CVS- Tutorial- 1

Properties of the Cardiac Muscle>>The Cardiac Cycle

Choose the correct answer :
1. What is the primary role of calcium ions in Skeletal and cardiac muscle?
a) Cause depolarization of the sarcolemma
b) Remove the inhibition of the reaction between actin And myosin
c) Provide energy necessary for contraction
d) Cause muscle relaxation
e) Regulate ionic composition of the cell

2. Which of the following would be most likely to occur if the AV node is

damaged by ischemia?
a) The ability to intrinsically increase heart rate during stress (such as
exercise) would be impaired.
b) Conduction of the depolarizing electrical signal from the atria to the
ventricles would be delayed or blocked.
c) Spreading of the depolarizing electrical signal from the septum to the
ventricular walls would be impaired.
d) Cardiac contractility would be impaired.

3. According to Starling’s Law of the heart, what is the result of a moderate

increase in the end diastolic volume?
a) Greater shortening of the ventricular muscle
b) Decreased stroke volume
c) Increased level of contractility
d) Decreased net external work done by the heart

4. What is the effect of increased afterload on the ventricle?

a) Velocity of shortening in the ventricular muscle will increase
b) Pressure development during isovolumetric contraction will increase
c) Stroke volume will increase
d) The pressure at which the aortic valve opens will be lower

5. What is the main cause of repolarization of ventricular myocytes during phase

3 of their action potential?
a) influx of Ca++
 b) influx of K+
c) efflux of K+
d) influx of Na+
e) efflux of Na+

6. What is typically required for contraction of cardiac muscle?

a) Ca++ influx through voltage-gated Ca++ channels to trigger a rise in
cytosolic [Ca++].
b) Ca++ influx through voltage-gated Ca++ channels, which is sufficient to
support contraction.
c) Ca++ influx through the Na+-Ca++ antiporter.
d) Phosphorylation of myosin heavy chain .

7. What is typically required for relaxation of cardiac muscle?

a) Myosin light-chain dephosphorylation.
b) Activation of the Ryanodine receptor.
c) Ca++ uptake by the sarcoplasmic reticulum.
d) Activation of T-tubules.

8. Opening of which of the following channels causes the spike phase (Phase 0)
of the action potential of the sinoatrial node pacemaker cells?
a) Fast voltage-gated Na+ channels.
b) Voltage-gated L- type Ca++ channels.
c) Voltage-gated T- type Ca++ channels.
d) Voltage-gated K+ channels.

9. Of the conductive tissues of the heart, which part has the highest conduction
velocity?
a) Cells of the sinoatrial (SA) node
b) Cells of the atrioventricular (AV) node
c) Purkinje fibers
d) Atrial internodal pathways
10. Phase 4 (the prepotential) of the pacemaker potential of the heart results
from:
a) K+ influx and Ca2+ influx
b) Na+ influx and Ca2+ influx
c) Na+ influx and Cl− influx
d) Cl− influx and K+ influx

11. The plateau phase of the cardiac action potential is due to:
a) opening of voltage-gated L- type Ca++ channels
b) opening of fast voltage-gated Na+ channels
c) opening of voltage-gated K+ channels
d) all of the above

12. Cells of the sinoatrial node are the primary pacemakers of the heart. In the
absence of any input from the autonomic nervous system, how many action
potentials do these cells generate on the average every minute?
a) 30
b) 70
c) 100
d) 120

False (F) or True (T)?

13. The pacemaker cells of the heart have stable resting membrane potentials.
14. The cardiac muscle is less excitable than the skeletal muscle.
15. Increased contractility means an increase in the force of contraction produced
by increasing the preload.

16. In human beings, what is the normal average duration of the cardiac cycle?
a) 0.008 sec
b) 0.5 sec
c) 0.8 sec
d) 8 sec

17. The P wave of the ECG represents __________

a) ventricular depolarization
b) atrial repolarization
c) ventricular repolarization
d) atrial depolarization

18. During the isometric contraction phase, the ventricular volume:

a) slowly increases
b) rapidly increases
c) slowly decreases
d) doesn’t change

19. During the rapid ejection phase, the left ventricular pressure:
a) increases from 80 to 120 mmHg
b) remains at 0 mmHg
c) increases from 15 to 30 mmHg
d) doesn’t change

20. Why does the tricuspid valve close at the beginning of ventricular
contraction?
a) The pressure in left atrium is higher than the pressure in left ventricle
b) The pressure in right ventricle is higher than the pressure in right atrium
c) The pressure in the aorta is higher than the pressure in left ventricle
d) The pressure in the right ventricle is more than the pressure in the pulmonary
artery

21. If 200 ml of blood return to the heart, filling of the ventricle occurs by:
a) 200 ml atrial contraction
b) 100 ml passive filling, 100 ml atrial contraction
c) 140 ml atrial contraction, 60 ml passive filling
d) 140 ml passive filling, 60 ml atrial contraction

22. Which of the following is true regarding the isovolumetric contraction of the
left ventricle?
a) It begins when the aortic valve opens and ends when the aortic valve
closes
b) It begins when mitral valve closes and ends when the aortic valve opens
c) It requires less time (is shorter) than isovolumetric contraction of the
right ventricle
d) It is not influenced by changes in aortic pressure
23. “a” wave of the jugular venous pressure is caused by which of the following?
a) Atrial systole
b) Ventricular systole
c) Atrial diastole
d) Ventricular diastole

24) A pacemaker is inserted in a patient in order to treat a prolonged PR interval

detected on ECG. Which of the following normally occurs during the PR-
interval?
a) The cardiac action potential passes through the AV node.
b) The second heart sound is heard.
c) The ventricles are contracting.
d) The mitral and aortic valves are both closed.

25. During which interval on the ECG below does the ventricular septum
depolarize?
a) A
b) B
c) C
d) D
e) E

False (F) or True (T)?

26. With moderate increase in the heart rate, only the duration of the diastole
becomes shorter.

27. During the isovolumic contraction and isovolumic relaxation phases of the
cardiac cycle, both AV and semilunar valves are closed

28. Increased contractility means an increase in the force of contraction produced

by increasing the preload

29. A 55-year-old man with hypertension (pathologically high blood pressure) is

prescribed a drug that changes the flow of cations in myocardial tissue. The
image is a trace of a myocardial action potential. Each phase is associated with
the opening and/or closing of various ion channels. Which of the following
would be affected by a drug that affects phase 0 of the myocardial action
potential?

a) Ligand-gated calcium channels opening

b) Ligand-gated potassium channels closing
c) Ligand-gated sodium channels opening
d) Voltage-gated calcium channels opening
e) Voltage-gated potassium channels closing
f) Voltage-gated sodium channels closing
g) Voltage-gated sodium channels opening

30. A 72-year-old male is undergoing a preoperative evaluation prior to

scheduled hip replacement surgery. He states that he has felt well and has no
complaints other than his right hip condition.
During your cardiac examination, you listen to heart sounds produced by
closure of cardiac valves. At which time point in the figure the mitral valve
suddenly closes?

a) A
b) B
c) C
d) D
e) E
 CVS Tutorial-2
CVS regulatory mechanisms >> cardiac work
1. Sympathetic drive to the heart is increased in all of the following
conditions, EXCEPT:
a) In exercise.
b) In excitement.
c) During sleep.
d) Hypotension.
2. All of the following can occur when the activity of the vasomotor center
increases EXCEPT:
a)Widespread vasodilatation in the body.
b) The cardiac output is increased.
c) The arterioles are constricted.
d) The heart rate accelerates.

3. Which of the following is associated with bradycardia?

a) Hypothermia.
b) Hypothyroidism.
c) Use of Para-sympathomimetic drugs.
d) All of the above.

4. In respiratory sinus arrhythmia, the increase in heart rate during

inspiration is partially due to:
a)Reduced stretch of arterial baroreceptors.
b) Stimulation of peripheral chemoreceptors.
c) Release of atrial natriuretic peptide.
d) Increased stretch of atrial stretch receptors.

5. Buffer nerves are branches of:

a) Trigeminal nerve
b) Facial nerve
c) Vagus and glossopharyngeal nerves
d) Non of the above
6. What is the mechanism of the normal physiologic response to hypotension?
a)Decreased baroreceptor afferent firing in the aortic body leads to
increased sympathetic efferent firing.
b)Decreased baroreceptor afferent firing in the carotid sinus leads to
increased sympathetic efferent firing.
c)Increased baroreceptor afferent firing in the aortic arch leads to increased
parasympathetic efferent firing.
d)Increased baroreceptor afferent firing in the carotid sinus leads to
increased sympathetic efferent firing.

7. Raised intracerebral pressure(ICP)causes which of the following?

a)BP increase, HR decrease, decrease
b) BP increase, HR increase, RR decrease
c) BP decrease, HR increase, RR increase
d) BP increase, HR decrease,RR increase

8. Which of the following is not true about arterial baroreceptors?

a)Attached to buffer nerves
b)Present in carotid sinus
c) Stimulated by mean arterial blood pressure
d) Works maximally below 50 mmHg of blood pressure

9. A 2-year-old boy had head injury, which compresses the underlying brain
tissue and leads to an increased intracranial pressure. Which of the following
may be found in this boy?
a) Blood pressure and heart rate decrease.
b) Blood pressure and heart rate increase.
c) Blood pressure decreases and heart rate increases.
d) Blood pressure increases and heart rate decreases.

10. Reduced firing of the atrial “B” receptors will:

a)Increase activity in the Nucleus of the Solitary Tract.
b) Increase heart rate.
c) Increase vasopressin (AVP) secretion.
d) Cause a reflex reduction in blood volume.

11. Heart rate is increased by all the followings, EXCEPT:

 a)Fever.
b) Sympathomimetic drugs.
c) Parasympatholytic drugs.
d) Hypothyroidism.

12. Which of the following receptors monitor blood pressure by the degree of
stretch on the vessel wall?
a) Atrial baroreceptors
b) Arterial baroreceptors.
c) Osmoreceptors
d) Peripheral chemoreceptors.

13. An acute decrease in arterial blood pressure elicits which of the following
compensatory changes?
a) Decreased firing rate of the carotid sinus nerve
b) Increased parasympathetic outflow to the heart
c) Decreased heart rate
d) Decreased contractility

14. Which of the following is associated with decreased heart rate?

a) Young age.
b) In the early morning.
c) Standing position.
d) Increased metabolic rate.

15. An increase in the venous return to the right atrium elicits which of the
following changes?
a) Increased Atrio-ventricular (AV) nodal delay
b) Increased heart rate
c) Decreased contractility
d) Increased total peripheral resistance

16. patient has an end diastolic volume 130 ml and end systolic volume 65 ml.
Which of the following is his ejection fraction?
a)20%
b)40%
c)50%
 d)90%

17. Which of the following is not correct about cardiac output?

a)Is normally expressed as the output of one ventricle in litres/ minute.
b) May not increase when heart rate rises.
c) Usually decreases when a person lies down.
d)Rises in a hot environment.

18. Cardiac output of the right side of the heart is what percentage of the
cardiac output of the left side of the heart?
a)25%
b)50%
c)75%
d)100%
e)125%
19. Which of the following, in the absence of changes in other variables, will
tend to decrease venous return?
a)Increased right atrial pressure
b) Decreased venous compliance
c) Increased blood volume
d) Increased mean circulatory filling pressure

20.According to Starling’s Law of the heart, an increase in end diastolic volume:

a) Decreases stroke volume.
b) Decreases tension within the ventricular muscle.
c) Causes shortening of the ventricular muscle.
d) Increases tension within the ventricular muscle.

21. Which of the following can increase mean systemic filling pressure?
a)Decreased blood volume.
b) Decreased venous compliance.
c) Veno-dilatation.
d)Neither venous compliance nor blood volume affect mean circulatory
filling pressure.
22. Compared to preload effect on myocardial contraction, the sympathetic
stimulation increases myocardial contractility by which one of the following
mechanisms?
 a) Increasing systolic time.
b) Decreasing diastolic time.
c) Increases Ca++ sensitivity
d) Increased Ca++ availability.

23. Which of the following factors can cause a decrease in cardiac output?
a) Severe exercise.
b) Emotions.
c) Prolonged standing.
d)Pregnancy.

24. In a normal healthy person, an increase in cardiac output will decrease:

a) Venous return
b) Pulmonary vascular resistance
c) Pulmonary arterial pressure
d) Systemic arterial pressure

25. What will happen if afterload on the ventricle increases?

a) Velocity of shortening in the ventricular muscle will increase.
b)Pressure development during isovolumetric contraction will increase
c) Stroke volume will increase.
d) The pressure at which the aortic valve opens will be lower.

26.Ach, released by the Vagus nerve, reduces heart rate by:

a) Decreasing i,( funny) current
b) Reducing ca2+current
c) Reducing K+ current causing resting membrane potential to move towards
threshold
d) Both A and B
e) All of the above

27. When blood pressure is increased, stimulation of the baroreceptor reflex

rapidly (within a minute) reduces blood pressure because:
a) Venous capacitance is reduced
b) Vasopressin secretion is increased
c) Inhibition of the rostral ventral lateral medulla
d)Parasympathetic nerve activity to the heart and vasculature is reduced.
28. Cardiac reserve is carried out by the following mechanisms, EXCEPT:
a)Heart rate reserve.
b) Stroke volume reserve.
c) Blood pressure reserve.
d)Hypertrophy of the myocardium.

29. diastolic volume is increased by all of the following, EXCEPT:

a) Increased venous return.
b) Increased blood volume.
c) Changing posture from supine to standing.
d) Venoconstriction.

30. Compared to non-athlete, which of the following characterizes the trained

athlete?
a) Increased vagal tone.
b) Decreased cardiac index.
c) Decreased venous return.
d) Marked increase in the heart rate.

31. Which one of the following organs has the highest arteriovenous oxygen
difference under normal resting condition?
a) Brain.
b)Heart.
c) Skin.
d)Skeletal muscle.

32. Why is the work performed by the left ventricle substantially greater than
that performed by the right ventricle?
a) The wall is thicker.
b) The stroke volume is greater.
c) The preload is greater.
d) The afterload is greater.

33. What is the characteristic feature ensuring that ventricular muscle has an
adequate oxygen supply?
a)Good functional anastomoses that exist between adjacent coronary
arteries.
 b)Structural arrangements that prevent vascular compression during
systole.
c)High oxygen extraction ratio from blood circulating through the
myocardium.
d) Strong direct sympathetic vasodilator effect.

CVS Tutorial-3
Physiology of circulatory system
1- An increases in which of the following would expected to decrease blood flow
in a vessel?
a- pressure gradient across the vessel.
b- viscosity of the blood .
c- plasma colloid osmotic pressure.
d- radius of the vessel.

2-If a patient administered a large dose of ACE inhibitor which has caused
profound arterial vasodilatation. Compensation for this condition would
include;
a- increased parasympathetic activity.
b- increased sympathetic activity.
c- peripheral vasodilatation.
d- increased capillary filtration.
3-A magnetic resonance angiography study of 37-year –old woman showed that
the abdominal aorta was constricted to one-half of its resting diameter. As a
result, resistance to blood flow through it would be which of the following?
a- decreased to half.
b- increased by 50%.
c- doubled.
d- increased 16- fold
4-An increase in the local concentration of which of the following agents will
cause systemic vasoconstriction?
a- nitric oxide.
b- angiotensin II.
c- atrial natriuretic peptide.
d- adenosine.
5- If the diameter of a precapillary arteriole is increased in a Muscular vascular
bed. A decrease in which of the Following would be expected?
a- Capillary filtration rate.
b- Vascular conduction.
c- Capillary blood flow.
d- Arteriolar resistance

6-During exercise, total peripheral resistance decreases Because of the effect of:
a- Sympathetic nervous system on splanchnic arterioles.
b- Parasympathetic nervous system on skeletal muscle Arterioles.
c- Local metabolites on skeletal muscle arterioles.
d- Local metabolites on cerebral arteriole

7-Which of the following is greater in veins than arteries?

a- Resistance.
b- Wall thickness
c- Compliance.
d- Total blood flow.

8-Vascular resistance is most markedly affected by:

a- Vessel lumen diameter.
b- Vessel cross sectional area.
c- Blood viscosity.
d- Vessel length.
9-The tendency for turbulent flow is greatest in which of the following?
a- Arterioles.
b- Capillaries.
c- Aorta.
d- Small arterioles.

10- Blood flow to which organ is controlled primarily by the Sympathetic

nervous system rather than by local Metabolites?
a- Skin.
b- Heart.
c- Brain.
d- Skeletal muscle during exercise.

11-If the blood flow to the forearm is temporarily obstructed During blood
pressure measurement, the release of cuff will Result in an increase in blood
flow which is:
a- Called active hyperaemia.
b- Caused by increase in arterial blood pressure.
c- Accompanied by an increase in total peripheral resistance.
d- Called reactive hyperaemia.

12-Which of the following statements is true? Vascular Resistance increases:

a- By 50% when the vascular radius is halved.
b- When the wall thickness increases.
c- When the blood viscosity increases.
d-from the arteriolar to the capillary bed

13- Which of the followings is incorrectly paired?

a- prostacyclin: vasodilation.
 b- histamine : increased capillary permeability.
c- increased H+ concentration in tissue : vasoconstriction.
d- decreased right atrial pressure : increased ADH secretion

14-Which of the following segments of the circulatory system has the highest
velocity of blood flow?
a- aorta.
b- arteries.
c- capillaries.
d- veins.
15-As regards the arterioles, which of the following is true?
a- have a smaller wall: lumen ratio than the arteries.
b- play a major role in regulating arterial blood pressure.
c- they are called capacity vessels.
d- have a large total cross- sectional area than do the capillaries.

15-While investigating a 34 –year- old man with essential Hypertension it was

noticed that he had high blood renin Level. Which of the following could be a
major stimulus for the release of renin?
a- Dilatation of renal arteries.
b- Hypertension.
c- Increased delivery of sodium to the distal tubules.
d- Increased sympathetic activity via renal nerves.

16-Which of the following does not dilate Arterioles in the skin?

a- Increased body temperature.
b- Bradykinin.
c- Substance P.
 d- Vasopressin.

17- Blood flow to a tissue remains relatively constant despite a reduction in

arterial pressure. Which of the following would be expected to occur in
response to Reduction in arterial pressure?
a- Decreased conductance.
b- Decreased CO2 concentration.
c- Increased tissue O2 concentration.
d- Decreased vascular resistance

18-Which of the following has the highest total Cross-sectional area in the
body?
a- Arteries.
b- Arterioles.
c- Capillaries.
d- Veins.

19-Most of the blood volume is present in:

a- Heart.
b- Arterial side.
c- Venous side.
d- Capillaries.

20- About renin – angiotensin system, which of the following statements is

WRON
a- is stimulated following blood loss
b- relies on angiotensinogen secretion form the kidneys
c- promotes aldosterone secretion from adrenal cortex
d- can stimulate vasoconstriction
21- Which of the following would be expected to raise Blood pressure
a- Bradykinins.
 b- A drug that inhibits angiotensin-converting enzyme.
c- A substance which inhibits NO synthase
d- A drug which inhibits vasopressin receptors in the Vascular smooth
muscle.

22-Excess production of which of the following Would most likely result in

chronic hypertension?
a- atrial natriuretic peptide (ANP)
b- prostacyclin
c-Angiotensin II
d-Nitric oxide
23-Carbon dioxide (CO2) regulates blood flow to which one of the following
organs?
a- Heart
b- Skin
c- Brain
d- Skeletal muscle.

24-Regarding endothelial- derived substances Affecting tissue blood flow, all the
following are true EXCEPT:
a-Endothelin-1 is a vasodilator agent.
b-Thromboxane-A2 is a vasoconstrictor.
c-Prostacyclin is a vasodilator.
d-Nitric oxide is a vasodilator.
25-Hyperaemia in skeletal muscle during exercise is Normally associated with:
a- Increased sympathetic tone in the exercising muscles.
b- Capillary dilatation due to relaxation of capillary smooth Muscle.
c- A fall in arterial pressure.
d- Reflex vasoconstriction in other vascular beds.
 CVS Tutorial-4
Regulation of Arterial Blood pressure>>edema
1-The blood pressure increases while the heart rate decreases in response to:
a. Increased intracranial tension.
b. Exercise.
c. Exposure to high altitude.
d. Increased body temperature

2-Activation of the baroreceptor Reflex:

e- Causes release of atrial natriuretic peptide (ANP)
f- Inhibits neurons in the vasomotor areas.
g- Is primarily involved in long-term regulation of Systemic blood pressure.
h- Occurs only under situations in which blood Pressure is markedly
elevated.

3-Which of the following is an action of Angiotensin II?

a. Stimulate aldosterone secretion.
b. Decreases vasopressin secretion.
c. Vasodilatation of arterioles.
d. Increases K+ reabsorption.

4- An increased discharge of impulses from the baroreceptors leads to:

a. Stimulation of the vasomotor centre.
b. Stimulation of the cardioinhibitory centre (CIC).
c. Stimulation of the respiratory centre.
d. Increasing the secretion of ADH.

5-The sympathetic V.C. tone is decreased in response to increased activity of

the:
a. Carotid sinus baroreceptors.
b. Medullary chemoreceptors.
c. Pain receptors.
d. Carotid body chemoreceptors

6-The normal level of arterial B.P. is kept constant mainly by the activity of:
a. The baroreceptors in the carotid sinus and aortic arch.
 b. Vasoconstriction.
c. Accelerated respiration.
d. Activation of the symp. V.D. cholinergic discharge to skeletal muscle.

7-The systolic A.B.P. is:

a. Unaffected by changes in posture.
b. Directly increased by renin.
c. Affected by the venous return to the heart.
d. Unaffected by the peripheral vascular resistance.

8- Angiotensin II has the following effects EXCEPT:

a. Stimulates antidiuretic hormone release.
b. Stimulates renin release.
c. Is a powerful vasoconstriction.
d. Stimulates aldosterone release.

9- In the mechanism of Cushing reflex, all the following is true EXCEPT:

a. It occurs when the intracranial tension is elevated.
b. Cerebral ischemia stimulates the vasomotor area.
c. The arterial blood pressure rises.
d. The heart and respiration accelerate to correct cerebral ische

10.When ABP falls to very low levels (50mmHg), the nervous mechanism which
helps to regulate it is mainly:
A. Baroreceptor reflex
B. Chemoreceptors
C. CNS ischemic response
D. Cushing’s reflex
E. Vasoconstriction

True or false

11. Mean systemic arterial blood pressure usually increases in response to

a. stimulation of the carotid sinus baroreceptors.
b. stimulation of peripheral chemoreceptors.
c. brainstem compression/asphyxia.
d. sleep
12. Arterial baroreceptors
a. Respond primarily to stretch, not pressure
b. Are located chiefly in the aortic and carotid bodies.
c. Reflexly attenuate fluctuations in the mean arterial pressure.
d. Have afferent fibres in both the trigeminal and vagus nerves

12. An acute increase in extracellular fluid volume in a human

a. Can stimulate both arterial baroreceptors and venoatrial stretch
receptors.
b. Elicits a reflex vasoconstriction in the skin, muscle and renal circulations.
c. Elicits a reflex fall in circulating vasopressin.
d. Elicits a rise in circulating atrial natriuretic peptide.
e. Elicits a reflex activation of the renin–angiotensin system

13- The coronary blood flow in human heart/minute equals:

a. 250 ml.
b. 300 ml.
c. 330 ml.
d. 360 ml.

14. The lowest coronary blood flow occurs during which of the following cardiac
phases:
a. Ventricular diastole.
b. Isometric contraction phase.
c. Isometric relaxation phase.
d. Atrial systole.

15. Increased coronary blood flow during exercise is achieved by all the
following EXCEPT:
a. Metabolic autoregulation.
b. Marked tachycardia.
c. Local vasodilatation by accumulated metabolites.
d. Increased sympathetic stimulation.

16. Coronary blood flow is regulated mainly by:

a. Autonomic nerve
 b. Diastolic aortic pressure
c. Heart rate
d. Hormones
e. Local metabolism

17- The plasma colloidal osmotic pressure is:

a. The main filtering force in tissue fluid formation.
b. Determined mainly by the albumin concentration of the plasma.
c. Equivalent to the osmotic pressure of 0.9% NaCl solution.
d. Normally about 30 mmHg.

18. About the dynamics of interstitial fluid formation at the venous end of the
capillary:
a. Net outward force = 40 mmHg.
b. Net inward force = 9 mmHg.
c. Interstitial fluid pressure = +3 mmHg.
d. Interstitial fluid colloid osmotic pressure = 28 mm

19- Pitting edema is produced by all the following factors EXCEPT:

a. Renal disease.
b. Congestive heart failure.
c. Liver disease & hypoproteinaemia.
d. Hyperproteinaemia

20- Edema is produced by all the Following factors EXCEPT:

a)Renal disease.
b) heart failure.
c) Liver disease & hyperproteinaemia.
d) Hyperproteinaemia

21- The tendency for edema to occur will Be increased by

a. Arteriolar constriction.
b. Increased venous pressure.
c. Increased plasma protein concentration.
d. Decreased Muscular activity
22.The net loss of fluid from capillaries in the legs is increased by all except:
A. Arteriolar dilation.
B. Change from the recumbent to the standing position.
C. Lymphatic obstruction.
D. Plasma albumin depletion.

23. If haemorrhage causes precapillary resistance arterioles to constrict and

capillary hydrostatic pressure decreases, which of the following is most likely to
occur?
A. Net filtration of fluid from the capillaries will increase
B. Net absorption of fluid in the capillaries will increase
C. Net absorption of fluid in the capillaries will not change
D. Capillary diameter will decrease
E. Capillary diameter will increase

24. If capillary hydrostatic pressure is 30mmHg, capillary osmotic pressure is 25

mmHg, and interstitial osmotic pressure is 3 mmHg, which of the following
describes fluidmovement across the wall of the capillary?
a) no movement occurs
b) net filtration
c) net absorption
d) movement of fluid occurs only through vesicular transport

25. Filtration from the blood into the interstitial fluid would be increased by:
A. Decreased interstitial fluid colloid osmotic pressure
B. Increased interstitial fluid hydrostatic pressure
C. Decreased capillary hydrostatic pressure
D. Decreased blood plasma colloid osmotic pressure

26.The capillaries contain what percentage of the circulatory blood ?

A. 50%
B. 25%
C. 10%
D. 5%

27. Regarding capillaries T/F

a. 80 % of the total capillaries in the body are completely closed .
 b. Blood flowing through capillaries is minimal and unimportant .
c. Capillary tone refers to the degree of opening/closing of each capillary .
d. If all capillaries open at any one time, shock deve

CVS Tutorial-5
Mechanics of ventilation>>V/Q ratio

1.Which of the following is true during inspiration?

a. Alveolar pressure is lower than Intrapleural pressure.
b. Alveolar pressure is higher than atmospheric pressure.
c. Alveolar pressure equals atmospheric pressure.
d. Alveolar pressure is lower than atmospheric pressure.
2.Which of the following is a function of dead space?
a. Warms expired air to body temperature.
b. Saturates inspired air with water vapor.
c. Allow gas exchange between breathes.
d. Maintains the patency of the alveoli.
3. Which of the following is the first branching of the bronchial tree that has gas
exchanging capabilities?
a. Terminal bronchioles.
b. Respiratory bronchioles.
c. Alveoli.
d. Alveolar ducts
4. Contraction of the abdominal muscles is important in which of the
followings?
a. PppNormal (quiet) inspiration.
b. Forced (maximum) inspiration
c. Normal (quiet) expiration
d. Forced (maximum) expiration.
5. A healthy, 25-year-old medical student participates in a 10-km charity run.
Which of the following muscles contract during expiration?
a. Diaphragm and external intercostals
b. Diaphragm and internal intercostals
c. Internal intercostals and abdominal recti
d. Scaleni & Sternocleidomastoid muscles
6.What is the pressure difference that acts to distend the lungs?
a. Alveolar pressure
b. Airway opening pressure
c. Transthoracic pressure
d. Transpulmonary pressure
7. What is the pressure of gas within the alveoli at the end of inspiration ( just
before expiration) relative to that of atmospheric air?
a. Less than atmospheric air
b. Greater than atmospheric air
c. Cannot be predicted
d. The same as atmospheric air
8. If the lung were punctured, which of the following would happen?
a) The lung would collapse on the side of the puncture.
b) Both the lung and the chest wall would collapse on the side of the puncture.
c) The alveolar pressure would increase above Atmospheric pressure.
d) The intrapleural pressure becomes more negative.
9. A man inspires 1000 ml from a spirometer. The intrapleural pressure was - 4
cm H2O before inspiration and -12 cm H2O the end of inspiration. What is the
compliance of the lungs?
A) 50 ml/cm H2O
B) 100 ml/cm H2O
C) 125 ml/cm H2O
D) 250 ml/cm H2O
10. Which of the following could decrease pulmonary compliance?
 a) Old age.
b) Pulmonary fibrosis.
c) Surfactant.
d) Emphysema
11. What is the function of alveolar surfactant?
a. Increases pulmonary surface tension.
b. Decreases pulmonary compliance.
c. Maintains stability of alveoli
d. Decreases pulmonary blood flow

12. What best characterizes the respiratory distress syndrome in premature

infants?
a) Their ability to synthesize DPPC is increased.
b) Higher pressures are required to ventilate the lungs.
c) Lung compliance is high.
d) Alveoli tend to over expand and sometimes burst.

13. Alveolar surfactant acts to increase pulmonary

a. Surface tension
b. Compliance
c. Airway resistance
d. Work of breathing
14. Comparing a premature infant with respiratory distress syndrome to a
normal full-term infant, how do lung compliance and surfactant levels
compare?
Compliance in preterm Surfactant in preterm
A) High low
B) Low low
C) Normal high
 d) Normal high
15. What is the effect of Gravity on pulmonary ventilation?
a. Causes a less negative intrapleural pressure at the apex of the lungs.
b. Causes ventilation to be greater at the apex of the lungs than at the base.
c. Causes larger resting volume of the alveoli at the base of the lung than the
apex.
d. Causes ventilation to be greater at the base of the lungs than at the apex.
16. What distinguishes the pulmonary circulation from the systemic circulation?
a. Higher blood flow
b. Lower resistance
c. Lower compliance
d. Higher pressure

17. is the relation between arterial (Pa), alveolar (PA) ,and venous (Pv)
pressures in zone 2 of the lung?
a. PA >Pa>Pv
b. Pv >PA>Pa
c. Pv>Pa>PA
d. Pa>PA>Pv

18. Hypoxic pulmonary vasoconstriction depends on:

a) PO2 of mixed venous blood.
b) PO2 of alveolar gas.
c) PCO2 of mixed venous blood.
d) PCO2 of alveolar gas.

19. When a person is standing, what is the effect of gravity on the blood flow
through the lungs?
a. Equal at the apex and the base because of the lowest alveolar pressure.
b. Highest at the apex because of the effect of gravity.
c. Highest at the base because of the highest arterial pressure.
d. Lowest at the base because of the highest alveolar pressure.
20. What is the ratio of total systemic vascular resistance to pulmonary
vascular resistance?
a. 2: 1
b. 3: 1
c. 5: 1
d. 10: 1
21. Why do the basal regions of the upright human lung are normally better
ventilated than the upper regions?
a. Airway resistance in the upper regions is higher than the lower regions.
b. There is less surfactant in the upper regions.
c. The blood flow to the lower regions in higher
d. The lower regions have a small resting volume and a relatively large
increase in volume.
22. Which of the following sets of differences best describes the
hemodynamics of the pulmonary circulation when compared with
systemic circulation?
Flow Resistance Arterial Pressure
a. Higher Higher Higher
b. Higher Lower Lower
c. Lower Higher Lower
d. Same Lower Lower
23. What decreases pulmonary vascular resistance during muscular exercise?
a) Decrease in pulmonary arterial pressure.
b) Decrease in pulmonary venous pressure.
c) Increase in alveolar pressure.
d) Distension of pulmonary capillaries.
24. If an area of the lung is not ventilated because of bronchial obstruction,
the pulmonary capillary blood serving that area will have a Po2 that is
a. Equal to atmospheric Po2
b. Equal to mixed venous Po2
c. Equal to normal systemic Po2
d. Lower than mixed venous Po2
25. Compared with the base, the apex of the upright human lung has:
 a. A higher PO2.
b. A higher ventilation.
c. A higher blood flow.
d. Smaller alveoli.
26. If blood flow to the left lung is completely blocked by an embolism in the
pulmonary artery, what is the V/Q ratio in the affected lung?
a. V/Q ratio will be zero
b. V/Q ratio will be lower than normal
c. V/Q ratio will be higher than normal
d. V/Q ratio will be normal
27. Which of the following statements best characterizes the V/Q ratio of the
apical alveoli of the healthy lung in a standing subject?
a) The apical alveoli have the highest V/Q ratio
b) apical alveoli have V/Q ratio = 1
c) The apical alveoli have the lowest V/Q ratio
d) The apical alveoli have V/Q ratio of 0.8
28. Venous admixture (shunt) is produced by blood from all of the following
EXCEPT:
a. The thebesian veins
b. High V/Q areas of the lung
c. The bronchial veins
d. Alveoli with impaired diffusion

CVS Tutorial-6
Diffusion & gas transport

1.Regarding diffusion of O2 across respiratory membrane

a) Increasing the thickness of the membrane increases the total flow of O2
 b) Increasing the surface area of the membrane increases the total flow of
O2
c)The lower the diffusion coefficient, the higher the total flow of O2
d)Decreasing the alveolar O2 tension would increase the total flow of O2

2. Approximately how long does an average red blood cell spend in The
pulmonary capillaries during resting conditions?
a. 0.25 second
b. 0.50 second
c. 0.75 second
d. 5.0 seconds
3. Which of the following factors increases diffusion through respiratory
membrane?
a. Increased thickness of the membrane
b. Increased mixed venous blood PO2
c. Increased solubility of the gas
d. Increased molecular weight of the gas
4.Which of the following can decrease the affinity of haemoglobin to Oxygen?
a. Increased PCO2.
b. Decreased 2,3 DPG
c. Alkalosis.
d. HB.
5. Regarding Haldane effect, which of the following is Correct?
a. Hypercapnia helps association of O2 with HB at lung side.
b. Alkalosis helps dissociation of O2 from HB at tissue side.
c. Oxygenation of HB helps CO2 unloading at lung side.
d. of HB helps CO2 loading at lung side.
6.What shifts the HB-O2 dissociation curve to the right?
A. Increased pH.
 B. Decreased 2-3 DPG.
C. Strenuous exercise.
D. Fetal-Hb.
7. The affinity of haemoglobin for O2 is increased by
A. Increased temperature
B. Increased PCO2
C. Acidosis
D. CO added to the blood
8.Which of the following describes diffusing capacity of O2 in the lung?
A. Does not change during exercise
B. Is greater than diffusing capacity for CO2
C. Is greater in residents at sea level than in residents at high altitude
D. Is directly related to alveolar capillary surface area
9. The O2 carrying capacity of the blood of anemic patient with HB
concentration 10 g /dl is approximately :
a) 10 ml/dl.
b) 13 ml/dl.
c) 18 ml/dl.
d) 20 ml/dl

10.On the O2 Dissociation curve (at pH 7.4, PCO2 40 mm Hg, temp 37 ℃ ) PO2
is:
A. 100 mm Hg for 50% saturation
B. 60 mm Hg for 50% saturation
C. 40 mm Hg for 50% saturation
D. 26 mm Hg for 50% saturation
11. A man fell asleep in his running car. He was unconscious when he was
brought into the emergency department with carbon monoxide (CO) poisoning,
you would expect his (PaO2) to be _______, while his arterial O2 content would
be ______.
A) Normal, decreased
B) Decreased, decreased
C) Increased, normal
D) Decreased, normal

12. Which of the below O2-Hb dissociation curves corresponds to blood from an
adult (red line) and blood from a fetus (green line)?
A) A
B) B
C) C
D) D
E) E
F) F

13. CO2 is transported from the tissues to the lungs predominantly in the form
of bicarbonate ion. Compared with arterial red blood cells, which of the
following options best describes venous red blood cells?
Intracellular CL- Concentration Cell Volume
A. Increased No change
B. Decreased Increased
C. Increased Increased
D. No change Decreased
14 .CO2 is transported from the tissues to the lungs predominantly in the form
of bicarbonate ion. Compared with arterial red blood cells, which of the
following options best describes venous blood HCO3 - and CL- concentrations?
Plasma HCO3- Concentration. RBC Cl- Concentration
A. Increased No change
B. Decreased Increased
C. Increased Increased
D. No change. Decreased
15. Regarding gas transport to the periphery:
A. Reduced HB is more acidic and so facilitates the loading of blood with
CO2
B. Carbon monoxide shifts the O2 dissociation curve to the right
C. Chloride shift results from the relative impermeability of the red cell
membrane to HC03-
D. The Haldane effect describes the increased unloading of CO2 at high
PO2.
16.Which of the following reduces synthesis of 2, 3- DPG in red blood cells?
A. Acidosis in red blood cells
B. Anaemia
C. Exercise
D. Ascent to high altitude
17. Carbon dioxide:
A. Is carried as carboxy haemoglobin on the haemoglobin molecule.
B. Uptake by the blood increases HB- oxygen binding power.
C. Content is greater than oxygen content in arterial blood
D. Uptake by the blood leads to left shift of O2-HB curve
18. Bohr effect describes the
A. Decrease in oxygen affinity of haemoglobin with high oxygen tension
B. Decrease in oxygen affinity of haemoglobin with decreased blood pH
C. Increase in oxygen affinity of haemoglobin with increased temperature
D. Increase in oxygen affinity of the haemoglobin with decreased blood pH
19. Blood gas measurements are obtained in a resting patient who is breathing
room air. The patient has an arterial content of 19.5 ml O2/dl and a PaO2 of 95
mm Hg. The mixed venous O2 content is 8 ml O2/dl. Which condition does the
patient have?
A) Right to left anatomic shunt.
B) Pulmonary edema
C) A low Hb concentration
D) A low cardiac output
20-Which point on the below figure represents arterial blood in a severely
anaemic person (HB concentration= 8 g / dl)?
A. A
B. B
C. C
D. D
E. E

21. Which of the below O2-Hb dissociation curves corresponds to normal blood
(red line) and blood containing CO (green line)?
A) A
B) B
C) C
D) D
E) E
F) F

CVS Tutorial-7
Regulation of ventilation>>cyanosis

1. From where does the normal rhythmic pattern of breathing originate?

a. The pneumotaxic centre in the pones
b. The motor area of the cortex
c. The ventral & dorsal respiratory group in the medulla
d. The Apneustic centre in the pones

2. What is the effect of impulses from the pneumotaxic centre?

a. Turn on inspiratory activity.
b. Turn off the inspiratory activity
c. on forced expiration
d. Turn on forced expiration

3. What are the central chemoreceptors responsive to?

a. Both the PCO2 and the PO2 of the arterial blood
b. pH of the surrounding extracellular fluid
c. Increased lactic acid during muscular exercise
d. Both the PCO2 and the PO2 of the venous blood
4. What is the peripheral chemoreceptors responsive to?
a) They respond to changes in the arterial PO2 but not pH.
b) They respond to changes in Pa CO2 but not arterial PO2.
c) They respond to both the PCO2 and the PO2 of the arterial blood
d) They respond to changes of pH of the CSF.

5. What is the ventilatory response to the normal level of arterial PCO2?

a) It has no effect on the normal level of ventilation.
b) It cannot stimulate the central chemoreceptors.
c) It is an important stimulus to the peripheral chemoreceptors.
d) It is a major factor controlling the normal level of ventilation.

6. What is the most important stimulus controlling the level of resting

ventilation?
a) PO2 on peripheral chemoreceptors.
b) PCO2 on peripheral chemoreceptors.
c) pH on peripheral chemoreceptors.
d) pH of CSF on central chemoreceptors.

7. The receptors responsible for Hering- Breuer inflation reflex are:

a. Rapidly adapting irritant receptors.
b. Slowly adapting stretch receptors.
c. Juxta capillary pulmonary receptors.
d. Peripheral chemoreceptors

8. PaO2 decreases in
a. Cyanide poisoning
b. Anaemia.
c. Stagnant hypoxia.
d. Lung fibrosis

9. How could Hypoxemia produces hyperventilation?

a. By a direct effect on the rapidly adapting irritant receptors.
b. By a direct effect on the Juxta capillary pulmonary receptors
c. By a direct effect on the Central medullary chemoreceptors
d. By a direct effect on the Carotid and aortic body chemoreceptors.
 10. Regarding hypoxemia:
a) It is the major stimulus to ventilation at high altitude.
b) It is the major stimulus to central chemoreceptors.
c) Ventilatory response to hypoxemia is reduced if the PaCO2 is also raised.
d) It is important in mild carbon monoxide poisoning.

11. Which of the following diseases does not show hypoxic hypoxia?
a. Congenital heart disease.
b. Pulmonary fibrosis.
c. Bronchial obstruction.
d. Pernicious anemia.

12. What causes reduction in the tension of O2 in the arterial blood?

a.Descent low altitudes.
b.In anemia.
c. In stagnant hypoxia.
d.In hypoxic hypoxia
14. What can cause stagnant hypoxia?
a. COPD
b. Shock or heart failure
c. Cyanide poisoning
d. Carbon monoxide poisoning

Case scenario
15. A12 years old boy has a severe asthmatic attack with wheezing. He
experiences rapid breathing and becomes cyanotic. His arterial Po2 is 60 mm Hg
and his PCo2 is 30 mm Hg.
1.Explain the changes in his arterial blood gases.
PaO2 is decreased because of poor ventilation caused by airway obstruction
PaCo2 is decreased because of hyperventilation washout of CO2
2. this patient suffer from hypoxia? If yes, which type?
Yes, he has hypoxemic hypoxia
3. the cause of cyanosis
Hypoxemia (PaO2 =60 mm Hg) increased amount of reduced HB.
4.Discuss the underlying regulatory mechanism(s) responsible for this patient’s
rapid breathing.
Effect of hypoxemia on peripheral chemoreceptors.
 Answers
Tutorial-1
1 B 2 B 3 A 4 B 5 C
6 A 7 C 8 B 9 C 10 B
11 A 12 C 13 F 14 T 15 F
16 C 17 D 18 D 19 A 20 B
21 D 22 B 23 A 24 A 25 C
26 F 27 T 28 F 29 G 30 B
Tutorial-2
1 C 2 A 3 D 4 D 5 C 6 B 7 A
8 D 9 D 10 C 11 D 12 B 13 A 14 B
15 B 16 C 17 B 18 D 19 A 20 A 21 B
22 D 23 C 24 B 25 B 26 D 27 C 28 C
29 C 30 A 31 B 32 D 33 C
Tutorial-3

1 B 2 B 3 D 4 B 5 D 6 C
7 C 8 A 9 C 10 A 11 D 12 C
13 C 14 A 15 B 15 D 16 D 17 D
18 C 19 C 20 B 21 C 22 C 23 C
24 A 25 D
Tutorial-4

1 A 2 B 3 A 4 B 5 A 6 A
7 C 8 B 9 D 10 C 11 F,T,T,F 12 T,F,T,F
12 T,F,T,T,F 13 A 14 B 15 B 16 E 17 B
18 B 19 D 20 C 21 B 22 C 23 B
24 B 25 D 26 D 27 T,F,F,T
Tutorial-5
1 D 7 D 13 B 19 C 25 A
2 B 8 A 14 B 20 D 26 C
3 B 9 C 15 D 21 D 27 A
4 D 10 B 16 B 22 D 28 B
5 C 11 C 17 D 23 D
6 D 12 B 18 B 24 B

Tutorial-6
1 B 6 C 11 A 16 A 21 E
2 C 7 D 12 C 17 C
3 C 8 D 13 C 18 B
4 A 9 B 14 C 19 D
5 C 10 D 15 D 20 E

Tutorial-7
1 C 5 D 9 D 13 B
2 B 6 D 10 A
3 B 7 B 11 D
4 C 8 D 12 D