2009

A 37-year-old man is stabbed in the arm and chest in a bar fight and experiences an
estimated blood loss of 1000 mL. His blood pressure is 100/50 mm Hg, and his heart rate is 110
beats per minute. Which of the following describes this patient’s physiologic response?
Vasoconstriction to the renal afferent and efferent arterioles
β-Adrenergic stimulation of the vasculature
Reduction of ADH release
Lowering of urine osmolality
A 22-year-old subject who is sitting quietly begins to squeeze a rubber ball repetitively in
her right hand,using moderate strength. During this time her mean arterial pressure does not
increase. Using her cardiovascular state prior to the exercise as a baseline, which of the
following would best describe her cardiovascular state during the exercise?
Increased blood flow through her right brachial artery
No change in cardiac output
Increased total peripheral resistance
Decreased blood flow through her left brachial artery
Decreased heart rate
A 25-year-old otherwise healthy patient is involved in a motor vehicle accident, and
suffers appreciable blood loss. The cardiac output is falling because of a loss of blood. As a
compensatory mechanism, the total peripheral resistance increases to attempt to maintain MAP.
Which of the following vasculature corresponding to the listed organ is contributing the least to
the elevated TPR?
Brain
Small intestine
Kidney
Skeletal muscle
Skin
If blood flow to an arm is obstructed for more than 30 seconds or so during the process of
a blood pressure measurement,the release of the blood pressure cuff will be followed by a
temporarily higher than resting level of blood flow through the arm. Which of the following best
describes the temporarily higher blood flow?
Caused by local vasodilation resulting from the buildup of local metabolites
Accompanied by an increase in total peripheral resistance
Called active hyperemia
Caused by a temporary increase in mean arterial pressure
Caused by the shifting of blood flow from other organs
 A patient has a renal condition that results in the loss of albumin in the urine that exceeds
the body’s albumin production. The resulting hypoalbuminemia will lead to edema of the hands,
face, and feet. Which of the following is likely to be noted?
Increase in lymph flow
Decrease in interstitial fluid hydrostatic pressure (PIF)
Increase in capillary hydrostatic pressure (Pc)
Increase in plasma oncotic pressure (πc)
Increase in the filtration coefficient (Kf) of capillaries in the skin
A patient exhibits an elevated jugular venous pressure. This could be the direct result of
which of the following?
Decreased myocardial contractility
Decreased blood volume
Increased heart rate
Increased total peripheral resistance (TPR)
Relaxation of venous smooth muscle Patients with elevated MAP often are prescribed
drugs that inhibit angiotensin-converting enzyme (ACE). Which of the following findings is
most likely to be observed in patients on these drugs alone?
Increased plasma renin levels
A further increase in TPR
Decreased sympathetic nerve activity
Decreased plasma angiotensin I levels
Increased plasma aldosterone levels
Licorice contains a chemical that enhances the aldosterone-like effects of cortisol. Thus,
patients who ingest large amounts of licorice (which is an ingredient in some herbal medicines as
well as a candy) will likely exhibit which of the following?
Increased blood pressure
Increased plasma renin levels
Increased plasma aldosterone levels
Increased TPR
Decreased central venous pressure
In response to the loss of blood,compensatory mechanisms come into play at various
times to blunt decreases in MAP and restore blood volume to normal. Which of the following
most accurately depicts the temporal order of effectiveness of three of these mechanisms, from
earliest to latest?
Sympathetic nerves, angiotensin II, aldosterone
Aldosterone, sympathetic nerves, angiotensin II
Angiotensin II, aldosterone, sympathetic nerves
Angiotensin II, sympathetic nerves, aldosterone
Sympathetic nerves, aldosterone, angiotensin II
An individual was in a car accident and is brought to the emergency room in an
unconscious state. Examination shows a very low blood pressure (80/40 mm Hg), tachycardia, a
very weak thready pulse, a distended abdomen,and clammy skin. Laboratory values indicate a
very low hematocrit (18%) and hypoalbuminemia. He is diagnosed as having internal
hemorrhage leading to severe hypovolemia and circulatory shock. To avoid having the patient go
into irreversible shock, the emergency room doctor immediately should initiate which of the
following treatments?
Administration of colloid-free volume expanders (eg, normal saline or lactated Ringer solution)
Administration of epinephrine to induce vasoconstriction
Administration of oxygen to improve blood oxygenation
Initiation of a platelet transfusion
A 35-year-old man had a tractor accident and lost approximately 1500 mL of blood. His
initial blood pressure is 90/60 mm Hg, and the heart rate is 120 beats per minute. On
resuscitation with intravenous lactated Ringer solution, his blood pressure increases to 110/70
mm Hg. Two hours later,he is noted to have significant peripheral edema of the hands and feet.
Which of the following is the best explanation for the edema?
Capillary leakage
High-output congestive heart failure
Infiltration of the intravenous line through the vein
Low oncotic pressure
If one considers a single vessel within each division of the systemic circulation in a
person who is lying down, one can arrange the vessels according to the end pressure, greatest to
least, within each vessel. (If the vessel exhibits a pulse pressure, one can consider the mean end
pressure.) Which of the following sequences of mean end pressure is correct in this case?
Large artery → arteriole → capillary → venule → large vein
Large artery → large vein → arteriole → venule → capillary
Capillary → arteriole → venule → large artery → large vein
Large vein → venule → capillary → arteriole → large artery
Capillary → venule → arteriole → large vein → large artery
A patient is suspected of having reduced flow of blood to the brain. Her blood pressure
taken from the brachial artery is normal. Bruits are detected in the right carotid artery but not in
the left carotid artery. A comparison of hemodynamic events in the two carotid arteries would
reveal which of the following?
Increased velocity of flow in the right carotid artery
A mean pressure in the right carotid artery proximal to the site of the bruit that is lower than the
mean pressure in the left carotid artery
Equal blood flow in both carotid arteries
Lower resistance to flow in the right carotid artery
Turbulent blood flow in both carotid arteries
A patient suspected of suffering a myocardial infarction is being monitored in the
Coronary Care Unit. The following data are obtained on this individual.: Arterial systolic blood
pressure 121 mm Hg Arterial diastolic blood pressure 82 mm Hg Venous blood pressure 2 mm
Hg Cardiac output 4185 mL/min Radius of the aorta 1.2 cm Which of the following can be
concluded from the monitored data?
The patient’s MAP is 95 mm Hg
The pulse pressure is 80 mm Hg
Total resistance to flow is approximately 45 resistance units
The patient’s blood flow in the carotid artery must be turbulent
The velocity of blood flow through the aorta is 3487 cm/s
A 32-year-old woman is seen in the emergency center with supraventricular tachycardia.
She is hypotensive. The cardiologist explains to the patient that the rapid heart rate does not
allow for sufficient ventricular filling, thus reducing cardiac output. Which of the following best
explains how ventricular filling is enabled during atrial contraction?
As a functional consequence of narrow fiber diameter, slow depolarization, and low density of
gap junctions in AV nodal cells
By the elevated contractility of ventricular muscle
By the high density of depolarization-activated Na+ channels in AV nodal cells
By the low basal activity of sarcoplasmic reticulum Ca+ pumps in ventricular muscle
By the prolonged time it takes for action potentials to be conducted from the bundle of His to
ventricular muscle
A 59-year-old man is admitted to the intensive care unit for a myocardial infarction. He is
given a β-adrenergic antagonist and instructed to avoid emotional turmoil to decrease
sympathetic stimulation of the heart. From a cellular perspective, sympathetic stimulation of the
heart does which of the following?
Increases depolarization-activated IK in the SA node
Decreases adenylyl cyclase activity in ventricular muscle
Decreases Ca2+ pump activity in the sarcoplasmic reticulum of atrial muscle
Decreases ICa in the AV node
Increases hyperpolarization-activated IK (inward rectifier) in the SA node
 A 28-year-old athlete is noted to have a baseline heart rate of 55 bpm, which his trainer
attributes to excellent parasympathetic (vagal) tone. This parasympathetic effect, among other
things, increases the ACh released in the SA and AV nodes. ACh released into the AV node
increases which of the following in AV fibers?
Probability of conduction failure (AV block)
Action potential amplitude
Conduction velocity
K+ equilibrium potential
Rate of depolarization of the pacemaker potential
A healthy 23-year-old medical student is participating in a cardiac echocardiography
study. During the isovolumetric ventricular contraction phase of the cardiac cycle, which of the
following findings take place?
Aortic blood pressure is falling
Aortic valve is open
AV valve is open
Second heart sound is produced
Ventricular muscle is undergoing repolarization
A 45-year-old man is seen by his cardiologist for increasing weakness and fatigue. He is
diagnosed with an enlarged dilated poorly pumping heart (cardiomyopathy). The larger
ventricular end-diastolic volumes (“enlarged hearts”) can compensate somewhat for the reduced
contractility that occurs in this condition because stretching of the ventricular muscle cells results
in which of the following?
Enhances interaction of myosin cross-bridges with actin
Decreases efflux of calcium during ventricular repolarization
Enhances reuptake of calcium by the sarcoplasmic reticulum
Enhances influx of calcium during the action potential
Improves conduction among muscle cells
A 45-year-old male is prescribed an antihypertensive agent that affects calcium channel
conductance. If this agent inhibits the influx of calcium into ventricular muscle cells during
ventricular excitation, which of the following statements is true?
The force of ventricular contraction at any given ventricular volume will be decreased.
The amount of calcium bound to troponin C during ventricular contraction will be increased.
The amount of calcium released from the sarcoplasmic reticulum during ventricular contraction
will be increased.
The overlap of thick and thin filaments during ventricular contraction will be increased.
2010
A patient is diagnosed with anaphylactic shock rather than hypovolumic shock because
Cardiac output is higher than normal
Ventricular contractility is greater than normal
Total peripheral resistance is greater than normal
Serum creatinine is elevated
Heart rate is greater than normal
Which one of the following will increase if massaging the neck stretches the carotid sinus
baroreceptor?
Vagal nerve activity
Total peripheral resistance
Right atrial pressure
Venous tone
Ventricular contractility
Lymph capillaries differ from systemic blood capillaries in that they
Are absent in the central nervous system
Are less permeable
Are not lined by endothelium
Lack valves
Collapse when interstitial pressure increases
Correct statements about the increase in pulmonary blood flow during vigorous exercise
include which of the following?
The increase in pulmonary blood flow is accommodated by dilation of pulmonary arterioles and
capillaries
The percentage of increase in flow is greater in the bases of the lungs than in the apices
The increase in flow is caused by a greater-than-fivefold increase in pulmonary arterial pressure
The increase in pulmonary blood flow is less than the increase in systemic blood flow
The increase in pulmonary blood flow is caused by sympathetic nerve stimulation of the
pulmonary vasculature
Pulmonary lymph flow exceeds that in other tissues because
Pulmonary interstitial fluids contain more proteins than the interstitial fluid in other tissues
Pulmonary capillary pressure is higher than systemic capillary pressure
Pulmonary endothelial cells contain a large number of fenestrations
Alveolar epithelial cells secrete a fluid that is added to the lymph formed from the blood plasma
Pulmonary capillaries have a lower oncotic pressure than systemic capillaries
At birth, changes that occur in the fetal circulation include
Increased systemic arterial pressure
Increased pulmonary vascular resistance
Increased pulmonary arterial pressure
Decreased left atrial pressure
Decreased pulmonary blood flow
Turbulence is more likely to occur in a blood vessel if
The velocity of blood within the vessel increases
The viscosity of blood within the vessel increases
The diameter of the vessel decreases
The density of the blood decreases
The length of the vessel increases
Systemic arteriolar constriction may result from an increase in the local concentration of
Angiotensin II
Nitric oxide
Atrial natriuretic peptide
Beta (β) agonists
Hydrogen ion
Which of the following will be lower than normal in a patient with an abnormally high
intracranial pressure?
Heart rate
Ventricular contractility
Mean blood pressure
Stroke volume
Total peripheral resistance
After an episode of exercise training, the trained individual will have a
Increased stroke volume
Decreased density of mitochondria in the trained muscles
Increased resting heart rate
Decreased maximum oxygen consumption
Decreased extraction of oxygen by exercising muscles
Which one of the following increases during aerobic exercise?
Cerebral vascular resistance
Diastolic blood pressure
Mixed venous oxygen tension
Blood flow to the kidney
Circulating blood volume
Pulse pressure increases when
Mean arterial pressure increases
Heart rate increases
Stroke volume decreases
Aortic compliance increases
Aortic stenosis develops
The distribution of blood among the various organs of the body is regulated by regulating
the resistance of the
Arterioles
Arteries
Precapillary sphincters
Postcapillary venules
Veins
Flow of fluid through the lymphatic vessels will be decreased if there is an increase in
Capillary oncotic pressure
Capillary pressure
Capillary permeability
Interstitial protein concentration
Central venous pressure
Central venous pressure is increased by
Decreasing heart rate
Decreasing blood volume
Increasing venous compliance
Increasing total peripheral resistance
Decreasing plasma aldosterone concentration
 Capillary permeability is lowest within the
Brain
Kidneys
Spleen
Liver
Skin
Blood flow through an organ would be increased by decreasing
The hematocrit
The diameter of the arterial vessels
The number of open arterial vessels
The arterial pressure
The diameter of the venous vessels
Net filtration from capillaries will increase following
Increased postcapillary resistance
Increased contraction of the precapillary sphincter
Decreased arterial pressure
Increased plasma protein concentration
Decreased capillary permeability
A reduction in carotid sinus pressure would cause a decrease in
Venous compliance
Heart rate
Myocardial contractility
Total peripheral resistance
Cardiac output
Which one of the following organs has the highest arteriovenous O2 difference under
normal resting conditions?
Heart
Brain
Skeletal muscle
Kidney
Stomach
 The percentage of the total cardiac output distributed to any single organ is most
dependent on
The ratio of an organ’s vascular resistance to total peripheral resistance (TPR)
The contractile state of the heart
The magnitude of mean blood pressure
The magnitude of diastolic pressure
The magnitude of cardiac output
At which of the following sites does the blood flow lose the greatest amount of energy?
Arterioles
Mitral valve
Large arteries
Capillaries
Venules
Which one of the following decreases during aerobic exercise?
Circulating blood volume
Heart rate
Skin temperature
Cerebral blood flow
Mean blood pressure
Which one of the following characteristics is most similar in the systemic and pulmonary
circulations?
Preload
Stroke work
Afterload
Peak systolic pressure
Blood volume
Which one of the following statements correctly describes the ductus arteriosus?
It prevents the flow of blood into the lungs of the fetus
It delivers oxygenated blood from the placenta to the left ventricle
It allows blood to flow from the aorta to the pulmonary artery in the fetus
Its resistance to blood flow decreases soon after birth
It is located in the septum between the left and right atrium
 Which one of the following values is greater in the pulmonary circulation than in the
systemic circulation?
The vascular compliance
The mean arterial pressure
The arterial resistance
The blood flow
The sympathetic tone
The greatest percentage of blood volume is found in the
Venules and veins
Heart
Aorta
Distributing arteries and arterioles
Capillaries
After a mild hemorrhage, compensatory responses initiated by the baroreceptor reflex
keeps blood pressure at or close to its normal value. Which one of the following values is less
after compensation for the hemorrhage than it was before the hemorrhage?
Venous compliance
Heart rate
Ventricular contractility
Total peripheral resistance
Coronary blood flow
The constriction of a blood vessel to one-half of its resting diameter would increase its
resistance to blood flow by a factor of
16
2
4
8
12
During aerobic exercise, blood flow remains relatively constant within
The brain
The skin
The heart
The skeletal muscles
The kidneys
Which of the following conditions causes pulse pressure to increase?
Hypertension
Tachycardia
Hemorrhage
Aortic stenosis
Heart failure
Sudden standing evokes the baroreceptor reflex. Which one of the following will be
greater after a person suddenly stands up than it was before the person stood?
The ejection fraction
The end-diastolic volume
The renal blood flow
The venous return
The pulse pressure
Closure of the aortic valve occurs at the onset of which phase of the cardiac cycle?
Isovolumetric relaxation
Isovolumetric contraction
Rapid ejection
Protodiastole
Rapid filling
If the QRS complex is positive in leads II and aVF and negative in lead III, the mean
electrical axis (MEA) is between
0° and +30°
−30° and 0°
+30° and +60°
+60° and +90°
+90° and +120°
Which one of the following is most likely to be observed in a patient with untreated atrial
fibrillation?
An increased left atrial pressure
An increased venous A wave
A decreased heart rate
An increased stroke volume
An increased arterial blood pressure
Normal splitting of the second heart sound (S2) into two components is increased during
inspiration because
The closing of the pulmonic valve is delayed
The closing of the aortic valve is delayed
The opening of the mitral valve is delayed
The stroke volume of the left ventricle is increased
The heart rate is decreased
Which of the following statements about the third heart sound (S3) is correct?
It is produced by turbulence during rapid ventricular filling in early diastole
It is usually diminished in congestive heart failure
It is produced by turbulence following atrial contraction
It is often associated with the “floppy” mitral valve syndrome
It is produced by flow through the patent foramen ovale
In a resting, healthy man, the ejection fraction is approximately?
0.6
0.1
0.2
0.3
0.9
Sustained elevation of cardiac output will occur with which of the following conditions?
Anemia
Hypertension
Aortic regurgitation
Third-degree heart block
Cardiac tamponade
A diastolic murmur accompanied by an increased preload can be caused by
Aortic regurgitation
Mitral stenosis
Mitral regurgitation
Atherosclerosis
Tachycardia
 Increasing vagal stimulation of the heart will cause an increase in
PR interval
Heart rate
Ventricular contractility
Ejection fraction
Cardiac output
During exercise, there is an increase in a person’s
Stroke volume
Diastolic pressure
Venous compliance
Pulmonary arterial resistance
Total peripheral resistance
Phase-4 depolarization of SA nodal cells is caused by
An increase in the flow of sodium into the cell
A decrease in the flow of potassium out of the cell
An increase in the activity of the Na/Ca exchanger
A decrease in the flow of chloride out of the cell
A decrease in the activity of the Na-K pump
Cardiovascular changes that occur during inspiration include decreased
Systemic blood pressure
Right ventricular filling
Right ventricular output
Pressure gradient from extrathoracic veins to the right atrium
Left ventricular contractility
Blood pressure increases and heart rate decreases in response to
Increased intracranial pressure
Exercise
Increased body temperature
Exposure to high altitude
Hemorrhage
During exercise, cardiac output is augmented by
Increased ventricular contractility
Sympathetic stimulation of resistance vessels
Dilation of venous vessels
Decreased end-diastolic volume
Decreased mean systemic arterial pressure
When flow through the mitral valve is restricted by mitral stenosis,
Exercise can induce acute pulmonary edema
Left ventricular preload increases
Left atrial pressure diminishes
Right ventricular end-diastolic pressure decreases
Central venous pressure decreases
Stroke volume can be decreased by
Increasing heart rate
Increasing ventricular contractility
Increasing central venous pressure
Decreasing total peripheral resistance
Decreasing systemic blood pressure
An ectopic extrasystole caused by a ventricular focus is characterized by
A skipped ventricular contraction
Interruption of the regular SA node discharge
Retrograde conduction of the action potential to the atria
A skipped atrial contraction
A larger than normal force of contraction
The electrocardiogram is most effective in detecting a decrease in
Coronary blood flow
Ventricular contractility
Mean blood pressure
Total peripheral resistance
Ejection fraction
Stroke volume can be increased by
Decreasing total peripheral resistance
Decreasing ventricular compliance
Increasing venous compliance
Increasing heart rate
Decreasing atrial contractility
Which one of the following will be observed in a patient with a dilated failing left
ventricle and a normal resting mean blood pressure?
An increased pulmonary capillary hydrostatic pressure
A decreased heart rate
A decreased left ventricular wall stress
An increased left ventricular ejection fraction
A decreased left ventricular energy consumption
Which one of the following correctly describes an event that normally occurs during the
PR interval?
The cardiac action potential passes through the AV node
The ventricle is contracting
There is no change in the voltage tracing on the ECG
The mitral and aortic valves are both closed
The second heart sound is heard

Left ventricular wall stress will be decreased by an increase in

The thickness of the free wall of the left ventricle
The left ventricular end-diastolic volume
The contractility of the left atrium
The total peripheral resistance
The mean arterial blood pressure
Which one of the following will be observed in a patient with aortic regurgitation?
An increased ejection fraction
An increased mean blood pressure
An increased diastolic blood pressure
A decreased pulse pressure
A decreased left atrial end-diastolic pressure
The diagnosis of a first-degree heart block is made if
The PR interval of the ECG is increased
The P wave of the ECG is never followed by a QRS complex
The P wave of the ECG is sometimes followed by a QRS complex
The T wave of the ECG is inverted
The ST segment of the ECG is elevated
Mitral prolapse is a common cause of mitral regurgitation in young women. Which one of
the following is observed in a patient with mitral prolapse?
An increase in the V wave
A diastolic murmur
A decrease in left ventricular volume
A normal stroke volume
A decrease in cardiac output
The upstroke of the SA nodal action potential is produced by opening a channel that is
Primarily permeable to Na+
Primarily permeable to Ca2+
Primarily permeable to K+
Primarily permeable to Cl−
Equally permeable to Na+ and K+

The channel responsible for the initiation of phase-4 depolarization in SA nodal cells
Is primarily permeable to Na+
Is opened by membrane depolarization
Is opened by vagal nerve stimulation
Is primarily permeable to K+
Is closed by norepinephrine
Sympathetic stimulation of the heart results in
An increase in the activity of the SR calcium pump
An increase in the duration of systole
An increase in the duration of diastole
A decrease in the affinity of troponin for calcium
A decrease in the concentration of Ca2+ during systole
An exercise stress test to rule out ischemic heart disease is positive if
The ST segment of the ECG is depressed
The systolic blood pressure rises
The heart rate fails to increase
A diastolic murmur is heard
The diastolic blood pressure decreases

2014
A 56-year-old woman presents for her annual physical examination. Her physician
auscultates a late systolic crescendo murmur with a midsystolic click. The murmur is best heard
over the apex, is loudest at S2, is shortened with squatting, and is longer and more intense when
venous return is decreased by standing or a Valsalva maneuver. Which of the following values is
the best index of the preload on her heart?
Ventricular end-diastolic volume
Blood volume
Central venous pressure
Pulmonary capillary wedge pressure
Ventricular end-diastolic pressure
A patient presents to the emergency department with intermittent chest pain. The ECG
and blood tests are negative for myocardial infarction, but the echocardiogram shows thickening
of the left ventricular muscle and narrowing of the aortic valve. An afterload-reducing
medication is prescribed. Which of the following values would provide the best measure of the
effectiveness of the medication in reducing left ventricular afterload in aortic stenosis?
Left ventricular mean systolic pressure
Left ventricular end-diastolic pressure
Mean arterial blood pressure
Pulmonary capillary wedge pressure
Total peripheral resistance
The spouse of a 58-year-old man calls 911 because her husband complains of chest pain
radiating down his left arm. He is transported to the emergency department, where an ECG and
cardiac enzymes indicate a recent myocardial infarction. The man undergoes cardiac
catheterization, including coronary angiography and hemodynamic recordings throughout the
cardiac cycle. No valvular defects were present. During ventricular ejection, the pressure
difference smallest in magnitude is between which of the following?
Left ventricle and aorta
Aorta and capillaries
Left atrium and left ventricle
Pulmonary artery and left atrium
Right atrium and right ventricle
 An 82-year-old woman was admitted to the hospital with ascites, peripheral edema, and
shortness of breath. Cardiac catheterization was conducted and the following values were
obtained:
Pulmonary vein O2 content = 20 mL O2/100 mL blood
Pulmonary artery O2 content = 12 mL O2/100 mL blood
Oxygen consumption (VO2) = 280 mL/min
Stroke volume = 40 mL
What is the woman’s cardiac output?
3.5 L/min
2.86 L/min
7.0 L/min
8.0 L/min
9.24 L/min
A patient undergoes cardiac transplantation for severe idiopathic cardiomyopathy. Upon
release from the hospital, the patient is referred to a cardiac rehabilitation program. The exercise
physiologist starts the patient on a walking regimen. During exercise in cardiac transplant
patients, cardiac output increases primarily due to an increase in which of the following?
Stroke volume
Arterial blood pressure
Heart rate
TPR
Venous compliance
A patient complaining of an irregular heartbeat is referred for a cardiac
electrophysiological study. Propagation of the action potential through the heart is fastest in
which of the following cardiac structures?
Purkinje fibers
SA node
Atrial muscle
Atrioventricular (AV) node
Ventricular muscle
A 75-year-old woman presents with fatigue and orthopnea. Rales are heard widely over
both lung fields. After several days of furosemide to treat the patient’s fluid retention, lisinopril
therapy is initiated. Which of the following is primarily responsible for the improvement in her
condition with lisinopril?
Stabilization of cardiac remodeling
An increase in cardiac contractility
An increase in ventricular end-diastolic pressure
An increase in ventricular wall thickness
A reduction in heart rate
A 72-year-old man is hospitalized with a history of respiratory distress, fever, and
fatigue. An ECG reveals ST-segment and T-wave abnormalities and echocardiography shows an
ejection fraction of 30%. Over the next several days, significant peripheral edema develops. The
edema is most likely caused by which of the following?
Increased central venous pressure
Decreased capillary permeability
Decreased arterial pressure
Increased lymphatic flow
Increased plasma protein concentration
A 38-year-old man has a murmur that ceases with the onset of the second heart sound.
The second heart sound occurs at the onset of which phase of the cardiac cycle?
Isovolumetric relaxation
Isovolumetric contraction
Rapid ejection
Rapid ventricular filling
Systole
A 24-year-old woman undergoes an annual physical examination for participation on the
varsity track team at her college. While auscultating her heart sounds, the sports medicine
physician instructs the woman to take in a deep inspiration. During this maneuver, he detects
normal splitting of the second heart sound. Which of the following is the mechanism underlying
this finding?
Delayed closing of the pulmonic valve
A decrease in heart rate
An increased left ventricular stroke volume
Delayed closing of the aortic valve
Delayed opening of the mitral valve
A 68-year-old man presents for his quarterly cardiology examination. Upon auscultation,
a third heart sound is heard. Of the following conditions, which is the most likely cause of an
S3?
Heart failure
Aortic regurgitation
Aortic stenosis
Right bundle branch block
Tricuspid regurgitation
A 23-year-old woman presents with fatigue. She is found to have a mid-systolic murmur
and higher-than-normal cardiac output. The differential diagnosis based on these findings
includes which of the following?
Anemia
Cardiac tamponade
Mitral regurgitation
Mitral stenosis
Third-degree heart block
A 22-year-old woman with lightheadedness and recurrent syncope is taken to the
emergency department. Her symptoms are relieved by intravenous atropine administration.
Antagonism of cholinergic muscarinic receptors causes an increase in which of the following
physiologic variables?
Heart rate
PR interval
Stroke volume
TPR
Ventricular contractility
Physical examination of a 41-year-old IV drug abuser reveals an early systolic murmur.
The physician also notes a 7-cm distance between the height of the blood in his right internal
jugular vein and sternal angle (normal = 3 cm). Which of the following conditions is most likely
responsible for the physical findings?
Tricuspid regurgitation
Aortic regurgitation
Atherosclerosis
Mitral stenosis
Tachycardia
A 50-year-old woman complains of intermittent chest discomfort. She is given an
exercise stress test to determine if the angina is a result of myocardial ischemia. The test will be
considered positive if which of the following occurs?
Depression of the ST-segment
An increase in mean arterial pressure
Tachycardia
A diastolic murmur
Widening of the QRS complex
A 64-year-old woman is postoperative day 1 after a cholecystectomy. She suddenly
stands up after being supine since the operation. As a result, which of the following
hemodynamic variables will increase?
Heart rate
Mean arterial pressure
Stroke volume
Venous return
Ventricular end-diastolic volume
A newborn baby is cyanotic upon delivery. The cyanosis is not relieved by breathing
100% oxygen. A diagnosis of persistent fetal circulation is made based on which of the
following?
Pulmonary vasoconstriction and hypertension
Aortic coarctation
Left ventricular hypertrophy
Mitral regurgitation
Systemic hypertension
A 19-year-old man severs an artery in a motorcycle accident. A bystander applies a
tourniquet to stop the bleeding. When the paramedics arrive, the blood pressure of the injured
man was only slightly hypotensive and his pupils were reactive. The greatest percentage of the
redistributed blood volume came from which of the following?
Venules and veins
Aorta
Arteries and arterioles
Capillaries
The heart
An 84-year-old woman presents with paroxysmal dizziness, syncope, confusion, and
fatigue. Her heart rate did not change when the patient was instructed to perform a Valsalva
maneuver. A 24-hour Holter monitor revealed periodic episodes of sinus bradycardia. Phase 4 of
the pacemaker potential of SA nodal cells is caused by which of the following?
An increase in the flow of sodium into the cell
A decrease in the activity of the Na–K pump
A decrease in the flow of potassium out of the cell
An increase in the activity of the Na/Ca exchanger
An increase in the flow of calcium into the cell
An 83-year-old woman with long-standing hypertension presents after a near-syncopal
episode upon standing. Her blood pressure is taken sitting and then standing. Systolic pressure
decreased slightly and pulse pressure increased in the standing position. Which of the following
can lead to an increased pulse pressure?
Stiffening of the arteries
A decrease in stroke volume
An increase in arterial compliance
An increase in heart rate
An increase in total peripheral resistance
A 68-year-old sedentary, obese man with four-vessel coronary occlusive disease has a
massive myocardial infarction while shoveling snow. In the blizzard conditions, it takes the
ambulance over an hour to reach the man’s home. When the paramedics arrive, the patient’s
radial pulse is rapid and thready, he has pink froth coming from his mouth, and he is
nonresponsive. Increasing which of the following would lead to an increased stroke volume in
this patient?
Ventricular contractility
Heart rate
Pulmonary capillary hydrostatic pressure
Systemic vascular resistance
Venous compliance
A pacemaker is inserted in a patient in order to treat a prolonged PR interval detected on
the ECG. Which of the following normally occurs during the PR interval?
The cardiac action potential passes through the AV node
The mitral and aortic valves are both closed
There is no change in the voltage tracing on the ECG
The second heart sound is heard
The ventricles are contracting
A 36-year-old athlete becomes alarmed when he notices a series of heart palpitations
several hours after he exercises. After examining the patient’s ECG, the physician notes a sinus
rhythm with occasional unifocal premature ventricular complexes (PVCs). Which of the
following may predispose an athlete to the occurrence of PVCs?
Bradycardia
An accessory bundle of Kent
Atrial fibrillation
Inverted P waves
Sinus tachycardia
A patient comes to his physician complaining that he is no longer able to exercise as long
as he used to. The physician auscultates crepitant rales and a third heart sound; blood pressure is
normal. He sends the patient to cardiologist because of suspected heart failure. Which of the
following is most consistent with a diagnosis of CHF?
Increased left ventricular wall tension
Decreased heart rate
Decreased left ventricular energy consumption
Decreased pulmonary arterial wedge pressure
Increased left ventricular ejection fraction
Cardiac catheterization is performed on a 39-year-old man who presents with angina. The
left ventricular pressure–volume curve shows a decreased stroke volume and ejection fraction.
Which of the following mechanisms may compromise stroke volume following myocardial
infarction?
Increased heart rate
Decreased arterial blood pressure
Decreased total peripheral resistance
Increased central venous pressure
Sympathetic-mediated positive inotropy
A 47-year-old man is brought to the emergency department because he had chest pain,
was short of breath, and fainted at the gym during his daily workout. A prominent systolic
ejection click and crescendodecrescendo systolic murmur is heard over the right sternal border.
Which of the following findings is consistent with the patient’s most likely diagnosis?
Decreased pulse pressure
Decreased cardiac oxygen consumption
Decreased left ventricular systolic pressure
Increased arterial blood pressure
Increased ejection fraction
A patient with an inferior MI develops a stable bradycardia of 50 beats per minute (bpm).
The cardiologist orders an ECG to evaluate whether there is sinus node dysfunction or an AV
conduction disturbance. The diagnosis of a first-degree heart block is made in which of the
following cases?
Prolonged PR interval with every P wave followed by a QRS complex
Asynchrony of P waves and QRS complexes
Fixed, prolonged PR interval followed by a nonconducted QRS complex at regular intervals
Normal PR interval, normal QRS complexes, increased R-R interval
The PR interval is progressively prolonged until a QRS complex is dropped
A 67-year-old man with a history of rheumatic heart disease presents with difficulty
breathing when he exercises, which has worsened over the last year. Auscultation reveals a
holosystolic murmur at the left 5th intercostal space along the midclavicular line. The murmur is
loudest at the apex, radiates to the axilla, and is enhanced during expiration and when the patient
is instructed to make a fist. Which of the following findings is most likely to be present?
Increased ν wave
Decreased arterial pressure
Decreased left ventricular preload
Increased cardiac output
Increased pulse pressure
During a routine physical examination, a 35-year-old man is found to have a blood
pressure of 170/105 mm Hg. The history reveals episodes of headache accompanied by
palpitations, diaphoresis, and anxiety. Which of the following is the best initial pharmacotherapy
for this patient’s most likely diagnosis?
α-Adrenergic antagonist
α-Adrenergic agonist
β-Adrenergic agonist
β-Adrenergic antagonist
Glycoprotein IIb/IIIa antagonist
A 43-year-old man comes to his physician complaining of exhaustion and shortness of
breath. After completing the physical examination, the physician suspects the patient may be
suffering from pericardial tamponade. Which of the following observations led to the physician’s
putative diagnosis?
Pulsus paradoxus
Bradycardia
Expiratory rales
Hypertension
Third heart sound
A 37-year-old patient is brought to the emergency department in shock. A decision is
made to treat anaphylactic shock rather than hypovolemic shock based on an increase in which
of the following variables?
Cardiac output
Heart rate
Serum creatinine
Total peripheral resistance
Ventricular contractility
A 23-year-old collegiate dance squad member adopts a sedentary lifestyle once she starts
medical school. After the gross anatomy course, she decides to restore her state of physical
fitness by resuming a regular exercise routine. The cardiovascular responses to isotonic exercise
include an increase in which of the following?
Stroke volume
Diastolic pressure
Pulmonary vascular resistance
Systemic vascular resistance
Venous compliance
A 57-year-old woman is undergoing a femoral popliteal bypass for her peripheral
vascular disease. The vascular surgeon wishes to induce a localized arteriolar constriction to help
control hemostasis. An increase in the local concentration of which of the following agents will
cause systemic vasoconstriction?
Antidiuretic hormone
Adenosine
Atrial natriuretic peptide
β2-Adrenergic agonist
Nitric oxide
A 28-year-old woman gave birth without complications 48 hours ago to a term 8-lb 12-oz
boy. Which of the following best describes the functional closure of the ductus arteriosus?
It is the final event required for conversion of the transitional circulation in the newborn to the
adult circulatory pattern.
It causes blood to flow from the aorta into the pulmonary artery.
It is independent of gestational age.
It occurs due to hypoxic pulmonary vasoconstriction.
It precedes functional closure of the foramen ovale.
A 32-year-old man is diagnosed with primary hypertension. His physician recommends a
drug for hypertension that acts by decreasing vascular smooth muscle contractile activity without
affecting ventricular contractility. Which of the following is the most likely site of action for the
drug?
Calmodulin
β-Adrenergic receptors
Troponin
Tropomyosin
Protein kinase A
 A 59-year-old man with an ejection fraction of 15%, who is being treated with
medications for his heart failure, is asked whether he would like to participate in a trial for an
experimental drug. The drug being tested is designed to decrease the expression of
phospholamban on ventricular muscle cells. Which of the following would be increased by
decreasing phospholamban?
Concentration of calcium within the SR
Activity of the L-type calcium channels
Activity of the sodium–potassium pump
Diastolic stiffness of the ventricular muscle cells
Duration of the ventricular muscle action potential
A 62-year-old man with a history of diabetes mellitus and hypertension arrives in the
emergency room with substernal chest pain for the last hour. He is given intravenous
nitroglycerin to help reduce the pain. Which of the following would be expected with the use of
this drug?
Myocardial oxygen demand is decreased.
Arterial blood pressure is increased.
Coronary blood flow is decreased.
Left ventricular wall stress is increased.
Venous return to the heart is increased.
During a clinical elective, a second-year medical student auscultates the heart of a patient,
which reveals normal S1 and S2 heart sounds with no murmurs. In correlating the physical
examination with the cardiac cycle, when does the highest coronary blood flow per gram of left
ventricular myocardium occur?
At the beginning of diastole
At the beginning of isovolumic contraction
When aortic blood flow is highest
When aortic pressure is highest
When left ventricular pressure is highest
A 64-year-old man was admitted to the hospital with edema and CHF. He was found to
have diastolic dysfunction characterized by inadequate filling of the heart during diastole. The
decrease in ventricular filling is due to a decrease in ventricular muscle compliance. Which of
the following proteins determines the normal stiffness of ventricular muscle?
Titin
Calmodulin
Myosin light chain kinase
Tropomyosin
Troponin
A 22-year-old man with no history of congenital heart disease has a normal physical
examination prior to entering the military. Which of the following characteristics is most similar
in the systemic and pulmonary circulations of this patient?
Preload
Afterload
Blood volume
Peak systolic pressure
Stroke work
A 22-year-old woman is recovering from an upper respiratory infection with Coxsackie B
virus when her condition worsens and she becomes increasingly dyspneic. An echocardiogram
reveals global hypokinesis and an ejection fraction of 25%. Which of the following is the
underlying process in this patient’s most likely diagnosis?
Ventricular dilation
Global ventricular hypertrophy
Hypertrophy of the interventricular septum
Narrowing of the descending aorta
Vegetations on the cardiac valves
A 58-year-old man with a history of several months of exertional chest pain presents for
evaluation. He also has severe arthritis in his knees bilaterally and is unable to undergo exercise
stress testing. Thus, you elect to conduct a chemical stress test with dipyridamole to investigate
the nature of his chest pain. Momentarily after administering the drug he begins to experience
severe retrosternal chest pain and ST-segment depression in the anterior leads of the ECG. What
is the most likely mechanism of this patient’s chest pain?
Coronary blood redistribution
Bradycardia
Coronary vasospasm
Occlusive coronary embolus
Pulmonary embolism
A healthy 3-year-old girl presents for a health maintenance examination. Her
developmental history is unremarkable and her immunizations are up to date. Upon cardiac
auscultation, there are no murmurs, rubs, or gallops, and an S1 and an S2 are heard. S2 is split at
a fixed interval and does not vary with respiration. Which of the following conditions is most
likely present in this patient?
Atrial septal defect
Bicuspid aortic valve
Coarctation of the aorta
Dilated ventricles
Normal cardiac variant
A 58-year-old woman with idiopathic pulmonary hypertension presents with right
ventricular hypertrophy and cor pulmonale. Her ECG shows positive QRS complexes in leads
V1, III, and aVF, and equiphasic QRS complexes in lead aVR. Which of the following is her
mean QRS vector?
+120 degrees
−150 degrees
−120 degrees
+60 degrees
+90 degrees
A 54-year-old man with small cell lung cancer presents with lethargy, confusion, and
muscle cramps. Blood work shows an increase in plasma levels of antidiuretic hormone (ADH).
In patients with the syndrome of inappropriate antidiuretic hormone (SIADH), which of the
following will increase?
Intracellular volume
Plasma oncotic pressure
Plasma osmolarity
Plasma sodium concentration
Urine flow