causing greater contraction and stroke volume.The relationship between EDV,conta
3. What is the Starling effect? Why is it an example of intrinsic control?
4. What is preload? Afterload? How does each affect stroke volume?
5. What is a pressure gradient? Where are the pressure gradients present in the vasculature?
6. Define resistance. What are some factors that affect resistance in the vasculature?
7. What effect would furosemide, an inhibitor of Na+ reabsorption by the thick ascending limb of Loop of Henle, have on urinary Ca++ excretion?
8. What is the baroreceptor reflex?
9. Where does ADH act in the kidneys, and what does it do?
10. List the most important hormones involved in water-electrolyte balance regulation.
Part II
1. If cardiac muscle is deprived of its normal blood supply, damage would primarily result from:
A. a lack of blood cells to feed into metabolic pathways.
B. a decrease in the number of available mitochondria for energy production.
C. decreased delivery of oxygen.
D. an inadequate supply of lactic acid.
2. In comparing the right and left ventricular systems, the volume of blood pumped by each is
A. similar, but the pressure generated in the adjacent arteries is much higher for the right ventricle
B. similar, and the pressure generated in the adjacent arteries is the same
C. similar, but the pressure generated in the adjacent arteries is much lower for the right ventricle
D. different, with the right ventricle pumping considerably more blood for each stroke
3. Which of the following is not a vasodilator
A. bradykinin
B. angiotensin II
C. atrial natriuretic factor
D. nitric oxide
E. nitroglycerin
4. One difference between atrial contraction and ventricular contraction is that
A. atrial contraction is delayed and involves conducting-system fibers
B. ventricular contraction is faster than atrial, and involves conducting-system fibers
C. ventricular contraction is delayed and involves conducting-system fibers
D. atrial contraction is initiated by the AV node while ventricular contraction is initiated by the SA node
5. Which one of the following normally does not carry highly oxygenated blood
A. pulmonary veins
B. aorta
C. renal artery
D. pulmonary artery
6. One difference between atrial contraction and ventricular contraction is that
A. atrial contraction is delayed and involves conducting-system fibers
B. ventricular contraction is faster than atrial, and involves conducting-system fibers
C. ventricular contraction is delayed and involves conducting-system fibers
D. atrial contraction is initiated by the AV node while ventricular contraction is initiated by the SA node
7. The initial depolarization for initiating a heart beat originates in the
A. AV node
B. Brain
C. CNS
D. SA node
8. A person with a heart rate of 60 beats/ minute and a stroke volume of 85 ml will have a cardiac output of
A. 51.1 L/min
B. 3.06 L/min
C. 510 ml/min
D. 5.1 L/min
9. The amount of blood remaining in the heart after contraction is the
A. end-diastolic volume
B. cardiac output
C. stroke volume
D. end-systolic volume
10. A person with a blood pressure reading of 140/80 has a mean arterial pressure of
A. 90 mm Hg
B. 220 mm Hg
C. 100 mm Hg
D. 110 mm Hg
11. Atrial systole begins
A. immediately before the P wave.
B. during the P wave.
C. during the Q wave.
D. immediately after the T wave.
12. The major force bringing fluid back into the capillaries from the interstitial fluid is
A. osmotic pressure due to salts
B. osmotic pressure due to water
C. hydrostatic pressure
D. osmotic pressure due to protein
13. Baroreceptors involved in the regulation of blood pressure are found in the
A. capillaries only
B. arteries only
C. arteries and veins
D. veins only
14. AV valves open and close because of
A. nervous impulses
B. contractions of muscles attached to the valves
C. changes in blood content in the adjacent chambers
D. changes in blood pressure in the adjacent chambers
15. The major factor for setting long-term blood pressure is
A. venous baroreceptors
B. arterial baroreceptors
C. the brain
D. the medulla
E. blood volume
16. Action potentials are able to spread from myocardial cell to myocardial cell via
A. tight junctions
B. interneurons
C. nerve fibers
D. gap junctions
17. At any given moment, the percent of total blood volume in the veins is
A. 70%
B. 20%
C. 50%
D. 5%
18. Transport of oxygen and nutrients across most capillary walls occurs primarily by
A. active transport
B. vesicle transport
C. co-transport
D. diffusion
19. During exercise, which of the following is not true
A. there is vasodilation of arterioles in skeletal muscle
B. cardiac output increases more than total peripheral resistance decreases
C. the main increase in cardiac output is due to an increase in heart rate and in stroke volume
D. the main increase in cardiac output is due to a large increase in stroke volume and a small increase in heart rate
20. A typical stroke volume for an adult at rest would be
A. 20 ml
B. 40 ml
C. 130 ml
D. 70 ml
21. The preload is directly related to
A. isovolumetric contraction
B. isovolumetric relaxation
C. ventricular ejection
D. ventricular filling
22. Hemorrhage with a large loss of blood causes:
A. a lowering of blood pressure due to change in cardiac output.
B. a rise in blood pressure due to change in cardiac output.
C. no change in blood pressure but a slower heart rate.
D. no change in blood pressure but a change in respiration.
23. The Frank-Starling mechanism is a relationship in which
A. cardiac output is equal to heart rate multiplied by stroke volume
B. left ventricular output is always greater than right ventricular output
C. with continued stretch of cardiac muscle, there is an eventual decline of contractility
D. stroke volume increases as enddiastolic volume increases
24. The amount of blood in ventricles at the end of filling is called:
A. ejection fraction
B. end-systolic volume
C. end-diastolic volume
D. coronary circulation
E. stroke volume
25. SA node action potentials are due to
A. the opening of slow calcium channels.
B. the closing of potassium channels.
C. non-stable RMP.
D. potassium entrance.
E. potassium exit.
Part III
(TRUE & FALSE)
T F 26. Endothelial cells can secrete substances that cause either vasoconstriction or vasodilation.
T F 27. Even though blood pressure decreases throughout the circulatory system, when it finally gets back to the heart from the systemic circuit, the pressure in the veins is still relatively high.
T F 28. The decrease in arterial compliance due to atherosclerosis will cause the mean arterial pressure to lower in that individual.
T F 29. If the activity of the SA node is depressed or blocked another portion of the conducting system can take over as pacemaker and set the heart rate.
T F 30. Just standing up from a lying, or horizontal position can cause a decrease in the effective circulating blood volume.
Part IV
ase: 67-year-old male with acute HF.
67-year-old male was diagnosed with acute heart failure based on the clinical findings of decreased cardiac output, pulmonary congestion, and peripheral edema. His increased creatinine and BUN also indicated renal insufficiency.
His electrocardiogram shows evidence of old myocardial infarction.
Echocardiography reveals diminished left ventricular ejection fraction without ventricular dilatation.
Pharmacologic therapy is started, including a positive inotrope, a coronary vasodilator, an antihypertensive ACE inhibitor, and a loop diuretic.
Elective coronary angiography reveals significant stenosis of the left anterior descending artery. He undergoes balloon angioplasty and stent placement and remains stable as an outpatient. His discharge drug regimen is accompanied by a low-salt, low fat diet.
Give brief answers to the following Questions:
1. What mechanisms led to Mr. R’s pulmonary congestion and pedal edema?
How are they related to renal function and fluid-electrolyte balance?
2. Briefly describe the process of sodium and fluid retention and involvement of renin-angiotensin-aldosterone system.
Extra!
1. Select the correct statement about cardiac output.
A. A slow heart rate reduces stroke volume and force of contraction.
B. Decreased venous return will result in increased stroke volume.
C. If a semilunar valve were partially obstructed, the stroke volume in the affected ventricle would be decreased.
D. Stroke volume increases if the filling decreases.
E. a and c
2. Which one of the following is not a factor in determining the flow rate of blood in a particular vessel
A. viscosity of the blood in the vessel
B. length of the blood vessel
C. radius of the vessel
D. a and c
E. thickness of the vessel
1. The entry of calcium into a ventricular muscle cell helps to maintain depolarization of the membrane during the plateau phase of the action potential, but this calcium also performs what other function?
2. What event is associated with the first heart sound? With the second heart sound?t ventricular contraction varies directly with EDV.as EDV increase,myocardium is stretched more,causing greater contraction and stroke volume.The relationship between EDV,conta
3. What is the Starling effect? Why is it an example of intrinsic control?
4. What is preload? Afterload? How does each affect stroke volume?
5. What is a pressure gradient? Where are the pressure gradients present in the vasculature?
6. Define resistance. What are some factors that affect resistance in the vasculature?
7. What effect would furosemide, an inhibitor of Na+ reabsorption by the thick ascending limb of Loop of Henle, have on urinary Ca++ excretion?
8. What is the baroreceptor reflex?
9. Where does ADH act in the kidneys, and what does it do?
10. List the most important hormones involved in water-electrolyte balance regulation.
Part II
1. If cardiac muscle is deprived of its normal blood supply, damage would primarily result from:
A. a lack of blood cells to feed into metabolic pathways.
B. a decrease in the number of available mitochondria for energy production.
C. decreased delivery of oxygen.
D. an inadequate supply of lactic acid.
2. In comparing the right and left ventricular systems, the volume of blood pumped by each is
A. similar, but the pressure generated in the adjacent arteries is much higher for the right ventricle
B. similar, and the pressure generated in the adjacent arteries is the same
C. similar, but the pressure generated in the adjacent arteries is much lower for the right ventricle
D. different, with the right ventricle pumping considerably more blood for each stroke
3. Which of the following is not a vasodilator
A. bradykinin
B. angiotensin II
C. atrial natriuretic factor
D. nitric oxide
E. nitroglycerin
4. One difference between atrial contraction and ventricular contraction is that
A. atrial contraction is delayed and involves conducting-system fibers
B. ventricular contraction is faster than atrial, and involves conducting-system fibers
C. ventricular contraction is delayed and involves conducting-system fibers
D. atrial contraction is initiated by the AV node while ventricular contraction is initiated by the SA node
5. Which one of the following normally does not carry highly oxygenated blood
A. pulmonary veins
B. aorta
C. renal artery
D. pulmonary artery
6. One difference between atrial contraction and ventricular contraction is that
A. atrial contraction is delayed and involves conducting-system fibers
B. ventricular contraction is faster than atrial, and involves conducting-system fibers
C. ventricular contraction is delayed and involves conducting-system fibers
D. atrial contraction is initiated by the AV node while ventricular contraction is initiated by the SA node
7. The initial depolarization for initiating a heart beat originates in the
A. AV node
B. Brain
C. CNS
D. SA node
8. A person with a heart rate of 60 beats/ minute and a stroke volume of 85 ml will have a cardiac output of
A. 51.1 L/min
B. 3.06 L/min
C. 510 ml/min
D. 5.1 L/min
9. The amount of blood remaining in the heart after contraction is the
A. end-diastolic volume
B. cardiac output
C. stroke volume
D. end-systolic volume
10. A person with a blood pressure reading of 140/80 has a mean arterial pressure of
A. 90 mm Hg
B. 220 mm Hg
C. 100 mm Hg
D. 110 mm Hg
11. Atrial systole begins
A. immediately before the P wave.
B. during the P wave.
C. during the Q wave.
D. immediately after the T wave.
12. The major force bringing fluid back into the capillaries from the interstitial fluid is
A. osmotic pressure due to salts
B. osmotic pressure due to water
C. hydrostatic pressure
D. osmotic pressure due to protein
13. Baroreceptors involved in the regulation of blood pressure are found in the
A. capillaries only
B. arteries only
C. arteries and veins
D. veins only
14. AV valves open and close because of
A. nervous impulses
B. contractions of muscles attached to the valves
C. changes in blood content in the adjacent chambers
D. changes in blood pressure in the adjacent chambers
15. The major factor for setting long-term blood pressure is
A. venous baroreceptors
B. arterial baroreceptors
C. the brain
D. the medulla
E. blood volume
16. Action potentials are able to spread from myocardial cell to myocardial cell via
A. tight junctions
B. interneurons
C. nerve fibers
D. gap junctions
17. At any given moment, the percent of total blood volume in the veins is
A. 70%
B. 20%
C. 50%
D. 5%
18. Transport of oxygen and nutrients across most capillary walls occurs primarily by
A. active transport
B. vesicle transport
C. co-transport
D. diffusion
19. During exercise, which of the following is not true
A. there is vasodilation of arterioles in skeletal muscle
B. cardiac output increases more than total peripheral resistance decreases
C. the main increase in cardiac output is due to an increase in heart rate and in stroke volume
D. the main increase in cardiac output is due to a large increase in stroke volume and a small increase in heart rate
20. A typical stroke volume for an adult at rest would be
A. 20 ml
B. 40 ml
C. 130 ml
D. 70 ml
21. The preload is directly related to
A. isovolumetric contraction
B. isovolumetric relaxation
C. ventricular ejection
D. ventricular filling
22. Hemorrhage with a large loss of blood causes:
A. a lowering of blood pressure due to change in cardiac output.
B. a rise in blood pressure due to change in cardiac output.
C. no change in blood pressure but a slower heart rate.
D. no change in blood pressure but a change in respiration.
23. The Frank-Starling mechanism is a relationship in which
A. cardiac output is equal to heart rate multiplied by stroke volume
B. left ventricular output is always greater than right ventricular output
C. with continued stretch of cardiac muscle, there is an eventual decline of contractility
D. stroke volume increases as enddiastolic volume increases
24. The amount of blood in ventricles at the end of filling is called:
A. ejection fraction
B. end-systolic volume
C. end-diastolic volume
D. coronary circulation
E. stroke volume
25. SA node action potentials are due to
A. the opening of slow calcium channels.
B. the closing of potassium channels.
C. non-stable RMP.
D. potassium entrance.
E. potassium exit.
Part III
(TRUE & FALSE)
T F 26. Endothelial cells can secrete substances that cause either vasoconstriction or vasodilation.
T F 27. Even though blood pressure decreases throughout the circulatory system, when it finally gets back to the heart from the systemic circuit, the pressure in the veins is still relatively high.
T F 28. The decrease in arterial compliance due to atherosclerosis will cause the mean arterial pressure to lower in that individual.
T F 29. If the activity of the SA node is depressed or blocked another portion of the conducting system can take over as pacemaker and set the heart rate.
T F 30. Just standing up from a lying, or horizontal position can cause a decrease in the effective circulating blood volume.
Part IV
ase: 67-year-old male with acute HF.
67-year-old male was diagnosed with acute heart failure based on the clinical findings of decreased cardiac output, pulmonary congestion, and peripheral edema. His increased creatinine and BUN also indicated renal insufficiency.
His electrocardiogram shows evidence of old myocardial infarction.
Echocardiography reveals diminished left ventricular ejection fraction without ventricular dilatation.
Pharmacologic therapy is started, including a positive inotrope, a coronary vasodilator, an antihypertensive ACE inhibitor, and a loop diuretic.
Elective coronary angiography reveals significant stenosis of the left anterior descending artery. He undergoes balloon angioplasty and stent placement and remains stable as an outpatient. His discharge drug regimen is accompanied by a low-salt, low fat diet.
Give brief answers to the following Questions:
1. What mechanisms led to Mr. R’s pulmonary congestion and pedal edema?
How are they related to renal function and fluid-electrolyte balance?
2. Briefly describe the process of sodium and fluid retention and involvement of renin-angiotensin-aldosterone system.
Extra!
1. Select the correct statement about cardiac output.
A. A slow heart rate reduces stroke volume and force of contraction.
B. Decreased venous return will result in increased stroke volume.
C. If a semilunar valve were partially obstructed, the stroke volume in the affected ventricle would be decreased.
D. Stroke volume increases if the filling decreases.
E. a and c
2. Which one of the following is not a factor in determining the flow rate of blood in a particular vessel
A. viscosity of the blood in the vessel
B. length of the blood vessel
C. radius of the vessel
D. a and c
E. thickness of the vessel
Solution Preview
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Part I
1. The entry of calcium into a ventricular muscle cell helps to maintain depolarization of the membrane during the plateau phase of the action potential, but this calcium also performs what other function?
In Cardiomyocytes of the ventricle, Calcium ions are involved in the activation of protein kinase C.
2. What event is associated with the first heart sound?
The first sound, S1 of the heart is associated with the closing of the mitral (M1) and triscupid vales (T1). In addition, it corresponds to the end of the diastole and the start of the ventricular systole. There is a sudden block of reverse blood flow caused by closure of the atrioventricular valves (T1 and M1) when ventricular contraction is starting (systole). When these ventricles start to contract, the papillaries in each ventricle also contract. When the papillary muscles contract, the chordate tendineae, which attaches the papillary muscles cusps of the tricuspid and the mitral vales, becomes suddenly tense, preventing blood backflow into the lowe pressure side of the atria. The pressure created by the ventricular contraction then closes the valves. The sudden block of flow reversal by the now closed valves causes reverberation within the blood, which produces Sound 1.
3. What is the Starling effect? Why is it an example of intrinsic control?
Also known as the Frank-Starling effect or law, the Starling effect is a law stating that the heart’s stroke volume increases as it responds to an increase in the volume of the blood that is filling the heart chamber, provided all other factors remain constant. The mechanism is very important in intrinsic control as it allows adequate cardiac output to be in harmony with venous return, hemoral length as well as arterial blood supply independent of extrinsic regulations.
1. The entry of calcium into a ventricular muscle cell helps to maintain depolarization of the membrane during the plateau phase of the action potential, but this calcium also performs what other function?
In Cardiomyocytes of the ventricle, Calcium ions are involved in the activation of protein kinase C.
2. What event is associated with the first heart sound?
The first sound, S1 of the heart is associated with the closing of the mitral (M1) and triscupid vales (T1). In addition, it corresponds to the end of the diastole and the start of the ventricular systole. There is a sudden block of reverse blood flow caused by closure of the atrioventricular valves (T1 and M1) when ventricular contraction is starting (systole). When these ventricles start to contract, the papillaries in each ventricle also contract. When the papillary muscles contract, the chordate tendineae, which attaches the papillary muscles cusps of the tricuspid and the mitral vales, becomes suddenly tense, preventing blood backflow into the lowe pressure side of the atria. The pressure created by the ventricular contraction then closes the valves. The sudden block of flow reversal by the now closed valves causes reverberation within the blood, which produces Sound 1.
3. What is the Starling effect? Why is it an example of intrinsic control?
Also known as the Frank-Starling effect or law, the Starling effect is a law stating that the heart’s stroke volume increases as it responds to an increase in the volume of the blood that is filling the heart chamber, provided all other factors remain constant. The mechanism is very important in intrinsic control as it allows adequate cardiac output to be in harmony with venous return, hemoral length as well as arterial blood supply independent of extrinsic regulations.
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