Multiple Choice Question (MCQ)

session 4
CPR- Cardio 1
1. Using the ECG below, what is the mean electrical axis of the heart?

A. -90
B. -60
C. -30
D. 0
E. 30
F. 60
G. 90
H. 120
2. A 53-year old woman complains of generally feeling unwell and
swelling in her legs and feet. She also mentions an odd sensation of
pulsing in her neck. Auscultation reveals a holosystolic murmur, and
examination reveals jugular venous distention.
From the cardiac catheterization data define which abnormality is
likeliest.
A. Mitral regurgitation
B. Aortic regurgitation
C. Pulmonic regurgitation
D. Tricuspid regurgitation
E. Mitral stenosis
F. Aortic stenosis
G. Pulmonic stenosis
H. Tricuspid stenosis
3. A normal healthy subject has enlisted in an exercise physiology trial
that is designed to examine the effects of a potent new drug that
increases cardiac output. At rest the subject has a cardiac output of 5
L/min and a heart rate of 70 bpm. An IV drug infusion is started and after
10 minutes the subjects cardiac output has increased by 30% and heart
rate has remained stable at around 75 bpm.
Which of the following parameters would have likely decreased in this
patient, and what mechanism is likely to underlie this change?

A. Ejection fraction, negative chronotropy

B. End diastolic volume, increased ventricular
compliance
C. Diastolic period, positive chronotropy
D. End systolic volume, positive inotropy
E. Ventricular afterload, increased peripheral
resistance
4. A 62-year old man presents with breathlessness and swelling in his ankles. He reports
awakening at night with severe shortness of breath, that is relieved when he sits up.
During a physical exam jugular venous distention is apparent, and his blood pressure is
on the lower side of normal. Auscultation reveals pulmonary rales and there is a third
heart sound. His chest x-ray reveals cardiomegaly (LV hypertrophy) and pulmonary
edema. LV ejection fraction is reduced but still within normal limits and there are no
signs of systolic dysfunction. Echocardiography reveals LA enlargement and raised LA
pressures
On the graph below, which number likely represents the primary pathophysiological
abnormality in this patients LV pressure volume loop (assume solid line normal)?

A. 1
B. 2
C. 3
D. 4
E. 5
F. 6
5. A 62-year old man presents with breathlessness and swelling in his ankles. He reports
awakening at night with severe shortness of breath, that is relieved when he sits up. During a
physical exam jugular venous distention is apparent. Auscultation reveals pulmonary rales
and there is a third heart sound. His chest x-ray reveals cardiomegaly (LV hypertrophy) and
pulmonary edema. LV ejection fraction is reduced but still within normal limits and there are
no signs of systolic dysfunction. Echocardiography reveals LA enlargement and raised LA
pressures

1
2 Which cross plot best fits with this patients condition?
(A =normal, B = pathophysiological change)

A. 1
3 4 B. 2
C. 3
D. 4
E. 5
5 6
F. 6
6. A 70-year-old patient has a history of hypertension. His blood pressure is
145/90, and heart rate is normal at 60 bpm. During echocardiography a
normal left ventricular stroke volume of 50 ml was measured. This patient
is then placed on dihydropyridine class drug (Ca2+ channel blocker) that
selectively acts on the arterial vasculature to reduce his blood pressure.
Assume no reflex activity from the baroreceptors.
Select from the table below the changes expected to occur with the drug.
Inotropy Aortic Stroke
diastolic volume
pressure
A. A A No change
B. B B
C. C
C No change
D. D
D
E. E
E
F. F
F
G. G
G No change
7. Within a capillary the hydrostatic pressure is 25 mmHg and the
plasma oncotic pressure is 20 mmHg. Within the interstitium the
hydrostatic pressure is -3 mmHg, and oncotic pressure is 10 mmHg.
If the hydraulic conductance and reflection coefficients are = 1, the
calculated net pressure gradient in mmHg is:
A. - 8, favoring absorption
B. - 18, favoring absorption
C. - 10, favoring absorption
D. + 8, favoring filtration
E. + 18, favoring filtration
F. +10, favoring filtration
8. A 45-year-old patient has a history of alcoholism, type II
diabetes and complains of right upper quadrant pain. On
examination he has a severely enlarged abdomen and tissue
edema. Urine analysis indicates both glycosuria, and
microalbuminemia.
Which of the following best explains the underlying mechanism
contributing to his tissue edema symptoms?
A. Lowered interstitial fluid (If) oncotic pressure
B. Increased capillary hydrostatic pressure, and lowered If
oncotic pressure
C. Reduced tissue blood flow
D. Decreased capillary oncotic pressure
E. Reduced lymphatic flow
9. Discussion: A 65-year-old man presents to his physician with breathlessness and
chest pain on exertion. He also reports wakening at night with severe breathlessness
and having to sit up to get his breath back, this is often accompanied with chest pain.
He reports being very aware of his heart pounding when he is lying down at night. His
pulse is 80 bpm and palpation reveals a rapidly rising and falling pulse. BP is130/60.
The following LV pressure volume loop (ABCD) may be found in this patient.
Which auscultation pattern would you expect to be associated with this patient? (A2
aortic, P2 pulmonic second heart sounds)
(Hint - with this valvular disorder would you expect the associated valve closure sound to be louder or
softer?)

A. A
B. B
C. C
D. D
E. E
F. F
G. g
Answers iMCQ4 CPR Physiology

1. C

2. D

3. D

4. F

5. B

6. C

7. E

8. D

9. B